II. Management
- Distal Subungual Foreign Body
- Trim nail
- Grasp foreign body with forceps and extract
- Observe for Subungual Hematoma from Nail Bed Laceration
- Proximal Subungual Foreign Body
- Digital Block
- Elevate nail with Freer elevator to either side of the foreign body
- Avoid nail bed injury
- Attempt to grasp foreign body and extract without nail removal
- If unable, partially clip the nail in a V-Shape over the foreign body
- If still unable, See Nail Removal
- May remove half the nail plate to access the foreign body if needed
- Evaluate for complications
- Repair Nail Bed Laceration if present
- Careful exam for Retained Foreign Body (consider imaging, e.g. xray of Radiopaque Foreign Body)
- Nail Trephination as needed for Subungual Hematoma
III. References
- Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
- Warrington (2025) Crit Dec Emerg Med 39(6): 30