Test on Perionychium: Anatomy, Injuries, and Management

Question 1: The primary criterion for nail removal in cases of subungual hematoma is currently the percentage of the nail undermined by blood.

A. Ano

B. Ne

Explanation: At the present time, the decision for removal of the nail is based primarily on evaluation of the nail edges, rather than the percentage of hematoma. If nail edges are intact, drainage only is recommended. Nail removal with exploration and repair of the nail bed is recommended if the nail is broken or edges are disrupted.

Question 2: According to the study materials, which of the following describes the correct technique for using iris scissors during nail removal?

A. The scissors are inserted beneath the free edge of the nail and gently opened and closed while working them proximally.

B. The scissors are used to cut the nail transversely across the middle before elevation.

C. The scissors are placed over the nail and used to lift it directly from the nail bed with a prying motion.

D. The scissors are inserted at the proximal nail fold and used to separate the nail from the germinal matrix distally.

Explanation: The study materials state: 'The nail is removed with a periosteal elevator or iris scissors. The scissors are inserted beneath the free edge of the nail and gently opened and closed working them proximally.'

Question 3: Amputations through the eponychium can be replanted.

A. Ano

B. Ne

Explanation: Amputations through the eponychium may be replanted, though success is variable.

Question 4: Which of the following practices is crucial to prevent the development of a 'hook nail' after a fingertip injury?

A. Ensuring the nail bed is shortened to the end of the remaining distal phalanx if a portion is absent.

B. Avoiding tension when suturing the fingertip skin to the distal nail bed.

C. Crossing the DIP joint with Kirschner wires during fixation.

D. Using a single Kirschner wire for distal phalanx reduction.

Explanation: A hook nail can result from tension at the closure when suturing the fingertip skin to the distal nail bed, causing volar curvature of the nail bed and plate. It also occurs if a portion of the distal phalanx is absent and the nail bed is not shortened to the end of the remaining distal phalanx, leading to loss of bony support. Therefore, avoiding tension and shortening the nail bed appropriately are crucial preventive measures. Crossing the DIP joint or using a single Kirschner wire are unrelated to hook nail prevention.

Question 5: The exact etiology of the pincer or trumpet nail deformity is certain.

A. Ano

B. Ne

Explanation: Although the pincer or trumpet nail deformity has been attributed to several causes, the exact etiology of this deformity is uncertain.