Risk factors for nail dystrophy following distal phalangeal fractures of the hand

INTRODUCTION: Distal phalanx fractures are commonly associated with nail unit injuries and may cause long-term nail dystrophy. However, the risk factors associated with such deformities are poorly understood. In this study, we aimed to assess the potential risk factors for nail dystrophy after distal phalanx fractures. METHODS: We conducted a retrospective review of adult patients with distal phalanx fractures treated at a single hand surgery centre between January 2015 and December 2019. The patients were followed up clinically and radiographically for at least 1 year after injury. RESULTS: We included 112 patients with 128 distal phalanx fractures. Nail dystrophy developed in 50 fingers. The significant independent predictors of nail dystrophy included nail bed injury and nonunion. Nail bed suturing, fracture location, trauma type and dorsal rim incongruence were not independently associated with nail dystrophy using multivariate analysis. CONCLUSION: Nail bed injury and nonunion of the distal phalanx fracture significantly increased the risk of post-traumatic nail dystrophy. These findings underscore the importance of careful assessment and management of nail bed injuries and fracture healing when treating distal phalanx fractures. LEVEL OF EVIDENCE: III.