• 10% povidone-iodine (or equivalent).
• Sterile gloves and gauze.
• Single-use, disposable electrocautery device (sterile) is preferred.
• A needle or metal paperclip heated in a flame is an alternative to electrocautery. A metal paperclip is preferred because it is blunt and will do less damage if inserted too far.
• Another alternative is to use either an #11 blade or 18- or 20-gauge needle in a twisting motion to drill the nail.
• Immobilization is important for young children; movement during the procedure can lead to injury to the nailbed or fingertip.
• Hide the cautery device from view of the young child until just before the procedure. Explain the procedure to older children, emphasizing that holding still will prevent pain.
• Do not mistake the pain of an underlying fractured phalanx for the pain of a hematoma.
• Obtain a radiograph if indicated by history or examination.
• Consider nail removal or specialist consultation for management and follow-up when any of the following is present:
• The nail or nailbed is disrupted.
• There is a displaced fracture of the phalanx.
• There is substantial periungual blood (suggesting eponychial injury).
![](https://freepngimg.com/download/social_media/63059-media-icons-telegram-twitter-blog-computer-social.png)
Stay updated, free articles. Join our Telegram channel
![](https://clinicalpub.com/wp-content/uploads/2023/09/256.png)
Full access? Get Clinical Tree
![](https://videdental.com/wp-content/uploads/2023/09/appstore.png)
![](https://videdental.com/wp-content/uploads/2023/09/google-play.png)