An 18-year-old gentleman attends A&E having trapped his left fingers in a gate. He has a subungal haematoma on his index finger, a laceration to his middle finger nailbed, and his ring finger nail is hanging off.

How does a nail grow? (1 mark)

What vaccine must you ensure is up-to-date in this gentleman? (1 mark)

How can you treat a subungal haematoma? (1 mark)

This gentleman has an extremely tender middle and ring finger, and you therefore arrange an X-ray of these digits. This reveals a fracture of the distal phalanx of the middle finger. What type of fracture is this and what further medication is required for this patient? (2 marks)

What treatment is required for the ring finger, and what advice should the patient be given regarding the nail? (2 marks)

The middle finger is treated by excision of the nail followed by suturing the wound and replacement of the nail. What further treatment is required regarding the fracture? (1 mark)

165Another patient comes in with an infection around the nail bed. What is this called? (1 mark)

If left untreated, how may this spread? (2 marks)