Closed fractures may look harmless on x-rays, but in the majority of cases, the nail bed has been torn.
Flexor and extensor tendons displace the fracture with a typical plantar angulation of the tuft fragment.
Open fractures present in two ways: with an avulsed nail plate, or with a fractured nail. In both types, the fracture opens dorsally, and the nail bed is also injured. It is mandatory to repair precisely the nail bed. Otherwise, permanent deformity of the nail growth can result. These procedures are very difficult to conduct successfully without the help of magnifying loupes. The general principles for treating all open fractures apply. As the majority of these injuries are due to crushing, edema of the soft tissues is most likely to develop and primary closure of any associated skin lacerations is not advisable.