Condition category
Injury, Occupational Diseases, Poisoning
Date applied
Date assigned
Last edited
Retrospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Background and study aims
Accidental injuries to fingernails and the nail bed underneath are very common, especially among children. Injuries can arise as a result of various factors, such as having the fingers crushed while playing, or getting them caught in a closing door. Sometimes, surgery is required to repair the damage and reduce pain in the injured fingernail. Surgery can also reduce the likelihood of future nail deformity and risk of infection. Standard treatment for nail bed injuries involves removal of the damaged fingernail (which may already be partially detached) and repair of the nail bed using dissolvable stitches. Following this treatment, the surgeon can either replace the old nail before applying the dressings, or discard the nail and apply dressings straight onto the nail bed. Both techniques encourage the new nail to grow as normally as possible, but it is not known if one of these techniques works better than the other. This study seeks to answer the question: should the nail be replaced or discarded after nail bed repair in children? This study also aims to assess how feasible it would be to carry out a larger study within the NHS.

Who can participate?
Children under 16 with nail bed injury acquired within the previous 48 hours.

What does the study involve?
Participants are randomly allocated into one of two groups. Those in group 1 (intervention group) have their nail replaced following treatment to repair the nail bed. Those in group 2 (intervention group) have their nail discarded following treatment to repair the nail bed. Follow up assessments are carried out to determine post-operative complications, appearance of the nail and patient pain levels.

What are the possible benefits and risks of participating?
Not provided at time of registration.

Where is the study run from?
University of Oxford (UK)

When is the study starting and how long is it expected to run for?
April 2015 to September 2015

Who is funding the study?
British Society for Surgery of the Hand (UK)

Who is the main contact?
Miss N Farrar

Trial website

Contact information



Primary contact

Miss Nicola Farrar


Contact details

University of Oxford
Nuffield Orthopaedic Centre
Windmill Road
United Kingdom

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Nail bed INJury Analysis (NINJA) Pilot study: should the nail plate be replaced or discarded after nail bed repair in children?



Study hypothesis

Should the nail plate be replaced or discarded after nail bed repair in children?

Ethics approval

Ref: 15/LO/0067

Study design

Randomised interventional study

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet


Injury to the nail bed in children which requires surgery


Replace or discard nail plate after nail bed injury.

Intervention type



Drug names

Primary outcome measure

Complications measured at 2 weeks, 30 days and 4 months post intervention

Secondary outcome measures

1. Pain at dressing change measured at 2 week dressing change - before and during dressing change
2. Visual Analogue Score used 4 months post intervention
3. ZOOK classification measured at 4 months

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Age <16 years
2. Acute nail bed injury (occurring within 48 hours of presentation at trial centre) requiring surgical repair. This includes sharp lacerations, stellate lacerations, crush and avulsion injuries of the nail bed, injuries involving the sterile and/or germinal matrix, nail bed injuries with an associated pulp laceration and/or with an associated ‘tuft’ fracture of the distal phalanx
3. Patients whose parent or legal guardian consent to their inclusion in the trial and are willing to return for follow up

Participant type


Age group




Target number of participants

UK Sample Size: 60

Participant exclusion criteria

1. Patients aged >16 years
2. Patients who present with an already infected nail bed injury
3. Patients with underlying nail disease or deformity prior to the injury
4. Patients with an associated distal phalanx fracture requiring fixation with a Kirschner wire. This is considered to be another potential source of infection and therefore a confounding variable
5. Patients with complete amputation of the distal fingertip including all or part of the nail bed, which requires repair as a composite graft or replantation
6. Patients with loss of part or all of the nail bed requiring a nail bed graft or flap reconstruction

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

University of Oxford
Nuffield Orthopaedic Centre Windmill Road
United Kingdom

Sponsor information


University of Oxford

Sponsor details

Old Road
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

British Society for Surgery of the Hand (UK)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date

Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2015 protocol in:
2017 results in:

Publication citations

Additional files

Editorial Notes

21/11/2018: Publication reference added.