Work for Idle Hands: A Simulation Model for Nail Bed Injury and Avulsion Repair

Learning Objectives: Wounds of the fingernail bed are a frequent injury encountered in the emergency department however residents often learn techniques for repair at the bedside. We aimed to develop and evaluate an economical and accessible simulation model of nail bed repair that could be used during online lecturing.Introduction: Hand and fingertip trauma account for millions of visits to the emergency department annually. Nail bed injuries, including avulsions or unstable nails, are particularly common, however, there are limited opportunities for supervised practice and mastery of nail bed avulsion repair. We developed an economical and accessible simulation model to allow for practice of nail bed avulsion repair during remote lecturing in the early days of the Covid-19 pandemic.Curricular Design: The model consists of a halved hotdog with an acrylic nail embedded into and glued using nail glue at the terminal rounded end. Pressure was applied to the distal acrylic nail, tearing the hotdog at the insertion site of the nail, creating a horizontal nail bed laceration consistent with a nail bed avulsion injury. Red food coloring was used to mimic bleeding from a nail avulsion. The cost was approximately $0.20 per model. Models and suture material were available for residents to pick up at the hospital prior to the online conference.Impact/Effectiveness: The model was tested with thirty-four emergency medicine residents during an online conference and simulation session performed over Zoom; the ultimate goal was to reapproximate the nail in good anatomical position with appropriately placed absorbable sutures. A voluntary survey was available for residents which yielded highly positive feedback with survey results confirming that the model provided valuable education