Sophia Delgado
Nail injuries are common and can occur due to crushing forces, slicing or cutting, or tearing and ripping. Most nail injuries are best managed in a hospital's emergency department, and you should be seen within six hours of the injury. However, minor nail injuries can often be treated at home with basic wound care, including washing any cuts with soap and water and applying a bandage. If there is a large nail bruise, laceration, avulsion, or deformity, you should seek medical attention. Additionally, if you notice any signs of infection, such as redness, warmth, swelling, or pus, you should contact a healthcare provider or seek medical attention.
| Characteristics | Values |
|---|---|
| When to go to the hospital | If there are any lacerations, amputations, avulsions, large nail bruises, or deformities |
| First aid treatment | Wash cuts or scrapes with soap and water, apply a bandage, and wrap any amputated parts in a moist clean paper towel |
| Home treatment | Apply ice packs, use sterile scissors to cut off rough edges, clean the wound with soap and water, apply antibiotic ointment, and bandage |
| Signs of infection | Redness, warmth, swelling, pain, fever, pus, red streaks extending from the wound |
| Prevention | Keep nails trimmed, avoid biting nails, wear gloves when working with tools or machinery |
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What You'll Learn
When to go to the hospital for a cut nail
A nail cut can be very painful and uncomfortable, and can even limit finger movement. Most nail injuries are best managed in a hospital's emergency department instead of at the doctor's office. If the injury is mild, it can be treated at home and will heal without medical intervention. However, if the injury is severe, it is important to seek medical attention.
If you experience any of the following symptoms, it is recommended that you go to the hospital for a cut nail:
- Any laceration (cut) or amputation of the nail, the nail bed, or the skin surrounding the nail.
- Any part of the nail sticking out of the skin or pulled off the nail bed (nail avulsion).
- A nail bruise that covers more than a quarter of the total nail and that you would like to be drained.
- Any bend or deformity in the fingertip indicating that the bone may be broken.
- If the wound is bleeding severely or cannot be stopped.
- If there are signs of infection, such as warmth and redness in the area, a painful or throbbing sensation, fever, swelling, a red streak extending from the wound, or pus-like drainage.
- If it has been more than 10 years since your last tetanus shot.
It is important to seek medical attention within six hours of the injury. Calling an ambulance is unnecessary unless there are other more serious injuries. Basic wound care for a cut nail includes washing any cuts or scrapes in soap and water, then applying a bandage. Do not pull at the nail or try to remove it from the nail bed. If there are any amputated parts, wrap them in a moist clean paper towel, place them in a zip-locked plastic bag, and place the bag in ice before bringing them to the hospital.
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Treatment for a cut nail
- Clean the wound: Wash any cuts or scrapes with soap and warm water to prevent infection.
- Apply a bandage: Cover the wound with a clean bandage to keep it protected. Change the bandage daily.
- Treat pain and swelling: Use over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen (Advil) to manage pain. For swelling, ice the area and elevate it above the level of the heart.
- Monitor for infection: If signs of infection develop, such as redness, heat, or pus around the nail, call a healthcare provider.
For more severe cut nail injuries, it is recommended to seek medical attention at a hospital's emergency department. This includes injuries such as:
- Lacerations or amputations of the nail, nail bed, or surrounding skin.
- Nail avulsion, where the nail is lifted or pulled off the nail bed.
- Large nail bruises (subungual hematoma) that cover more than 25% of the nail and require drainage.
- Suspected bone fractures under the nail, which may require an X-ray for diagnosis.
In these cases, a healthcare provider will assess the injury and determine the appropriate treatment, which may include repairing tissue under the nail, draining blood, or providing a tetanus shot if necessary. It is important to seek medical attention promptly to ensure proper care and prevent further complications.
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Nail bed injuries
If the nail is cut or torn, you should apply direct pressure with a clean cloth. If the nail is torn, use sterile scissors to cut off rough edges to prevent further injury. Clean the wound and the torn nail area with soap and warm water, then apply an antibiotic ointment and bandage. For swelling, ice the area and elevate the injured area above the heart. Over-the-counter pain medication can also be used to manage pain and swelling.
If the nail bed injury is more severe, such as a large nail bruise, laceration, avulsion, or a bent or deformed finger or toe, you should go to a hospital's emergency department. A nail avulsion occurs when a portion of the nail is lifted off the nail bed or is sticking out of the skin at the base of the nail (the cuticle). There is usually blood visible around the avulsed nail, and it is often associated with a laceration. In the emergency department, the doctor will examine the hand or foot and the injured nail to determine the extent of the treatment and repair necessary.
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Crush injuries
A nail cut can be a crush injury, which occurs when excessive force or pressure is applied to a body part, often when squeezed between two heavy objects. Most nail injuries are best managed in a hospital's emergency department, where a doctor will make a detailed examination and decide on the treatment and repair required.
If the nail is cut or torn off, apply direct pressure with a clean cloth to stop the bleeding. If the nail is torn, use sterile scissors to cut off rough edges to prevent further injury. Clean the wound and nail area with soap and warm water, and apply an antibiotic ointment and bandage. For swelling, ice the area and elevate the injured area above the level of the heart. Over-the-counter pain medication can also be used.
If there is any laceration, avulsion, a large nail bruise, or if the finger or toe is bent or deformed, go to a hospital's emergency department. Do not pull at the nail or try to remove it from the nail bed. If there is any amputation, wrap the amputated part in a moist, clean paper towel, place it in a zip-locked plastic bag, then place the bag in ice and bring it with you to the hospital.
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Bruising and discolouration of the nail
A bruised nail, medically termed subungual hematoma, occurs when there is bleeding and bruising under the nail. It is usually the result of some form of injury to the blood vessels under the nail bed. The first symptom of a subungual hematoma is throbbing pain, caused by the pressure of blood pooling under the nail bed. This is followed by the discolouration of the nail, which can be red or purple-black, fading to blue over a few weeks. As the hematoma heals, the bruise grows out, creating more space between the discoloured part of the nail and the base of the nail.
A subungual hematoma is often caused by crushing forces, such as a hammer or a door slamming on the fingers, or slicing and cutting, such as with knives. It can also be caused by tearing or ripping, such as stubbing a toe or catching a fingernail on an object.
If you have a subungual hematoma, it is important to monitor the injury for signs of infection, such as redness, warmth, swelling, or pus-like drainage around the nail. If the nail is torn, use sterile scissors to cut off rough edges and prevent further injury. Clean the wound with soap and warm water, apply an antibiotic ointment, and bandage the area. Continue to use ice and over-the-counter pain medication as needed.
If the subungual hematoma covers more than 25% of the total nail, it is recommended to go to the hospital for evaluation and repair. This includes cases where there is any laceration or amputation of the nail, nail bed, or surrounding skin, or if there is any bend or deformity in the fingertip.
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Frequently asked questions
If the nail is only partially cut off, you can treat it at home by applying direct pressure with a clean cloth, cleaning the wound with soap and warm water, and applying an antibiotic ointment and bandage. However, if the nail is completely torn off or there is any sign of infection, you should go to the hospital.
Signs of infection include warmth, redness, swelling, a painful or throbbing sensation, fever, and pus-like drainage from the wound. If you experience any of these symptoms, seek medical attention promptly.
Do not remove any objects stuck in the wound, as this could cause further damage. Seek medical attention immediately if there is an object embedded in the wound or if you cannot see the object but know that a piece of it is missing.
At the hospital, a doctor will assess the extent of the injury and determine the appropriate treatment. Treatments may include removing the nail, repairing the nail bed, stitching any lacerations, and providing a tetanus shot if necessary.
