Ava Monroe
A laceration through the nail bed is a common injury, especially in children. It can be caused by a crush injury or a high-impact injury, resulting in a subungual hematoma, which looks like a bruise. If the hematoma involves more than half of the nail plate, there is a high chance of a nail bed laceration and fracture. While minor nail bed injuries often heal on their own, more severe injuries may require medical treatment. Doctors may remove part or all of the nail, depending on the severity of the injury, and repair any lacerations with stitches or adhesive glue. Antibiotics may be prescribed to prevent infection, and an X-ray may be required to check for bone fractures.
| Characteristics | Values |
|---|---|
| When to remove a nail after a laceration | If the subungual hematoma involves more than half the nail plate, there is a 60% chance of a nail bed laceration and a high likelihood of fracture. |
| If the bone is broken or the bruise is very large, the nail may need to be removed and the nail bed repaired. | |
| If the subungual hematoma involves greater than 50% of the nail, the nail should be removed and the nail bed should be examined for the presence of a nail-bed laceration. | |
| If the nail bed matrix is damaged, doctors may remove part or all of the nail. | |
| Treatment | Doctors use stitches to repair any lacerations to the nail bed and reattach the nail, if possible. |
| Doctors may attach a synthetic nail, which is gradually pushed forward as the new nail grows. | |
| When an avulsion is more severe, a surgeon may use reconstructive techniques, such as grafting. | |
| People with nail bed injuries may need a course of antibiotics to prevent infection. | |
| The doctor may also check the status of their tetanus injections and request an X-ray to check for any bone fractures. | |
| Nails have good regeneration capacity, but they grow slowly. | |
| Fingernails may grow one-tenth of a millimeter each day, so completely removed fingernails usually grow within 6 months. | |
| Home treatment | Cut off rough edges of your nail using sterile scissors if your nail is torn to avoid further injuries. |
| Apply pressure with a clean cloth to stop the bleeding. | |
| Apply ice to that area and take over-the-counter pain relievers such as acetaminophen to reduce swelling. | |
| Apply antibiotic ointment and bandages, if necessary. | |
| Elevate the injured arm or leg above the heart. |
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What You'll Learn
- Nail bed lacerations can be associated with subungual hematomas
- If a subungual hematoma covers over 50% of the nail, the nail should be removed
- A doctor may treat a subungual hematoma by draining the pooling blood
- A nail avulsion involves the nail and part of the nail bed pulling away
- A doctor may attach a synthetic nail to protect the nail bed as it heals
Nail bed lacerations can be associated with subungual hematomas
A laceration through the nail bed can be a serious injury, especially for children. Nails have good regeneration capacity, but they grow slowly—at a rate of 0.1 mm/day, so it will take several months for a nail to regrow.
Subungual hematomas are very common and can be extremely painful. They are typically minor injuries, and the pain gets better in a few days. The nail bed contains many nerve endings and blood vessels, which give nails their pink tinge. When there is direct trauma to the nail, these blood vessels break and start to bleed. Since the nail is connected to the finger or toe on all sides, the blood has nowhere to go and pools under the nail plate, causing pain and discoloration.
If the subungual hematoma involves more than 50% of the nail, the nail should be removed, and the nail bed should be examined for the presence of a nail bed laceration. Trephination, a procedure where a hole is made in the nail to drain the blood, can be performed to relieve the pressure and pain. However, this should only be done by a healthcare provider, as attempting to drain a subungual hematoma at home can lead to serious infection and permanent damage to the nail or finger.
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If a subungual hematoma covers over 50% of the nail, the nail should be removed
Lacerations through the nail bed are a common injury, especially in children. They are often caused by crush injuries, resulting in subungual hematomas—bruises that form when small blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. As blood accumulates, it puts pressure on the tender skin beneath, causing pain.
If a subungual hematoma covers over 50% of the nail, it is recommended that the nail be removed and the nail bed be examined for any lacerations or fractures. This is because there is a high likelihood of a nail bed laceration and a fracture when a subungual hematoma is this extensive. Removing the nail allows for repair of any lacerations and reduces the risk of infection.
In some cases, a doctor may treat a severe subungual hematoma by creating a small hole in the nail to drain the pooled blood and relieve pressure and pain. This procedure, known as trephination, can be effective in reducing symptoms without the need for nail removal. However, if the bone is broken or the bruise is very large, nail removal may still be necessary to facilitate repair of the nail bed.
It is important to note that nails have good regeneration capacity, but they grow slowly. Fingernails may grow at a rate of about 0.1 mm per day, with completely removed fingernails usually regrowing within 6 months. Proper management of nail bed injuries is crucial for fast healing and to prevent complications and deformities.
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A doctor may treat a subungual hematoma by draining the pooling blood
A subungual hematoma is a bruised fingernail or toenail that results from blunt or crush trauma. Blood collects under the nail, causing pressure and pain. This condition is usually caused by a crushing or stubbing injury, such as getting a finger pinched in a doorway. As blood enters the space under the nail, it applies painful pressure to the nail bed. Over time, the blood may turn dark, and the pressure may cause the nail to come off completely.
Doctors may treat a subungual hematoma by draining the pooling blood, a procedure known as trephination. This procedure can be performed quickly and relatively painlessly in a doctor's office or urgent care centre. It involves making a small hole in the nail to allow the blood to flow out and relieve the pressure. Most subungual hematomas can be relieved with simple trephination. Before performing the procedure, the doctor will clean the area with alcohol, iodine, or another solution. They may then administer a digital block, which is a form of pain relief or anesthetic.
The doctor will then drain the hematoma by applying gentle pressure to the nail with a heated 18-gauge needle or cautery device. Some clinics use specialized lasers for this purpose. As the needle penetrates the nail and reaches the blood, a "pop" sound may be heard. The hole created should be 3 to 4 millimeters thick to allow for continuous drainage, and additional holes may be necessary for large hematomas. The doctor may then milk or squeeze the nail to help the blood flow out of the hole. Finally, they will cover the affected area with a dry bandage or dressing and instruct the patient to keep the wound clean and dry while it heals.
It is important to note that home drainage methods for subungual hematomas are not recommended as they may cause pain and infection. It is always best to seek medical attention as soon as possible to ensure proper treatment and avoid potential complications.
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A nail avulsion involves the nail and part of the nail bed pulling away
A nail avulsion, or nail bed avulsion, involves the nail and part of the nail bed pulling away from the rest of the nail bed, either partly or entirely. This type of injury typically results from the nail being crushed or sustaining a high-impact injury. Avulsions can be extremely painful and may require medical attention, although minor nail bed injuries often heal on their own.
If you have suffered a nail avulsion, it is important to first address any bleeding. Apply pressure with a clean cloth to stop the bleeding. Next, apply ice to the area to reduce swelling. You may also take over-the-counter pain relievers, such as acetaminophen. If necessary, apply an antibiotic ointment and bandages. Elevate the injured arm or leg above the heart to reduce blood flow to the area.
If the nail is torn, cut off any rough edges with a sterile pair of scissors to avoid further injury. If the nail is cut or torn and not attached to the nail bed, or if your finger or toe is bent, displaced, or deformed, seek medical attention. Additionally, if the nail bed wound is deep and may require suturing, or if there is a large bruise, it is important to see a doctor. They may create a small hole in the nail to allow blood and fluid to drain out, relieving pressure and pain.
In some cases, the doctor may need to remove part or all of the nail, especially if the nail bed matrix is damaged. They will use stitches to repair any lacerations to the nail bed and reattach the nail if possible. If the nail is too badly damaged, a synthetic nail may be attached and gradually pushed forward as the new nail grows. In more severe cases, a surgeon may use reconstructive techniques, such as grafting.
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A doctor may attach a synthetic nail to protect the nail bed as it heals
Fingernails and toenails play a protective role for the nail bed underneath. When a nail sustains a laceration, it may need to be removed to treat the wound and prevent infection. However, removing the nail can expose the nail bed, which takes a long time to heal and regrow. In such cases, a doctor may attach a synthetic nail to protect the nail bed as it heals.
Nail bed injuries are common, especially among children, and can be caused by crush injuries or high-impact trauma. The nail and the nail bed can be pierced by a laceration, resulting in a subungual hematoma, which is a collection of blood between the nail and the nail bed. This can be extremely painful as blood accumulates and puts pressure on the tender skin.
If a subungual hematoma involves more than half of the nail, there is a high chance of a nail bed laceration and a fracture. In such cases, the nail may need to be removed to examine and treat the nail bed. However, removing the nail can leave the nail bed exposed, and it can take up to six months for a fingernail to regrow completely. During this time, the nail bed is vulnerable to further injury and infection.
To mitigate this risk, a doctor may attach a synthetic nail to protect the nail bed. This synthetic nail is gradually pushed forward as the new nail grows, providing ongoing protection and support. The synthetic nail can be secured with sutures or adhesives, ensuring that it remains in place while the nail bed heals. This approach helps prevent complications and reduce the risk of deformities, and promote the smooth growth of the new nail.
In some cases, a doctor may opt for other treatments, such as grafting or reconstructive techniques, especially if the injury is severe or the nail is too damaged to be reused. Antibiotics may also be prescribed to prevent infection, and a tetanus booster may be administered if necessary.
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Frequently asked questions
If you've lacerated your nail bed, you should first remove any rings or jewellery from your hand. Then, wash the injury gently with soap and water and apply a clean cloth to stop any bleeding. Apply ice to the area to reduce swelling and take over-the-counter pain relievers if necessary. If the nail is torn, cut off any rough edges with a sterile pair of scissors. Finally, apply an antibiotic ointment and a bandage.
If you have a serious nail injury, you should go to an urgent care centre or emergency room. The medical staff will stop any bleeding, clean the wound, and numb the area before treatment. They may also provide antibiotics to prevent infection and request an X-ray to check for any bone fractures.
The doctor will first assess the nail bed for any lacerations. If necessary, they will repair the nail bed with stitches or sutures and reattach the nail if possible. If the nail is too damaged, they may attach a synthetic nail. In more severe cases, a surgeon may use reconstructive techniques such as grafting.
Nails have a good regeneration capacity but grow slowly. Fingernails may grow at a rate of 0.1 mm per day or one-tenth of a millimetre each day, so it can take up to 6 months for a completely removed fingernail to grow back. Toenails may take longer.
A subungual hematoma is a type of nail bed injury that looks like a bruise. It occurs when small blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. This usually happens when the fingers or toes have been crushed or subjected to heavy impact. Minor subungual hematomas may heal on their own, but for larger bruises, a doctor may create a small hole in the nail to drain the blood and relieve pressure and pain. If the hematoma involves more than half of the nail, there is a higher likelihood of a nail bed laceration and fracture, and the nail may need to be removed.
