Liam Carter
Fingernail injuries are common and can occur due to various reasons, such as a blow to the nail, closing a finger in a door or drawer, or biting one's nails. While some injuries may only result in a bruised or cracked nail, others can be more severe and lead to the nail falling off completely. In such cases, it is important to take the necessary steps to promote healing and prevent infection. This includes seeking medical attention if there is a large amount of blood under the nail or if there are signs of infection. While the nail will not reattach to the nail bed, a new nail will usually regrow within four to six months.
| Characteristics | Values |
|---|---|
| What causes nail trauma? | Blow to the nail, closing the finger in a door or drawer, nail biting, cuticle biting, etc. |
| What is a subungual hematoma? | A collection of blood under the nail, usually red or purple-black in colour, which fades to blue over a few weeks. |
| What is a nail laceration? | A cut through the nail, to the nail bed, to the cuticle or lateral nail folds, or any combination of these. |
| What is a nail avulsion? | 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). |
| What is a hook nail? | When the nail doesn't have enough bony support and curves around the finger. |
| What is a split nail? | When the nail can't grow over scar tissue. |
| What is a nail matrix? | The "factory" where the body makes new fingernails and toenails. |
| What happens if the nail matrix is injured? | Bruising, ridges, discolouration, and the nail may fall off. |
| What happens if the nail is removed? | A new nail will grow back in its place in about 4 to 6 months for a fingernail and 12 months for a toenail. |
| What to do if the nail is injured? | Remove all jewellery from the hand, gently wash the injury, apply a bandage, and see a doctor if necessary. |
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What You'll Learn
Nail bed injuries
A subungual hematoma is a collection of blood between the nail and the nail bed, often caused by heavy impact or blunt force. It can cause the nail to turn black or purple, and may require drainage by drilling holes in the nail to relieve pressure and remove the accumulated blood. If the hematoma covers more than 50% of the nail surface area, it is important to seek medical attention.
Nail bed lacerations are cuts to the nail bed and can be caused by sharp objects penetrating the nail. These injuries may require stitches and, in some cases, removal of the nail.
Nail bed avulsions occur when the nail and part of the nail bed are pulled away or lifted off from the finger, often due to high-energy injuries with traction and crushing forces. Avulsion injuries commonly occur in the ring finger and are often associated with other injuries such as fractures and dislocations. In most cases of nail bed avulsions, the nail will need to be removed, and the finger may need to be splinted for several weeks.
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Subungual haematoma
The first symptom of a subungual haematoma is throbbing pain in the nail area due to the pressure of blood pooling under the nail bed. This is followed by the discolouration of the nail, which starts as reddish-purple and eventually turns dark brown and black as the blood clots. The pain typically goes away in a few days, but the nail will take longer to recover. The discoloured nail will eventually grow out and be replaced by a new, healthy one. This can take anywhere from four to six months for a fingernail and 12 to 18 months for a toenail.
A small subungual haematoma may not require medical treatment. To reduce swelling, it is recommended to elevate the affected hand or foot and ice the area. Over-the-counter anti-inflammatories can also be taken to relieve pain. If symptoms are intense or persist beyond a few days, medical treatment may be required. A doctor may perform decompression, also called trephination, which involves creating a small hole in the nail to allow the underlying blood to drain and relieve pressure and pain in the area.
In some cases, the nail may need to be removed to repair a deep tear with stitches, or if the nail bed is infected. If the nail is removed, it will likely fall off as a new nail grows back.
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Fingernail infections
Fingernail injuries can range from a bruise under the nail to the separation of the nail from the nail bed. In some cases, the nail may need to be removed if the nail bed is infected. This procedure is called a nail avulsion or evulsion.
Nail infections, known as paronychia, occur when bacteria or fungi get under the skin around the nail. The infected area can become swollen, red, and painful, and a pus-filled blister (abscess) may form. Paronychia is usually caused by irritation from water, chemicals, or occupational or environmental exposures. Nail biting, cuticle biting, and hangnails can also cause nail infections by creating tiny cracks in the nails or cuts in the skin through which bacteria can enter. Ingrown nails, particularly ingrown toenails, can also lead to paronychia.
Most cases of paronychia are not serious and can be treated at home. Soaking the infected area in warm water for about 15 minutes a few times a day can help. Antibiotics or antifungal medications may also be prescribed to treat the infection. In rare cases, if the infection spreads or an abscess forms, a doctor may need to drain the abscess and remove part of the nail.
People with certain risk factors, such as diabetes, poor circulation, AIDS, or chemotherapy, may be at an increased risk of developing nail infections and should seek medical attention if an infection occurs. It is important to keep nails trimmed and avoid biting nails or cuticles to prevent nail injuries and infections.
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Nail matrix injuries
The nail matrix is the area where your fingernails and toenails start to grow. It is located at the base of the nail and consists of two parts: the germinal matrix and the sterile matrix. The germinal matrix contributes to about 90% of nail growth, while the sterile matrix is responsible for the remaining 10% and helps keep the nail attached to the underlying skin.
Injuries to the nail matrix can occur due to pinching or crushing of the finger or dropping something heavy on the toe. Trauma to the nail matrix can cause the production of new nail cells to stop temporarily, leading to potential nail deformities. Ridges, bruising, or discolouration may develop, and in severe cases, the nail may fall off. Nail biting and cuticle biting are also common causes of nail trauma and can lead to acute paronychia, a type of infection characterised by swelling and irritation.
Proper management of nail matrix injuries is crucial to ensure good healing and prevent late deformities. If there is a large nail bruise or the nail has been removed, the injured nail will likely fall off as a new nail grows back. This process can take four to six months for a fingernail and up to 12 months for a toenail. In the case of severe nail matrix damage, some or all of the nail may not grow back.
If you experience a nail matrix injury, it is important to keep the area protected and clean. Cover the sensitive skin of the nail bed with a bandage to prevent dryness and cracking, which can affect nail growth. Additionally, keep your tetanus vaccination up to date, and seek medical attention if you observe any unusual symptoms or signs of infection.
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Preventing nail trauma
Fingernail and toenail injuries are common and can be caused by a blow to the nail, closing a finger in a door, or using sharp objects. These injuries can result in blood under the nail, a condition called subungual hematoma, or a nail laceration, where the nail is cut or torn. Repeated trauma to toenails due to ill-fitting shoes can also lead to deformities and lift the nail away from the nail bed.
To prevent nail trauma, it is important to take the following precautions:
- Keep your fingernails and toenails trimmed and well-maintained. Long nails can more easily catch on objects and lead to injuries.
- Avoid nail biting and cuticle biting. These habits can cause trauma to the nails and increase the risk of infection.
- Wear properly sized shoes. Ill-fitting shoes, especially those that are too small, can cause toenail trauma and lead to deformities. Choose shoes with a wide toe box to prevent rubbing and discomfort.
- Be cautious when using sharp objects or machinery. Always keep your supporting hand away from the path of sharp tools like box cutters or knives.
- Protect your nails when engaging in sports or activities that may pose a risk of nail injury. Wear appropriate safety gear, such as gloves or protective shoes, to minimize the chances of nail trauma.
- Keep a first aid kit accessible. In case of a nail injury, having a well-stocked first aid kit can help you address the issue promptly and reduce the risk of infection.
- See a dermatologist if you have concerns. If you notice any unusual changes in your nails or experience persistent nail injuries, don't hesitate to consult a board-certified dermatologist for professional advice and treatment.
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