Isla Bennett
Nail bed injuries are common and can be caused by a heavy object crushing or hitting the fingers or toes, or by a cut from a sharp object. A subungual hematoma, or bruised nail, is a type of nail bed injury that occurs when blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. This can lead to severe throbbing pain and discoloration of the nail. Treatment for a subungual hematoma involves relieving pressure by draining the blood, which can be done at home or by a healthcare provider. The nail may bleed a bit after draining, but this should stop quickly. The time it takes for the nail bed to heal and a new nail to grow back can vary depending on the severity of the injury, with fingernails regrowing in as little as 8 weeks and toenails taking up to 6 months.
| Characteristics | Values |
|---|---|
| Time taken for nail bed to heal after losing a nail | 7-10 days |
| Time taken for a new fingernail to grow | 4-6 months |
| Time taken for a new toenail to grow | 6 months |
| Time taken for the nail to fall off after bleeding | Several weeks |
| Time taken for the nail to grow back after draining the blood | 8 weeks |
| Time taken for the bruise to grow out | Weeks or months |
| Time taken for the nail to heal after a deep cut in the nail bed | N/A |
| Time taken for the nail to heal after a finger fracture | Up to 3 weeks |
| Time taken for the nail to heal after a severe injury | 6-9 months |
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What You'll Learn
- Subungual hematoma: a bruised nail caused by blood collecting under the nail
- Nail bed laceration: a cut that pierces the nail and nail bed
- Nail bed avulsion: the nail and nail bed pull away from the rest of the nail bed
- Fingertip fracture: a fracture that affects more than just the nail bed
- Home treatment: minor nail bed injuries can be treated at home
Subungual hematoma: a bruised nail caused by blood collecting under the nail
A subungual hematoma is a type of nail injury that occurs when blood collects under the nail, causing pain and discoloration. It can affect both finger and toenails and is usually caused by direct trauma to the nail, such as something crushing or slamming it. This type of injury damages the blood vessels under the nail plate, causing them to leak and pool blood, which gets trapped and puts pressure on the nail plate.
Subungual hematomas can cause severe throbbing pain and the affected nail may appear dark red, maroon, blue-black, or another dark colour. If the injury is severe, it may also damage the underlying bone, causing a fracture or a cut to the nail bed. In rare cases, a subungual hematoma may be caused by a malignant tumour, such as melanoma or squamous cell carcinoma.
If the hematoma is small and the pain is mild, it will usually heal without treatment. The trapped blood will eventually be reabsorbed, and the discolouration will disappear. This can take a few months to a few years, with fingernails healing faster than toenails. However, if the pain is severe or the damage to the nail bed is extensive, medical treatment is recommended.
Treatment for a subungual hematoma involves relieving pressure by draining the trapped blood. For small hematomas, this can be done at home by heating a needle or paper clip and using it to create a small hole in the nail. For larger hematomas, or if there are additional injuries, medical attention is required. A healthcare provider can perform a simple draining procedure and provide appropriate follow-up care.
After treatment, it is important to keep the area clean and dry. The nail may still look discoloured for several weeks, but this will gradually improve as the nail grows back. In some cases, the new nail may take 4 to 6 months to fully replace the old nail.
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Nail bed laceration: a cut that pierces the nail and nail bed
A nail bed laceration is a cut that pierces the nail and nail bed. The nail bed is the soft tissue below the nail that is bound to the underlying periosteum of the distal phalanx. It consists of the germinal and sterile matrix, which is responsible for nail growth.
Nail bed injuries are common, with fingertip injuries being the most frequently seen type of hand injury. This is because the fingertip is the most distal portion of the upper extremities and is the point of interaction between the body and its surroundings in most daily activities.
If you experience a nail bed laceration, you should seek medical attention. A healthcare provider will stop the bleeding and clean the wound. The nail and finger or toe will usually be numbed with medicine before treatment. The wound will then be treated with dissolvable sutures (fast gut or chromic). If the nail is still in place, instruments such as iris scissors or a periosteal elevator will be used to reach the nail fold, after which the nail can be removed with a hemostat or forceps. It is important to stent-open the eponychial fold to prevent scarring and impaired nail regrowth. A stent can be fashioned using foil from a suture pack or xeroform, cut into the shape of a nail, and tucked under the fold.
After treatment, it is important to keep the area clean and dry. The nail may bleed a bit after draining the blood, but this should stop soon after. The wound will need to be dressed, and a nonstick dressing (such as Telfa) is recommended to avoid pain when removing the dressing. Antibiotic ointment can be applied to prevent the dressing from sticking.
Nail bed injuries generally heal well with appropriate treatment, but it may take 3 to 12 months for the nail to grow back, and even then, it may be misshapen for a while. In some cases, it may take years for the nail to grow back into its proper shape.
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Nail bed avulsion: the nail and nail bed pull away from the rest of the nail bed
A nail bed avulsion is a painful injury that occurs when the nail and part of the nail bed pull away from the rest of the nail bed, either partly or entirely. This usually happens when the nail is crushed or sustains a high-impact injury, such as the finger getting stuck or jammed in something. Finger fractures are also common with this type of injury.
If the nail has not come off during the injury, it will need to be removed. A doctor may repair any lacerations to the nail bed with stitches and reattach the nail, if possible, to provide protection and support while a new nail grows. In some cases, the nail may be too damaged, and a synthetic nail may be attached instead. This synthetic nail will be gradually pushed forward as the new nail grows.
It is important to seek medical attention for a nail bed avulsion to ensure proper healing and reduce the risk of infection. The recovery time for a nail bed avulsion can vary depending on the severity of the injury, with severe cases taking up to 6-9 months to fully recover.
To care for a nail bed avulsion at home, follow your doctor's instructions for keeping the area clean and changing any bandages. It is also important to keep the injured area dry and protected with a splint or special shoe, if recommended by your doctor. A new nail will typically take about 4 to 6 months to grow and replace the lost nail. During this time, you may notice discoloration as the bruise grows out with the nail.
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Fingertip fracture: a fracture that affects more than just the nail bed
Fingertip fractures are a common injury, especially in children, and can happen when a finger is slammed in a door, stepped on, or crushed by a heavy object. They can result in a range of injuries, from cuts and scrapes to bone fractures.
One of the more serious injuries that can occur is a distal tuft fracture, which is a fracture of the distal phalanx bone in the fingertip. This bone is the most commonly fractured in the hand, usually as a result of a crush injury. Distal tuft fractures often accompany subungual hematomas, which are caused by bleeding beneath the nail. The force of the injury can cause damage to the blood vessels in the nail bed, leading to bleeding and swelling underneath the nail plate.
Subungual hematomas can be extremely painful and may require a simple draining procedure to relieve the pressure. In some cases, the nail may need to be removed to allow for deeper tears to be stitched and repaired. If the nail bed is lacerated, it will also need to be stitched, and the nail may fall off in the following weeks.
The treatment for a fingertip fracture that affects the nail bed will depend on the severity of the injury. In general, it is important to keep the area clean and dry, and to follow any instructions provided by a medical professional. A splint may be applied to protect the fingertip and allow the injury to heal. In some cases, referral to a hand or orthopedic surgeon may be necessary, especially if there is extensive soft tissue damage or a distal tip amputation.
The recovery process for a fingertip fracture can vary depending on the extent of the injury. It may take up to 9 months for a new nail to grow back, and the nail may have bends, creases, or splits. It is important to get bone fractures treated promptly to prevent future problems and ensure the nail regrows with a normal appearance.
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Home treatment: minor nail bed injuries can be treated at home
A nail bed injury occurs when any part of the nail, including the nail bed, cuticle, or surrounding skin, is injured. These injuries can be minor or very painful and uncomfortable, sometimes limiting finger movement. They can occur in many ways, such as when a nail is caught between two objects, crushed, or cut.
Minor nail bed injuries can often be treated at home. Here are some steps to take if you've experienced a minor nail bed injury:
- Remove any jewellery from your hand, especially rings, as the finger may begin to swell. If you are unable to remove a ring due to swelling, contact your healthcare provider.
- Gently wash any minor cuts or scrapes to clean the wound and stop the bleeding. You can use soap and water for this step.
- Apply a bandage to the injured area if needed.
- Keep the injured area clean and dry to prevent infection.
- If you have an artificial nail, it is recommended to leave it in place until the nail bed has healed.
- Follow up with your healthcare provider as needed and seek medical attention if the injury does not improve or worsens.
It's important to note that while minor nail bed injuries can be treated at home, more severe injuries may require medical attention. If you are uncertain about the severity of your injury, it is always best to consult with a healthcare professional. Additionally, if you experience a deep cut or severe bleeding that doesn't stop, seek immediate medical care.
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Frequently asked questions
A nail bed may bleed for a while after losing a nail, but the bleeding should stop after draining the blood.
A subungual hematoma is a bruised fingernail or toenail that may cause severe throbbing pain. It occurs when blood vessels under the nail bed leak, and blood pools between the nail and the nail bed.
If the hematoma is small (less than a quarter of the size of your nail), you can treat it at home by heating a needle or paper clip and creating a small hole in the nail to drain the blood. If the hematoma is larger, you should seek medical attention.
A new fingernail can regrow in as little as 8 weeks, while a new toenail may take up to 6 months.
Nail bed injuries can occur when the nail is caught between two objects, hit by a heavy object, or cut by a sharp object. They can also be caused by nail biting, cuticle biting, and repetitive picking.
