Ava Monroe
Nail trauma can result from a variety of injuries, including bruises, cuts, tears, and fractures. The duration of nail trauma depends on the severity of the injury and the type of treatment required. Minor nail injuries, such as subungual hematomas (bruises under the nail), usually heal within a few weeks without any major complications. However, more severe injuries involving the nail matrix or bone fractures may take longer to heal and can even result in permanent deformities or the loss of the nail. Proper medical care is crucial, especially in cases where there is bleeding, infection, or bone fractures, as it can help prevent long-term complications and ensure the best possible outcome for nail trauma recovery.
| Characteristics | Values |
|---|---|
| Nail trauma causes | Blow to the nail, closing finger or toe in a door or drawer, nail biting, cuticle biting, ill-fitting shoes, etc. |
| Symptoms | Blood under the nail (subungual hematoma), nail split or cracked, nail lifted away from the nail bed, thickened or discolored nails, swelling, irritation, horizontal hatch marks, etc. |
| Treatment | Basic wound care, draining blood under the nail, relieving pressure, antibiotics, stitches, reattachment of the nail, etc. |
| Recovery time | Fingernails regrow in about two months, toenails take about four months. |
| Permanent damage | In rare cases, the nail matrix may be permanently damaged, preventing nail growth. |
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What You'll Learn
Bruising and subungual haematoma
A subungual haematoma is a bruised fingernail or toenail that may cause severe, throbbing pain. It occurs when an injury breaks open blood vessels under the nail, causing blood to collect and become trapped in one spot. This can happen when the nail gets crushed in an injury, such as by hitting your fingertip with a hammer or dropping a brick on your toe. It can also be caused by stubbing your toe, wearing tight shoes, or repetitive stress from movements such as running.
The injury typically causes a red or purple-black discolouration, which fades to blue over a few weeks. The entire finger or toe may throb and be painful to touch or even move through the air. A subungual haematoma may be serious if the bleeding does not stop or if there is severe damage to the nail. If the bleeding is severe or accompanied by extreme physical trauma, it is important to contact a doctor for advice on medical treatments.
A small subungual haematoma may not need medical treatment. Home remedies can help manage the injury while it heals. Over-the-counter pain relievers can reduce discomfort and swelling. The RICE method can also be useful: rest the digit, use a cool pack, keep the hand or foot elevated, and apply compression.
For larger bruises, a doctor may perform a simple drainage procedure to relieve the pressure and pain. They will numb the affected finger or toe with a nerve block and then use a cautery method, burning a hole with a heated wire or carbon laser to allow the blood to drain. In some cases, the entire nail may need to be removed and the nail bed repaired with stitches. A new fingernail can regrow in as little as 8 weeks, while a new toenail may take about 4 to 6 months.
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Nail lacerations
Nail injuries are common and can be caused by a blow to the nail, a fracture of the bone under the nail, or by catching your finger in a door. They can result in blood under the nail, a condition called subungual hematoma, or a nail laceration. A nail laceration refers to a cut through the nail, the nail bed, the cuticle, or the lateral nail folds. There is always blood visible on the skin, and the nail can appear mangled.
If you experience a nail injury, make sure your tetanus vaccination is up to date. If there is a lot of bleeding, go to an urgent care center or the emergency room. They will stop the bleeding and clean the wound. The wound will be cleaned so that a doctor can examine it more closely. A tetanus shot will be given if it has been more than 10 years since your last one. The finger or toe will be numbed with medicine before it is treated. If there is a large bruise, a doctor will create a small hole in the nail to allow blood and fluid to drain out and relieve the pressure and pain. If the bone is broken or the bruise is very large, the nail may need to be removed, and the nail bed repaired. Part or all of the nail may be removed. Cuts in the nail bed will be closed with stitches, and the nail will be reattached with a special glue or stitches. If the nail cannot be reattached, a doctor may replace it with a special type of material. Antibiotics may be prescribed to prevent infection.
Nail bed lacerations should be repaired using 6-0 or smaller absorbable sutures. Minimal to no debridement should be performed to avoid undue tension on the repair, which can result in scarring. If the nail is detached proximally, it must be removed to inspect for any damage to the nail bed.
Nail injuries can be noticeable until the damaged nail grows out. Fingernails usually regrow completely in about two months, while toenails take about four months. In some cases, it may take up to 12 months for the nail to grow back, and even then, it may be misshapen for a longer period. If there are still problems with new nail growth at 6 or 12 months, patients may want to consult a hand surgeon for scar excision or nail bed revisions.
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Fingertip amputation
Fingernail and toenail trauma can be caused by a blow to the nail, or by crushing, cutting, or tearing the nail. This can result in a subungual haematoma (blood under the nail), or the nail can split, crack, or lift away from the nail bed. Treatment depends on the type and severity of the injury. For example, a small haematoma can be treated by heating a needle and using it to drain the blood. More serious injuries may require urgent medical attention, where the wound will be cleaned, and the nail and finger or toe will be numbed with medicine before treatment. In some cases, the nail may need to be removed, and the nail bed repaired.
The recovery time for fingertip amputation varies depending on individual health and lifestyle factors. For example, a young, healthy non-smoker will likely recover much faster than an older individual with health conditions such as obesity and high blood pressure who smokes. Some patients heal within weeks, while others may require months. To promote healing, aggressive wound care is necessary. Additionally, hyperbaric oxygen therapy (HBOT) can be beneficial for patients with restricted blood flow and a compromised ability to fight infection due to conditions such as smoking, diabetes, or other comorbidities. HBOT involves lying in a hyperbaric chamber while inhaling pure oxygen, aiding in lasting fingertip amputation healing.
It is important to note that even with proper repair, permanent deformity to the nail can occur following a nail injury. Additionally, if the injury includes the base of the nail, some cosmetic changes may be permanent. Therefore, it is crucial to take precautions to avoid nail trauma by wearing properly sized shoes, keeping fingernails trimmed, and avoiding nail-biting and cuticle-biting habits.
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Nail matrix damage
The nail matrix is where your fingernails and toenails form. Injuries and certain health conditions can damage your nail matrix and interfere with nail growth. Minor damage to your nail matrix can temporarily change your nail's appearance. You might notice changes in how your nail feels to the touch, dents, horizontal ridges or lines, soreness, splits or cracks, spots or streaks of colour, and texture changes such as thicker or crumbly nails.
If the nail matrix is damaged, a ridge or split can develop. If the matrix heals normally, this deformity will disappear as the nail regrows. However, in the case of severe nail matrix damage, some or all of the nail may not grow back. The speed of nail growth returning to normal depends on the severity of the injury and how quickly appropriate treatment is undertaken. Even if the nail has completely detached from the matrix, it may regrow over time. Unfortunately, in the case of serious injuries, there is a high risk that proper nail growth will be compromised—the new nail plate may have a changed shape and/or uneven surface.
If you suspect damage to the nail matrix, consult a specialist who will assess the severity of the damage and decide on the method of treatment. If a hematoma or pus appears after the injury, the first step will be to apply antiseptic agents (soaking the nail in them) to prevent infection. If the damage is serious, the doctor may decide on the necessity of nail reconstruction or surgical intervention. It is important to note that not every injury requires such measures. Injuries that are not permanent heal spontaneously over time.
There are various methods of repairing the nail matrix that promote faster regrowth of a healthy nail. One method involves clearing the space under the nail plate to allow trapped fluid (blood, pus) to escape. This drainage involves making a small hole in the plate, which allows for its cleansing. If the nail begins to detach from the matrix or has cracked, it may be necessary to remove the entire plate. This procedure can only be performed by a specialist. The procedure under local anaesthesia involves removing the damaged part of the nail, stimulating the nail bed, and placing reconstructive material (acrylic or UV gel). These materials also protect against bacterial and fungal infections.
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Permanent deformity
Nail trauma can lead to permanent deformities. The nail is a complex structure with three layers: the nail plate, the nail bed, and the eponychium (cuticle). When a nail is traumatised, it can be cut, torn, smashed, or bruised, or even torn away from the nail bed. This can result in a subungual haematoma, or blood under the nail, which is usually red or purple-black and fades to blue over a few weeks. While subungual haematomas usually go away without causing major problems, they can sometimes lead to further damage.
Injuries to the bone under the nail, called distal tuft fractures, can also cause permanent deformity. An x-ray is usually needed to diagnose this type of injury unless there is an obvious bend at the end of the finger.
To prevent permanent nail deformities, it is important to seek medical care for nail injuries. Basic wound care is similar for all nail injuries, but specific repair techniques will depend on the type of injury. It is recommended to keep the injured area clean and dry and to follow up with a healthcare provider as needed.
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Frequently asked questions
Nail trauma occurs when any part of the nail becomes injured, including the nail, nail bed, cuticle, and the skin around the sides of the nail.
Nail trauma can be caused by a blow to the nail, closing a finger in a door or drawer, or by cutting, tearing, or smashing the nail.
The time it takes for a nail trauma to heal depends on the severity of the injury. Basic wound care is the same for all nail injuries, but specific repair techniques will vary. Most bruised fingernails and toenails heal without complications, and the pain should ease within a few days. Fingernails usually regrow completely in about two months, while toenails can take up to four months.
You should seek medical attention if the bleeding does not stop, if there is a fracture or tissue tear, or if there are signs of infection such as redness or drainage at the site of the injury. It is also recommended to seek medical attention if it has been more than ten years since your last tetanus booster shot.
