Caleb Foster
Nail bed injuries are common and can be extremely painful. They often occur when fingers or toes are crushed or cut by a heavy or sharp object, or when long nails are hit or jammed. Treatment depends on the type and severity of the injury, but it is important to act quickly to ensure the nail grows back smoothly and to prevent infection. Minor injuries can be treated at home, but more serious injuries may require urgent medical attention.
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What You'll Learn
Trimming and bandaging the nail
If your nail has separated from the nail bed, it will not reattach. You will have to trim and bandage the nail until a new nail grows back in its place. Nails grow back slowly, with a fingernail taking about 6 months or longer to grow back, and a toenail taking up to 18 months.
If any part of your nail is hanging off, gently trim away the part that is not connected to your skin. File any sharp edges smooth to prevent catching the nail and tearing it further. If there is a large tear, trim off the detached part. If the tear is small, you may choose to leave the nail alone.
Once you have trimmed the nail, gently clean the wound using soap and water. Apply petroleum jelly to keep your wound moist, then cover it with gauze or an adhesive bandage. Do not put sticky products on your nail, only apply them to the skin around your nail. Repeat these steps daily while your wound heals, applying a new bandage whenever the old one gets wet.
You can also wrap your wound with an elastic bandage, but make sure not to wrap it too tightly. To reduce swelling, apply a cool, damp washcloth to your wound.
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Applying ice packs
It is important to note that while ice packs can help with pain management and reduce swelling, they do not address the underlying cause of the injury or promote healing. For more severe injuries, such as deep cuts or lacerations, it is recommended to seek medical attention. A doctor may prescribe antibiotics to prevent infection and check for any bone fractures with an X-ray.
Additionally, if there is severe damage to the nail bed, the nail may regrow incorrectly or not at all. In such cases, medical intervention is necessary to ensure proper healing and nail regrowth. It is always advisable to consult a healthcare professional if you are uncertain about the severity of your nail bed injury or if the pain is unmanageable.
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Draining blood under the nail
Draining blood from under the nail
If you have bleeding under a large area of the nail surface, it is likely that your nail bed is injured. This is called a subungual hematoma. It usually happens when the nail gets crushed in an injury. As blood accumulates in the small space beneath the nail, it can put pressure on the tender skin of the nail bed, causing intense pain and throbbing.
If you have a subungual hematoma, you should see a healthcare provider to drain the blood as soon as possible, preferably within 24 to 48 hours of the injury. This procedure is called nail trephination. During the procedure, your provider will clean your nail and the surrounding area with soap and water, and then apply a wound-cleansing solution, such as chlorhexidine. They will then use a needle, an electrocautery device, or a special tool designed for trephination to make a small hole in the middle of the bruise, releasing the trapped blood.
Nail trephination is a quick, safe, and effective procedure that can provide immediate relief from pain and pressure. It is an outpatient procedure, which means you can go home right after the treatment. You may notice drainage through the hole in your nail for the next 24 to 36 hours, and the pain may build back up again in a few days. It is important to keep the area dry and clean and follow your provider's instructions for changing bandages.
It is important to note that you should never attempt to drain a subungual hematoma on your own as it could lead to complications such as infection, further trauma, and delayed healing. Only a trained medical professional should perform this procedure. If you are uncertain whether your nail bed injury requires treatment, you should consult a doctor.
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Antibiotics and other medication
Oral antibiotics with gram-positive coverage against S aureus, such as amoxicillin-clavulanate, clindamycin, or cephalexin, are typically administered with warm water soaks. These antibiotics are useful in treating patients with paronychia caused by oral anaerobes contracted through nail-biting or finger-sucking. Clindamycin is a suitable alternative for patients allergic to penicillin.
For community-acquired methicillin-resistant S aureus (MRSA), trimethoprim-sulfamethoxazole or doxycycline may be considered. Cephalexin may also be effective in these cases. Inpatient treatment may involve combination therapy with an IV agent that provides antimicrobial activity against staphylococci.
In addition to antibiotics, nonsteroidal anti-inflammatory agents (NSAIDs), analgesics, toxoids, and immunoglobulins may also be used in the management of nail bed injuries. NSAIDs can help reduce inflammation and pain associated with the injury. Analgesics can provide additional pain relief, while toxoids and immunoglobulins can help prevent or treat infections.
It is important to note that the decision to use antibiotics and other medications should be made by a healthcare professional based on the specific circumstances of the injury. Self-medication without proper medical advice is not recommended.
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Preventing future nail injuries
Nail bed injuries are common, and they can occur in many ways, including:
- Blunt force trauma to the fingertip
- Trapping fingers in doors or drawers
- Cuts from sharp objects
- Nail biting
- Ill-fitting shoes
- Sports injuries
To prevent nail injuries, it is recommended to:
- Keep your nails short and trimmed to avoid snagging and catching on things.
- Wear properly-sized shoes with a wide toe box to prevent rubbing and trauma to the toenails.
- Wear protective gear when playing sports.
- Keep up-to-date with your tetanus vaccination.
It is important to note that proper management of nail injuries is essential to prevent late deformities and ensure good healing. If you experience a severe nail injury, it is recommended to seek medical attention to reduce the risk of long-term cosmetic and functional issues.
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Frequently asked questions
A nail bed injury occurs when a heavy object crushes or hits the fingers or toes, resulting in blood under the nail, known as a subungual haematoma.
Depending on the severity of the injury, it may take anywhere from a few weeks to several months for a full recovery. Toenail injuries generally take longer to heal than fingernail injuries.
Minor nail bed injuries can often be treated at home. It is recommended to apply a light dressing, such as an adhesive bandage, to protect the nail and keep it in place. Keeping the wound clean is also important.
If the injury is severe, particularly painful, or if there is a large amount of blood under the nail, it is recommended to seek medical attention. A doctor will be able to assess the injury and determine the best course of treatment.
To prevent nail bed injuries, it is recommended to keep your nails short and well-trimmed. Wearing properly sized shoes and protective gear during sports can also help reduce the risk of injury.
