Noah Sinclair
Fingernail bed injuries are common and can occur in many ways, such as when the finger is crushed by a heavy object, cut by a sharp object, or shut in a door. Treatment depends on the type and severity of the injury. Some injuries can be cared for at home, while others require urgent medical attention. In some cases, surgery may be required to repair the nail bed. This involves numbing the finger, removing the nail, repairing the nail bed with stitches, and reattaching the nail or attaching a synthetic nail.
How to repair a damaged fingernail bed
| Characteristics | Values |
|---|---|
| What is a nail bed injury? | An injury to the nail bed, the tissue that sits underneath the fingernail that helps the nail grow normally. |
| How does it happen? | When the nail is cut, torn, smashed, bruised, or torn away from the skin. This can be caused by a sharp object, heavy impact, or crushing injury. |
| Treatment | Depending on the type and seriousness of the injury, some nail injuries can be cared for at home. For more serious injuries, seek medical attention. |
| Home care | Bandages, ice packs, and antibiotic ointment can help treat minor injuries. |
| Medical treatment | For more severe injuries, a doctor may remove the nail, repair the nail bed with stitches, and reattach the nail or attach a synthetic nail. Antibiotics may be prescribed to prevent infection. |
| Healing time | The nail bed will heal in about 7-10 days. A new fingernail will take about 4-6 months to grow back. |
| Complications | In rare cases, severe injuries can lead to nail deformities, such as hook nail or split nail. |
| Prevention | Proper management of injuries is essential to prevent late deformities. |
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What You'll Learn
Home care for minor nail bed injuries
Many nail bed injuries are minor and can be treated at home. However, some require prompt medical attention to ensure that the area heals and the nail grows back smoothly.
If you have an artificial nail, it should stay in place until your nail bed heals. If your doctor recommends it, change the dressing daily. You may apply a small amount of antibiotic ointment to keep the dressing from sticking. You may be given a splint or a special shoe to help protect your nail and toe as they heal.
If you lose your nail, it will take about 7 to 10 days for the nail bed to heal. A new fingernail will take about 4 to 6 months to grow to replace the lost nail. Toenails take about 12 months to grow back. The new nail will probably have grooves or ridges and be somewhat misshapen. This may be permanent. If you broke a bone in your finger or toe along with the nail injury, it will take about 4 weeks to heal.
Minor nail bed injuries, including subungual hematomas, often heal on their own, especially when no other injuries are present. Bandages and ice packs can help treat these injuries. Subungual hematomas look like bruises and form when small blood vessels under the nail bed leak, and blood pools between the nail and the nail bed. This leakage usually occurs when the tips of the fingers or toes have been crushed or subjected to a heavy impact. As the blood clots, the colour of a hematoma can change from red or purple to brown or black.
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When to seek medical attention
It is recommended to seek medical attention for a damaged fingernail bed in the following scenarios:
- If you lose a large portion of your nail or experience heavy bleeding.
- If you notice any signs of infection, such as increasing pain, swelling, or a smelly fluid.
- If you have a subungual hematoma that covers more than 50% of your nail bed, or if it is causing you a lot of pain or discomfort. In this case, a doctor may need to drain the blood collection through a small hole created in the nail, a procedure known as trephining.
- If you have a serious cut or laceration to the nail bed, as it may require stitches and possibly the removal of the nail.
- If you have a nail avulsion, which involves the tearing of the nail from the nail bed. This will likely require a visit to the emergency department for the removal of the nail and repair of the nail bed.
- If you have a fractured or broken finger bone along with the nail injury, as this will need to be splinted and may require further treatment.
- If you are unable to remove a ring because your finger is swollen.
It is important to note that nail bed injuries can be serious and have potential complications, so it is always best to err on the side of caution and seek medical advice if you are unsure about the severity of your injury.
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Surgical treatment
Surgical reconstruction is an option for treating nail bed injuries. Before the procedure, an X-ray will likely be taken to determine the extent of the damage and the best course of action. In most cases, minor injuries are fully repaired, leaving the finger looking and functioning normally.
During nail bed repair surgery, the nail is usually removed, and the cut beneath it is stitched up. Surgeons typically put the dead nail back or use foil as a substitute if the nail is too damaged. An alternative is to discard the nail and dress the injury after repairing the nail bed. This option is thought to save costs and may improve patient recovery.
If the nail plate is still partially attached, it may be removed using a blunt instrument between it and the nail bed gently. The nail bed is then sutured, and the finger is splinted for three weeks, after which the fractures will heal.
If the nail bed is scarred, the scar is assessed. If it is narrow, it can be excised, and tension-free closure of the nail bed can be performed. If closure is not possible, the scarred area can be replaced with a nail bed graft.
After surgery, patients will be reviewed in a clinic one to two weeks later. It typically takes a long time for the nail to recover. Patients can expect a new but abnormal nail by three months, and the return of a normal nail can take around nine months.
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Post-surgery care
Keep the Dressing Dry and Clean: It is important to keep the dressing on the affected finger clean and dry. Avoid getting the dressing wet, especially during the first few weeks of recovery.
Finger Exercises: Perform gentle finger exercises to prevent stiffness in the finger joints. Try touching the tip of the affected finger to your thumb, and then move your wrist forward and backward. Repeat this exercise with all your fingers to maintain flexibility.
Protect the Finger: For the first three weeks after surgery, it is recommended to use a protective splint for the finger. This can be in the form of a volar slab or a finger splint. This helps immobilize the finger, aiding in the healing process and protecting the nail bed repair.
Follow-up Appointments: Attend your scheduled follow-up appointments, usually within 1-2 weeks after the surgery. During these appointments, a medical professional will assess your healing progress and advise on any further care or treatments needed.
Avoid Heavy Activities: Refrain from any heavy activities or lifting heavy objects for a few weeks to avoid reinjury or putting too much pressure on the affected finger.
Monitor for Infections: Keep an eye out for any signs of infection, such as redness, swelling, or discharge. If you notice any unusual symptoms, contact your healthcare provider immediately.
It is important to follow the specific post-surgery care instructions provided by your medical team, as they may vary depending on the individual's condition and the type of surgery performed.
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Preventing nail deformities
Maintaining healthy nails involves keeping them dry and clean, and trimming them regularly with sharp manicure scissors or nail clippers. It is also important to avoid biting, tearing, or pulling at your nails and hangnails. If you get manicures or pedicures, ensure your nail salon is certified and uses proper sterilisation techniques. Bring your own manicure tools to the salon, and do not allow the manicurist to work on your cuticles. Keep your nails short to avoid breakage, and use lotion to keep your nail beds moisturised.
If you have brittle nails, avoid using nail polish, as this can cause nails to peel. Instead, use an emollient (skin-softening) cream after washing or bathing, and consider taking vitamin biotin supplements to strengthen your nails.
In addition to practising good nail care, it is important to be mindful of any changes in the appearance of your nails, as this may indicate an underlying health condition. Consult a doctor if you notice any abnormalities, such as discolouration, spots, nail separation, or changes in nail shape or thickness. These symptoms can result from injuries, infections, or other health conditions, and proper medical attention can help prevent nail deformities.
If you experience a nail injury, it is important to treat it promptly to ensure the nail bed heals properly and the broken nail grows back smoothly. For minor injuries, bandages and ice packs can be used at home, while more serious injuries may require a visit to the urgent care centre or emergency room for medical treatment.
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Frequently asked questions
A nail bed injury occurs when the nail bed, or the skin underneath the nail, is injured. This can be caused by a cut, tear, smash, bruise, or the nail being torn away from the skin.
If you have a nail bed injury, you should first try to stop the bleeding and clean the wound. You should then seek medical attention, especially if the injury is serious. Depending on the type and severity of the injury, your doctor may recommend different treatments, such as stitches, antibiotics, or surgery.
Minor nail bed injuries can often be treated at home. You can use bandages and ice packs to help reduce swelling and pain. It is important to keep the wound clean and dry and to seek medical attention if the injury does not heal or becomes infected.
If you experience any of the following, you should seek medical attention:
- The injury is severe, or you are unable to stop the bleeding.
- You have a fracture or broken bone in your finger or toe.
- You have a large bruise or blood pooling under the nail.
- You are unable to remove a ring due to swelling.
The time it takes for a nail bed injury to heal will depend on the severity of the injury. Minor injuries may heal within a few weeks, while more severe injuries can take up to several months. It typically takes about 7 to 10 days for the nail bed to heal, and a new fingernail will take about 4 to 6 months to grow back completely.
