Liam Carter
Fingernails and toenails can be injured by a blow to the nail, by shutting them in a door or drawer, or by cutting or tearing them. This can cause a subungual hematoma, or blood under the nail, which can increase the risk of losing a fingernail. Losing a fingernail can also be caused by a fingertip amputation, where a portion of the fingertip, including part or all of the nail, is removed from the rest of the finger. If the nail cannot be reattached, a doctor may replace it with a special type of material to allow the nail bed to heal. A new fingernail will take about four to six months to grow back, and it may have grooves or ridges and be misshapen. This misshapenness may be permanent.
| Characteristics | Values |
|---|---|
| Possibility of losing a fingernail | Yes |
| Cause of losing a fingernail | Smashing a finger in a door, hitting with a hammer, cutting with a knife, etc. |
| Treatment for a lost fingernail | Reattachment, replacement with a special material, antibiotics, stitches, pain relievers, etc. |
| Healing time for the nail bed | 7 to 10 days |
| Regrowth time for a new fingernail | 4 to 6 months |
| Possibility of permanent deformity | Yes |
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What You'll Learn
Nail injuries and their causes
A nail injury occurs when any part of the nail, including the nail, nail bed, cuticle, or the skin around the sides of the nail, is injured. This can be caused by a blow to the nail, closing the finger in a door or drawer, or by cutting, tearing, smashing, or bruising the nail. Smashing a finger with a hammer or heavy object, or cutting it with a sharp object, can cause a nail injury.
There are five categories of nail injuries, often occurring in combination:
- Subungual hematoma (nail bruise): This is a collection of blood under the nail, usually red or purple-black, fading to blue over a few weeks. It causes throbbing pain and requires medical attention if it covers more than a quarter of the nail area.
- Nail laceration: A cut through the nail, nail bed, cuticle, or lateral nail folds, with visible blood on the skin.
- Fingertip amputation: A portion of the fingertip, including part or all of the nail, is removed, with possible exposure of the bone.
- Nail avulsion: The nail is pulled off the nail bed, either partially or completely.
- Bone fracture or tissue tear: This occurs when there is significant bleeding under the nail, not caused by trauma, and requires medical evaluation.
Nail injuries can result in permanent deformities, even with proper repair. Treatment depends on the type and severity of the injury. Minor injuries can be managed at home with proper cleaning, elevation, and pain medication. More severe injuries may require emergency medical care, including numbing, wound cleaning, stitching, reattachment with glue or stitches, or replacement with a special material. Antibiotics may be prescribed to prevent infection.
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Types of nail injuries
Fingernails and toenails can be injured in several ways, including through trauma caused by a blow to the nail, or by closing a finger or toe in a door or drawer. This can result in a subungual hematoma, which is blood under the nail. Nails can also be accidentally torn or split, or a splinter can get under the nail. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails.
Nail biting and cuticle biting can also cause trauma to the nails, and nail biting is a common cause of acute paronychia, an infection where bacteria get under the tissue at the side of the nail, causing swelling and irritation. Repeatedly picking at the nail and cuticle can produce horizontal hatch marks in the middle of the nail.
Nail bed injuries are a common type of fingertip injury, which can be minor or very painful and uncomfortable, sometimes limiting finger movement. They can occur when the nail is caught between two objects or hit by something heavy, such as a door or a hammer, or when the finger is cut by a sharp object. They can also be caused by crushing injuries, such as when the finger gets caught between two objects or in a doorway, or when heavy objects fall on the finger.
A nail bed laceration is when the nail and underlying nail bed are cut, usually by a sharp object like a knife or saw. A nail bed avulsion occurs when the nail and part of the nail bed are pulled away from the rest of the finger, often when the finger gets stuck or jammed in something. This type of injury is very painful and can cause the finger to swell, and finger fractures are common.
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Treatment and recovery
Fingernails can be injured in several ways, including a blow to the nail, catching your finger between two objects, or having something heavy dropped on it. Nails can also be accidentally torn or split, or a splinter can get under the nail. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails.
If you experience a nail injury, it is important to make sure that your tetanus vaccination is up to date. If there is bleeding, apply a pressure bandage to stop the bleeding and keep the area clean. Over-the-counter pain medications can be taken to minimize discomfort in the finger and hand. It is also important to keep the area clean and free from infection. Hydrogen peroxide or over-the-counter antibiotic creams can be applied to prevent infection. The injured area should be regularly cleaned and the bandage changed until the nail has healed. It is recommended to keep the nail bed protected with gloves and a bandage until the nail has fully regrown, which can take 3-6 months.
If the injury is more severe, such as a deep cut to the nail bed or a large subungual hematoma (a collection of blood under the nail), it is important to see a doctor. A doctor may prescribe antibiotic ointment or medication to prevent infection and provide dressings for the injured nail bed. In some cases, a minor surgical procedure may be required to improve the nail's appearance or treat an infection.
If the nail matrix, the tissue inside the cuticle where new nail is formed, is damaged, a ridge or split can develop in the growing nail. Minor damage will produce minor defects, while more significant damage can result in a permanently deformed nail. However, if the matrix heals normally, the deformity will eventually disappear as the nail regrows.
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Permanent deformities
Fingernails and toenails can be injured by a blow to the nail, by shutting the finger or toe in a door or drawer, or by cutting or tearing the nail. This kind of trauma can cause a subungual hematoma, or a collection of blood under the nail, which can be identified by its red or purple-black colour that fades to blue over a few weeks. The entire finger or toe will throb and be painful to touch or move.
If the nail is injured, it is important to make sure that your tetanus vaccination is up to date. If there is a lot of blood under the nail bed, a doctor may need to drain the accumulated blood by drilling a small hole in the nail plate. If the bone is out of line, a specialist may place a wire on the tip of the finger to keep the bone in place. Antibiotics may be prescribed to prevent infection.
Even with proper treatment, a permanent deformity of the nail is possible. If the injury affects the nail matrix (the tissue inside the cuticle where new nails are formed), a ridge or split can develop. If the matrix heals normally, this deformity will disappear as the nail regrows. However, the new nail will likely have grooves or ridges and be somewhat misshapen, and this may be permanent.
If the nail cannot be reattached, a doctor may replace it with a special type of material that will remain on the nail bed as it heals. A new fingernail will take about 4 to 6 months to grow back, and toenails will take about 12 months.
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Preventing nail injuries
Fingernails and toenails can be injured by a blow to the nail, or by closing a finger or toe in a door or drawer. This kind of trauma can result in a condition called subungual hematoma, which is blood under the nail. Nails can also be accidentally torn or split, or a splinter can get under the nail. Repeated trauma to toenails, caused by ill-fitting shoes, can lead to deformities in the nails.
Keep your nails short: Short nails are less likely to bend or catch on objects, which can prevent them from being injured. Short nails are also less likely to harbour dirt and bacteria, which is good for overall health.
Wear properly fitting shoes: Make sure your shoes fit well and have a wide toe box to prevent rubbing. This can help to avoid nail injuries caused by ill-fitting shoes.
Protect your nails during sports: When playing sports, wear the proper gear to protect your nails from potential injuries.
Keep a light dressing on injured nails: Even after the wound has stopped bleeding, cover the nail with a light dressing, such as an adhesive bandage or a small piece of gauze. This provides padding and protection while the nail heals.
See a dermatologist if needed: If your nail injury isn't improving after a few days, or if you notice any concerning symptoms, consult a board-certified dermatologist. They can help provide relief and ensure there are no underlying issues.
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Frequently asked questions
Yes, it is possible to permanently lose a fingernail. Fingertip amputation is one of the five categories of nail injuries, where a portion of the fingertip, including part or all of the nail, is removed from the rest of the finger.
A new fingernail will take about 4 to 6 months to grow back and replace the lost nail. The nail bed will take about 7 to 10 days to heal.
If you lose your fingernail, you should first stop any bleeding by applying pressure with a clean cloth. Then, clean the wound with soap and water, apply a bandage, and take an analgesic to help with pain if needed. You should also ice your finger if there is swelling.
If the nail cannot be reattached, a doctor may replace it with a special type of material that will remain on the nail bed as it heals. Antibiotics may be prescribed to prevent infection.
