Isla Bennett
Nail injuries are common and can occur in many ways, from catching your finger in a door to hammering it with a heavy object. The injury could be a simple nail bruise, a cut, or a more serious injury like a fracture or amputation. Depending on the severity, you may be able to treat it at home, or you may need to go to the emergency room or urgent care center. In some cases, the injury may result in permanent deformity, even after proper repair.
| Characteristics | Values |
|---|---|
| Type of Injury | Nail Injury/Trauma |
| Cause | Blow to the nail, finger caught in a door or drawer, heavy object falling on the finger, being hit by a hammer, etc. |
| Symptoms | Blood under the nail, nail turning black and blue, throbbing pain, nail appearing mangled, cuts, etc. |
| Treatment | For minor injuries, home care includes stopping the bleeding, removing jewelry, washing cuts, and applying a bandage. For more serious injuries, go to an urgent care center or the emergency room. Treatment at the hospital may include draining blood under the nail, stitches, antibiotics, X-rays, anesthesia, splinting, etc. |
| Recovery | Fingernails usually regrow in about two months, while toenails take about four months. Some injuries may result in permanent cosmetic changes or deformities. |
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What You'll Learn
Nail bed injuries
The management of nail bed injuries will depend on the type and extent of the injury sustained. Following initial assessment and irrigation, simple nail bed injuries may be managed conservatively, often with a short course of prophylactic oral antibiotics. Most nail bed injuries will require removal of the nail plate, nail bed repair, and splinting of the eponychial fold. Many injuries to the nail bed can be fully repaired. For example, your nail should return to normal after a subungual hematoma is drained. However, some severe injuries can lead to a deformed nail, which is more likely when the base of the nail bed is injured. The most common complications of nail bed injuries are hook nail and a split nail.
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Subungual hematoma
A subungual hematoma is a type of nail bed injury that occurs when blood gets trapped under the nail bed, typically caused by a direct blow or a crush injury to the distal phalanx. This can happen when a finger is caught in a doorway or hit by a hammer or another heavy object. The trapped blood causes intense throbbing pain and the nail often turns red, purple-black, or blue.
In some cases, if the subungual hematoma covers more than 50% of the nail, the entire nail may need to be removed to access and repair the nail bed with stitches. If the injury is severe or there is a risk of infection, antibiotics may be prescribed. Most nail injuries are best managed in a hospital's emergency department, and it is recommended to be seen within six hours of the injury.
To manage a subungual hematoma at home, it is important to act quickly as the procedure is most effective within 48 hours of the injury. Ice can be applied to reduce swelling, and over-the-counter anti-inflammatories like aspirin or ibuprofen can help with minor pain. It is crucial to follow up and ensure that there is no infection and that the hematoma has resolved.
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Nail laceration
A nail laceration is a cut to the nail, nail bed, cuticle, or lateral nail folds. This type of injury always results in visible blood on the skin and can be caused by a knife, saw, or crushing injury. In the case of a nail bed laceration, the nail is cut along with the underlying nail bed, which is the area underneath the nail responsible for nail growth and support.
If you experience a nail laceration, it is important to stop the bleeding and ensure that your tetanus vaccination is up to date. You can apply direct pressure to the wound using a gauze pad or clean cloth and press down for 10 minutes. Soaking the finger in cold water for 20 minutes can help with pain relief. It is also recommended to gently wash any minor cuts or scrapes and apply a bandage if needed.
For more serious nail lacerations, it is advised to seek medical attention at an urgent care center or emergency room. The doctor will examine the injury and may take an X-ray to check for broken bones or other complications. In some cases, anesthesia may be administered to allow for a closer examination and treatment without causing additional pain.
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Fingertip amputation
Fingertip injuries are the most common type of hand injury seen in hospital emergency rooms. They can occur in accidents at home, at work, or during play. A nail injury can occur when the nail is cut, torn, smashed, or bruised, or when the nail is torn away from the skin. A nail injury may also involve a broken bone in the finger or toe.
The treatment for a fingertip amputation depends on the angle of the cut, the extent of the injury, the patient's general health and lifestyle, and their preferences. If the wound is small and not deep enough to expose bone, it may heal on its own. The doctor may place a protective dressing over the wound and instruct the patient to change the bandage regularly. They may also recommend wearing a splint to protect the area while it heals. For deeper wounds, surgery may be required.
If a large part of the fingertip has been amputated, the surgeon may consider reattaching the amputated part. This is called replantation, a complicated surgical procedure in which blood vessels are repaired to allow the inflow and outflow of blood to the amputated part. Replantation can require significant recovery time and may not always be possible or appropriate. Fingertip amputations in children younger than six years of age are treated differently. After cleaning and preparing the amputated fingertip, the surgeon may reattach it to the finger. The fingertip may continue to grow relatively normally, even if the bone was exposed.
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Distal tuft fracture
A distal tuft fracture is a type of injury that occurs when there is a fracture of the bone under the nail. This type of fracture is often associated with crush injuries, such as getting your fingertip caught in a door or dropping a heavy weight on it. These injuries are also commonly associated with injuries to the nail bed or the nail itself, which may require surgery.
When a distal tuft fracture occurs, there may be a collection of blood under the nail, called a subungual haematoma. This can cause the nail to turn a bluish-black colour and may be elevated. The fingertip will be swollen and tender, and there may be a laceration or cut to the nail bed. In some cases, the nail may need to be removed, and the nail bed repaired with thin, absorbable sutures. Antibiotics may be prescribed to prevent infection, and a splint or bandage may be worn to immobilize the finger and protect it while it heals.
The recovery time for a distal tuft fracture is typically about four weeks. During this time, it is important to keep the finger elevated above the level of the heart to reduce throbbing and swelling. Over-the-counter painkillers and ice packs can also be used to reduce pain and swelling. It is important to follow the instructions of a hand therapist to improve the rate of recovery and prevent stiffness and further injury.
Overall, a distal tuft fracture is a serious injury that requires medical attention and may require surgery in some cases. It is important to seek medical help as soon as possible to ensure proper treatment and reduce the risk of complications.
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Frequently asked questions
A nail injury is any damage to the nail or nail bed, which can be caused by a blow to the nail, catching the nail between two objects, or closing the finger in a door or drawer.
There are five categories of nail injuries:
- Subungual hematoma (nail bruise): a collection of blood under the nail, usually caused by a crush injury.
- Nail laceration: a cut to the nail, nail bed, cuticle, or lateral nail folds.
- Fingertip amputation: a portion of the fingertip, including part or all of the nail, is removed from the finger.
- Nail avulsion: the nail and part of the nail bed are pulled away from the finger.
- Fracture: a break in the bone under the nail, often associated with crushing injuries.
The treatment for a nail injury depends on the type and severity of the injury. Minor injuries, such as small nail bruises, can be treated at home with ice, pain relievers, and by keeping your hand elevated. For more serious injuries, such as lacerations, amputations, or avulsions, you should go to an urgent care center or hospital emergency department.
The treatment will depend on the specific type of injury. For subungual hematomas, the blood under the nail may be drained through a small hole. For nail bed lacerations or avulsions, stitches may be required, and the nail may need to be removed. If there is a fracture, the bone may need to be stabilized with a wire. Antibiotics may be prescribed to prevent infection.
Fingernails usually regrow completely in about two months, while toenails can take up to four months. However, some severe injuries can lead to permanent nail deformities, even with proper treatment.
