Caleb Foster
Fingernail injuries are a common occurrence, often caused by blunt trauma, such as slamming a finger in a door, or even biting your nails. If your fingernail is hanging off, it is important to assess the severity of the injury and take appropriate action. Here are some crucial steps to take and considerations to keep in mind when dealing with a fingernail that is barely attached.
| Characteristics | Values |
|---|---|
| First steps | Apply pressure to slow bleeding, clean the wound with soap and water, and apply a bandage |
| When to seek medical attention | If there is a lack of blood flow, loss of sensation, unusual colours in the fingertip, large amounts of blood under the nail bed, or signs of infection (red streaks on the hand or forearm, fever, nausea) |
| Medical treatment | The provider may create a small hole in the nail to drain blood and fluid, remove part or all of the nail, close cuts in the nail bed with stitches, and reattach the nail with glue or stitches |
| Recovery | The nail bed will take about 7-10 days to heal, and a new fingernail will take about 4-6 months to grow back |
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What You'll Learn
Cover the wound with a bandage
If your fingernail is hanging off, it is important to cover the wound with a bandage to protect the sensitive skin of the nail bed and keep it clean. Here is a step-by-step guide on how to do this:
First, if your fingernail is still attached, trim away any parts that are not connected to your skin. Be gentle and careful during this process to avoid causing further pain or injury.
Next, clean the wound. Wash your hands with soap and water, and then gently clean the affected area. If there is any bleeding, apply pressure with a clean cotton or gauze pad to help stop it. You can also run your injured finger under cool water to ensure it is clean and free of dirt or debris before bandaging.
Once the wound is clean and dry, it's time to apply the bandage. If you have access to a specialised fingertip bandage, this is ideal. Otherwise, you can create your own by trimming a triangle from two opposite sides of a large square or rectangular bandage to form an hourglass shape.
Peel off one of the plastic coverings from the bandage. Position your fingertip near the bottom of the bandage, ensuring your fingernail is centred on the gauze. This will allow you to fold the bandage over your fingertip, covering the wound.
Secure the bottom corner of the bandage with the adhesive exposed onto your fingertip and press it in place. Now, you can pull off the remaining plastic covering. Bring the other corner onto your fingertip and fold the top over your finger, pressing it firmly to ensure the bandage is secure.
Finally, wrap the exposed ends of the bandage onto your fingertip to anchor it in place. Take each corner with adhesive and bring them towards the centre of your fingernail, pressing them down to ensure a snug fit.
Remember, if you notice any signs of infection, such as red streaks on your hand or forearm, feverishness, or nausea, seek medical attention as it could indicate a more serious condition.
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Cut down the nail, but let the injury heal on its own
If your fingernail is hanging off, it is recommended to cut down the nail but let the injury heal on its own. This is because nails will not reattach to the nail bed after they have separated from it. However, new nails will slowly regrow, and the old nail will fall off when it is ready as the new nail pushes it up.
While you wait for the nail to grow back, it is important to care for the injury to prevent infection and ensure proper healing. Here are some steps to follow:
- Stop the bleeding: If your nail is hanging off, there may be bleeding from the nail bed. To stop the bleeding, apply pressure to the area with a clean cloth or gauze. You can also elevate your hand above your heart to help reduce the bleeding and swelling.
- Clean the wound: Once the bleeding has stopped, clean the wound with soap and water to remove any dirt or debris. This will help prevent infection.
- Apply petroleum jelly and cover the area: After cleaning the wound, apply a thin layer of petroleum jelly to keep the area moist and promote healing. Then, cover the area with a bandage or gauze to protect it. Make sure not to use a dry bandage or gauze directly on an open wound, as it can stick to the wound and cause further irritation. Change the dressing daily while the wound heals.
- Manage pain and swelling: You can take over-the-counter pain medications such as ibuprofen or acetaminophen to help relieve pain and reduce swelling. Applying a cool, damp washcloth to the wound can also help reduce swelling.
- Monitor for signs of infection: Keep an eye on the injury site for any signs of infection, such as redness, swelling, or pus. If you notice any red streaks on your hand or forearm, or if you feel feverish or nauseated, seek medical attention immediately, as these could be signs of a more serious infection, such as sepsis.
- Keep your tetanus vaccination up to date: It is important to ensure that your tetanus vaccination is current to reduce the risk of developing tetanus, a serious bacterial infection that can occur through wounds or cuts.
- Be patient with the healing process: It can take 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. The new nail may have grooves, ridges, or bumps, and it may be somewhat misshapen.
Remember, if you are uncertain about the severity of your injury or if you experience any unusual symptoms, it is always best to seek medical advice from a healthcare professional.
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Check for signs of infection
If your fingernail is hanging off, it is important to check for signs of infection. One such infection is paronychia, which is a common nail condition that can be caused by bacteria or fungi. It is characterised by inflammation (red, swollen area) at the base of the nail, and the nail itself may appear detached, abnormally shaped, or discoloured. Paronychia can develop when bacteria enter broken skin near the cuticle and nail fold, causing an infection. The cuticle is the skin at the base of the nail, and the nail fold is where the skin and nail come together. It is important to note that bacterial paronychia usually appears suddenly, while fungal paronychia can take longer to notice and can be a chronic condition.
To check for signs of infection, look for red streaks on your hand or forearm, which could indicate that the infection has spread to the bloodstream, possibly leading to sepsis. Other signs of a serious infection include feeling feverish or nauseated. If you experience any of these symptoms, seek immediate medical attention.
Additionally, be aware of unusual colours in your fingertip. The skin at the tip of your finger should not appear blue or blanched white, as these unusual colours are a sign of a potential infection. Lack of blood flow is another indicator. Press on an uninjured portion of your nail or finger, and if the area does not turn white and then turn pink within seconds upon releasing the pressure, it could indicate poor capillary refill and reduced blood flow.
If your nail has separated from the nail bed, it is important to note that nails will not reattach. However, in most cases, a new nail will regrow slowly. If there is a large amount of blood under your nail, it is recommended to see a doctor as it could indicate an underlying bone fracture or tissue tear.
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Manage the pain with an analgesic
If your fingernail is hanging off, it is important to manage the pain effectively. You can take an analgesic to help with the pain. Basic first aid wound care applies here: put pressure on the area to slow any bleeding, clean the wound with soap and water, and apply a bandage.
If your fingernail is hanging off, it is likely that you have a hangnail. Hangnails are extra tags of skin that can flake off your nail bed, near your fingernails. They are often caused by environmental factors or personal habits, such as dry skin, harsh chemicals, or nail-biting. Hangnails can be very painful and irritating, and they can also become infected. Infections near fingernails are called paronychia, and they can cause pus and swelling around the site of the injury.
If you have a hangnail, it is important to resist the urge to rip, tear, or bite it off. This will likely tear the skin and may cause bleeding, further discomfort, and infection. Instead, use clean fingernail clippers to cut the hangnail as close to the nail bed as possible. After you have cut the hangnail, you can try a warm water soak or apply an antibiotic cream to the area. Start by filling a bowl with warm water and soaking your affected nail 2 to 4 times daily for 15 minutes at a time. If bottled water is not available, boil your tap water and allow it to cool to an acceptable temperature.
If your hangnail is infected and does not improve within a week, or if you notice any unusual colors in your fingertip, it is important to see a doctor. Signs of infection include redness, swelling, and tenderness, and it may feel warm or fill with pus. Your doctor can evaluate the need to drain the abscess and initiate oral antibiotics if necessary.
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Seek medical attention if there's a lot of blood under the nail
If you have a lot of blood under your nail, you may have what is called a "subungual hematoma". This is a bruised fingernail or toenail that develops after sudden trauma to your nail, such as slamming your finger in a car trunk or dropping a brick on your toe. The injury injures the blood vessels in your nail bed, causing them to leak blood, which builds up and puts pressure on your nail plate, resulting in pain and discoloration.
If you have a large subungual hematoma, you should seek medical attention. Your doctor can perform a simple draining procedure to relieve the pressure and provide relief. This procedure should be done within 24 hours, before the blood coagulates. Your doctor will numb the affected finger or toe with a nerve block before draining the blood. After the procedure, your nail may still bleed a bit, and you should keep the area clean and dry.
If the trauma caused additional damage, such as a broken bone or deep cut, you will likely need further treatment and more time to heal. You may also experience a bacterial infection in the area of the injury, especially if the injury is severe. Seek immediate medical attention if you see signs that the infection has spread to your bloodstream, such as red streaks on your hand or forearm, or if you feel feverish or nauseated.
It is important to note that you should never attempt to drain a subungual hematoma at home. Always seek medical care if you are experiencing a large subungual hematoma or any other concerning symptoms.
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Frequently asked questions
If your fingernail is hanging off, it's important to first assess the injury. If there is bleeding, apply pressure to the area and clean the wound with soap and water. If there is a lot of blood under your nail bed, it is recommended to see a doctor as soon as possible. If your nail has completely come off, you can try to replace it and hold it in place with a bandage.
You can take an analgesic to help with pain.
Fingernails usually take about 4 to 6 months to grow to full size.
This condition is called a subungual hematoma. For small hematomas, you can heat a needle or paper clip and use it to gently penetrate the nail, creating a small hole for the blood to drain.
Keep your fingernails trimmed and avoid biting your nails or cuticles.
