Noah Sinclair
A nail bed injury is a common occurrence, often caused by a heavy object crushing or hitting the fingers or toes, or by a sharp object. The nail bed is the fleshy area beneath the nail plate, made of tightly packed cells called keratinocytes, which are constantly shed and replaced. The nail matrix, on the other hand, is the factory where new nails are produced. While nail bed injuries can often be treated at home, some may require medical attention to ensure proper healing and smooth nail regrowth. The good news is that in most cases, with proper treatment, nails will grow back, although full recovery may take 6 to 9 months.
| Characteristics | Values |
|---|---|
| Nail bed injury types | Subungual hematoma, laceration, avulsion, amputation, fracture |
| Treatment | Bandages, ice packs, surgery, stitches, anaesthesia, home remedies |
| Healing time | 3-9 months |
| Prevention | Wear gloves, trim nails, file nails, cut nails properly |
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What You'll Learn
Nail bed injuries: causes and treatment
Nail bed injuries are common and can occur during everyday activities such as working, playing, or gardening. They can also occur during accidents involving heavy objects that crush or hit the fingers or toes, or when a sharp object, such as a knife or saw, is mishandled.
Types of Nail Bed Injuries
There are several types of nail bed injuries, and they can occur together. Some of the most common types include:
- Subungual hematoma: This occurs when small blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. This usually happens when the fingers or toes have been crushed or subjected to a heavy impact.
- Nail bed laceration: This occurs when the nail and the underlying nail bed are cut, typically by a sharp object such as a knife or saw, but it can also be caused by a crushing injury.
- Nail bed avulsion: This happens when the nail and part of the nail bed are pulled away from the rest of the finger, often due to the finger getting stuck or jammed.
Treatment for Nail Bed Injuries
The treatment for nail bed injuries depends on the type and severity of the injury. Many minor injuries can be treated at home with first aid measures such as bandages and ice packs. For more severe injuries, medical attention may be required. Here are some specific treatment methods:
- Trephination: For a subungual hematoma, a procedure called nail trephination can be performed to drain the trapped blood and relieve pain. This must be done within 48 hours of the injury.
- Draining: A doctor may also drain a large subungual hematoma by making a small hole in the nail with a needle.
- Stitches: If the subungual hematoma covers more than 50% of the nail, the nail may need to be removed and stitches may be required.
- Surgery: In cases of complete loss of the nail bed, surgery may be necessary to repair the damage. Doctors may also use artificial nail beds to aid in nail regrowth.
Nail Bed Injury Prevention
To prevent nail bed injuries, it is important to take certain precautions when engaging in activities that could potentially damage the nails. This includes wearing gloves during activities such as gardening or housework, and being cautious when using sharp objects. Keeping nails trimmed and filed can also help prevent injuries.
Nail Bed Injury Recovery
With proper treatment, nails can usually grow back after an injury, although the rate of growth may be affected. Fingernails typically regrow completely in 3-6 months, while toenails may take longer. In some cases, the nail may grow back with small ridges or bumps, but eventually, the growth rate and smoothness should return to normal.
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Nail matrix damage
The nail matrix is the "factory" where your body makes new fingernails and toenails. It is responsible for nail growth and is located at the base of the nail. The nail matrix has two parts: the germinal matrix and the sterile matrix. The germinal matrix, located below the lunula (closest to the knuckle), contributes to about 90% of nail production, giving the nail its natural curvature. The sterile matrix, located above the lunula, is responsible for the remaining 10% of nail cells and is crucial for keeping the nail attached to the underlying skin.
Proper treatment is essential for nail matrix injuries. While minor nail bed injuries often heal on their own, severe injuries may require medical attention to ensure proper healing and smooth nail regrowth. A procedure called nail trephination can be performed within 48 hours of the injury to drain trapped blood, providing pain relief and supporting correct nail growth. In rare cases of permanent nail matrix damage, individuals can adapt to living without a fingernail or toenail, although precautions may be necessary during physical activity.
Certain habits and nail care procedures can also lead to matrix damage. For example, cuticle picking can cause a wavy nail plate due to excessive pressure in the lunula area. Improper use of a drill or excessive pressure when using a cuticle pusher can also result in nail plate distortion and matrix damage.
Various conditions can affect the nail matrix, including fungal infections, illnesses, and diseases. Toenail fungus may manifest as thick, yellow, cracked, or cloudy nails. Illnesses like COVID-19 or pneumonia can cause horizontal ridges, known as Beau's lines. Subungual melanoma, or nail matrix melanoma, is a condition where cancerous cells grow in the nail matrix, causing striped discolouration. Pterygium unguis is another condition that causes scarring that extends to the nail matrix, resulting in ridged nails.
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Home treatments for nail bed injuries
A nail bed injury can occur when your nail gets caught between two objects, is hit by a heavy object, or sustains a cut from a sharp object. Depending on the severity of the injury, it may take 6–9 months to fully recover.
- Subungual hematoma ( bruise under the nail ): This occurs when blood vessels under the nail bed leak, causing blood to pool between the nail and the nail bed. If the injury is recent (within 48 hours), a doctor can drain the trapped blood through a small hole in the nail, providing pain relief and helping the new nail to grow in correctly.
- Cuts or lacerations: Clean the wound and nail area with soap and warm water. Apply an antibiotic ointment and bandage.
- Swelling: Ice the area and elevate the injured area above the heart.
- Pain: Take over-the-counter pain medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Aleve).
- Sharp nail edges: File down any sharp edges to prevent further injury and cover the nail bed with petroleum jelly or neomycin ointment.
It is important to note that if there are any signs of infection, swelling, increasing pain, or pus that develops a few days after the injury, seek medical attention immediately.
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Medical treatments for nail bed injuries
A nail bed injury occurs when the nail, nail bed, cuticle, or the skin around the sides of the nail is damaged. It is usually caused by a heavy object crushing or hitting the fingers or toes, or by a sharp object. Many nail bed injuries are minor and can be treated at home, but some require medical attention.
Home Treatment
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. Any sharp ends should be filed smoothly to prevent them from catching on clothing or socks. The uncovered nail bed can be covered with petroleum jelly or neomycin ointment and dressed with a clean bandage.
Medical Treatment
Medical treatment can help ensure that the nail bed heals appropriately, forming a smooth surface for the new nail to grow. A doctor may treat a severe subungual hematoma by making a small hole in the nail and draining the pooling blood, a procedure known as trephination or nail trephination. If the collected blood covers more than half of the nail bed, the doctor may remove the nail and repair the nail bed and matrix. If the nail is damaged or torn, the doctor may remove it and repair the nail bed.
If there is a broken bone, a wire may need to be placed in the finger to keep the bone in place. Antibiotics may be prescribed to prevent infection. If there is no permanent damage to the nail matrix or nail bed, the nail should regrow and appear normal. However, if there is damage to the nail matrix, the growing nail plate may contain defects, resulting in a permanently deformed nail.
Full recovery from a nail bed injury may take 6–9 months, depending on the type and severity of the injury.
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Preventing nail bed injuries
Nail bed injuries are common and can be caused by a variety of factors, including cuts, crush injuries, and heavy impacts. While some nail bed injuries are minor and can be treated at home, others require prompt medical attention to ensure proper healing and nail regrowth. Here are some tips for preventing nail bed injuries:
Keep Nails Trimmed:
Longer nails are more prone to damage as they can be levered off the nail bed or caught in objects. Keeping your nails trimmed can reduce the risk of nail bed injuries.
Protect Your Hands:
When engaging in activities that may pose a risk to your hands, such as sports or manual labour, consider wearing protective gloves or finger guards. This can help shield your nails and fingers from potential trauma.
Be Mindful of Your Surroundings:
Many nail bed injuries occur when fingers get stuck or jammed in objects, such as doors or heavy machinery. Pay attention to your surroundings and take precautions to avoid finger entrapment.
Avoid Walking Barefoot:
Toenail bed injuries can occur when heavy objects fall on or crush the toes. Wearing protective footwear, even at home, can help prevent such injuries.
Maintain a Healthy Diet:
A well-rounded diet contributes to strong nails. Ensure you are getting adequate nutrients, such as protein, vitamins, and minerals, to promote nail health and reduce the risk of nail bed injuries.
Keep Nails Clean and Dry:
Fungal infections can affect the nail bed and compromise nail health. Maintaining proper nail hygiene and keeping your nails clean and dry can help prevent fungal infections.
Be Cautious with Sharp Objects:
Cuts from knives, saws, or other sharp objects can pierce the nail and nail bed. Be extremely cautious when handling sharp tools to prevent lacerations.
By following these preventative measures, you can significantly reduce the risk of nail bed injuries and maintain healthy nails. Remember that prompt treatment is crucial for nail bed injuries to ensure proper healing and nail regrowth.
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Frequently asked questions
A cut nail bed can grow back, but it depends on the extent of the damage. If the injury is minor, it will likely grow back on its own. However, if the damage is severe, such as a complete loss of the nail bed, surgery may be required, and in some cases, the nail may not grow back at all.
The nail bed is the fleshy area located beneath the nail plate. It is made up of tightly packed cells called keratinocytes, which provide nutrients and support to the nail plate while protecting the sensitive tissue beneath.
If you have cut your nail bed, it is important to determine the severity of the injury. If it is a minor injury, you may be able to treat it at home with bandages and ice packs. However, if there is a deep cut or persistent bleeding, seek medical attention immediately.
The time it takes for a cut nail bed to grow back can vary depending on the severity of the injury. On average, fingernails grow at a rate of 0.13 inches per month and can take 3-6 months to completely regrow. Toenails grow at a slower rate, usually taking closer to 6-9 months to fully recover.
