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Nail injuries

Nail laceration; Nail avulsion; Nail bed injury; Subungual hematoma

Description

A nail injury occurs when any part of your nail becomes injured. This includes the nail, nail bed (skin underneath the nail), cuticle (base of the nail), and the skin around the sides of the nail.

An injury occurs when the nail is cut, torn, smashed, or bruised, or the nail is torn away from the skin.

More About Nail Injuries

Smashing your finger in a door, hitting it with a hammer or other heavy object, or cutting it with a knife or other sharp object can cause a nail injury.

Depending on the type of injury, you may notice:

• Bleeding underneath the nail (subungual hematoma)
• Throbbing pain
• Bleeding on or around the nail
• Cuts or tears to the nail, cuticle, or other skin around the nail (nail lacerations)
• The nail pulling away from the nail bed partly or completely (nail avulsion)

Treatment depends on the type and seriousness of the injury.

Self-care

You may be able to care for a nail injury at home if you can stop the bleeding quickly and:

• The nail is not cut or torn and is still attached to the nail bed
• You have a nail bruise that is less than one fourth the size of your nail
• Your finger or toe is not bent or misshapen

To care for your nail injury:

• Remove all jewelry from your hand. Apply soap, if needed, to help rings slip off your fingers. If you cannot remove a ring because your finger is swollen, call your health care provider.
• Gently wash any minor cuts or scrapes.
• Apply a bandage if needed.

Treatment

For more serious nail injuries, you should go to an urgent care center or the emergency room. They will stop the bleeding and clean the wound. Usually, the nail and finger or toe will be numbed with medicine before it is treated.

Nail bed injuries:

• For a larger bruise, your provider will create a small hole in the nail.
• This will allow blood and fluid to drain out and relieve the pressure and pain.
• If the bone is broken or the bruise is very large, the nail may need to be removed and the nail bed repaired.

Nail lacerations or avulsions:

• Part or all of the nail may be removed.
• Cuts in the nail bed will be closed with stitches.
• The nail will be reattached with a special glue or stitches.
• If the nail cannot be reattached, your provider may replace it with a special type of material. This will remain on the nail bed as it heals.
• Your provider may prescribe antibiotics to prevent infection.

If you have a broken bone, your provider may need to place a wire in your finger to keep the bone in place.

Pain Management

You should:

• Apply ice (inside a cloth) for 20 minutes every 2 hours on the first day, then 3 to 4 times a day after that.
• To reduce the throbbing, keep your hand or foot above the level of your heart.

Take prescription pain relievers as directed. Or you can use ibuprofen or naproxen to reduce pain and swelling. Acetaminophen helps with pain, but not swelling. You can buy these pain medicines without a prescription.

• Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your provider.

Wound Management

You should:

• Follow your provider's recommendations to care for your wound.
• If you have an artificial nail, it should stay in place until your nail bed heals.
• If your provider recommends it, change the dressing every day.
• If your provider says it is OK, you can apply a small amount of antibiotic ointment to keep the dressing from sticking.
• You may be given a splint or special shoe to help protect your nail and finger or toe as they heal.
• Often, a new nail will grow in and replace the old nail, pushing it off as it grows.

Getting Active Again

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.

When to Call the Doctor

Contact your provider if:

• Redness, pain, or swelling increases
• Pus (yellow or white fluid) drains from the wound
• You have a fever
• You have bleeding that does not stop

References

Schoener B, Wagner MJ. Hand injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 42.

Stone DB, Scordino DJ. Foreign body removal. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 36.

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Review Date: 10/13/2023  

Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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