The fingernails are important for the proper functioning of the fingertip by providing support for the finger pad and improving sensation. Nail injuries can range from a bruise under the nail or even the separation of the nail from the nail bed. Always bear in mind that they are complex wounds to repair. Permanent deformity to the nail can result, even after proper repair.
The nail is a complex structure that has three layers:
- Nail bed is beneath the nail and responsible for nail support and growth
- The nail is the hard substance on the back of the finger
- The eponychium and lateral nail folds
Causes of nail injuries
Majority of nail injuries can be due to the following mechanisms:
- Slicing or cutting such as machinery, knives or box cutters
- Crushing force such as from human bites, hammers, door slamming on fingers and machinery
- Tearing or ripping such as catching a fingernail on an object or stubbing a toe
Symptoms of nail injuries
There are categories in which an injury can occur to the nail. Oftentimes, a combination of these injuries can occur in the same nail.
- A laceration is a cut through the nail, cuticle, nail bed, lateral nail folds or any combination of these. There is blood visible on the skin and the nail can appear mangled depending on the type of injury.
- A nail bruise is the collection of blood beneath the nail. It is usually purple or red in color that eventually fades to blue over a few weeks. The whole finger or toe throbs and painful to touch. It can occur on its own or can be seen in combination with other nail injuries.
- Amputation of the fingertip indicates that a part of the fingertip or part or the entire nail has been removed from the rest of the finger. The bone may or may not be visible.
- Avulsion can occur if part of the nail is lifted off the nail bed or sticking out of the skin at the base of the nail. Blood is usually visible and often linked with a laceration
- A fracture of the bone beneath the nail is often linked to crushing injuries.
When to seek medical care
It is best to visit a doctor for the following cases:
- Infection, drainage, redness at the site of injury 2-7 days later.
- It has been more than 5 years since the last tetanus booster shot was received.
- Injured individual has poor circulation, diabetes, AIDS, under chemotherapy or has other causes for poor healing or increase risk for infection.
Majority of nail injuries can be properly managed at the emergency department in the nearest hospital. Any injury must be assessed within 6 hours. Always remember that anything worse than a small-sized bruised must be taken to the emergency department for evaluation and repair. It includes the following injuries:
- Lacerations or amputation of the nail, skin surrounding the nail and the nail bed.
- Any part of the nail sticking out of the skin or pulled off the nail bed.
- Any deformity or bend in the fingertip since it indicates that the bone might be broken.
- Nail bruise that takes up more than 25% of the whole nail.
- Any injury caused by animal or human bite.
Treatment for nail injuries
First aid measures such as initial wound care can be performed after proper evaluation of the injury.
- Initially remove all jewelry from the affected hand or foot
- Control bleeding by applying direct pressure using a clean cloth. Once the bleeding has been controlled, remove the cloth and check the injury.
- Keep the hand or foot elevated above the heart level.
- Provide over-the-counter medications for pain.
- Cuts or scrapes must be washed with soap and water and apply an antibiotic ointment and cover with bandage.