NAIL INJURIES

A lot of injuries to the nail bed come from fingertips getting shut in a door, but nail injuries can be caused by anything that crushes or pinches the nail bed. Other tissues and structures around the nail bed may simultaneously be injured, including nerve endings and the tendons that work to straighten or bend the fingertips. In any accident to the fingertip, the skin or pulp of the fingertip can be injured and the bone at the end of the finger, the distal phalanx, might even be fractured. 

If the fingertip is injured by a simple crush, a very painful collection of blood can show up under the fingernail. If the injury is more serious, the nail can crack or fall off. The greater the damage, the more likely it is that injury to the nerve, tendon, or bone can result. 

The first step in identifying what injuries might exist is to explicitly describe the injury itself, explaining what specifically happened to the nail bed. If the cause was severe enough, your doctor may have your finger x-rayed to see if any bones were injured. To fully determine the extent of the injury, local anesthesia is often used so the fingernail can be examined under magnification. If you know about other conditions that may affect the healing of your nail, you should mention them to your hand surgeon. 

The treatment of any nail bed injury is designed to resume typical health of the nail bed. If the injury was simple and there is only a collection of blood under the nail, your hand surgeon may make a small hole in the nail to relieve the pressure and pain you may be experiencing. If the nail was cut, the pieces are placed back into their appropriate positions. Fixing the nail bed where the pieces attach will usually facilitate the growth of the pieces in a typical manner. If the bone was fractured, a splint or pins may be necessary to let the bone heal.

If pieces of the nail bed are missing, they can be grafted from the same finger or other fingers. A splint is normally required to repair any injured tendon, and if any pieces of skin are missing, they can be left to heal on their own.

The final appearance and function of the finger that incurred damage depends on the extent of the damage. Almost all minor injuries can be fully repaired, and your nail and finger will look normal after treatment. If the injury was greater and the nail bed was severely crushed, there is a greater chance that the nail bed will be scarred and the nail will be deformed. Any injury to the germinal matrix, the half-moon crescent at the base of the fingernail, will likely contribute to deformity in the nail as it grows. It typically takes three to six months for the fingernail to grow all the way from the cuticle to the tip, so any damage will be visible for that length of time.

If the bone or tendon inside the finger was damaged, your ability to use the finger will depend on the extent of the injury.

If the nail bed was destroyed or lost because of injury, part or all of it can be reconstructed by surgically grafting parts from other fingers or toes. The nail bed of a toe is often used to prevent further problems and deformities to an injured finger, and this can help restore use of a badly damaged finger. The most common type of graft is called a split-thickness graft, and this is used to repair a missing nail bed.