Nail Bed Injuries: Causes, Symptoms, and Treatment
Nail bed injuries are often linked to damage to surrounding structures, including:
- Bone fractures: Typically involving the distal phalanx.
- Nail bed or fingertip skin (pulp) cuts.
- Tendons: Those responsible for straightening or bending the fingertip.
- Nerve endings.
These injuries often result from crushing incidents, such as getting the fingertip caught in a door. Any type of pinching, crushing, or sharp cut to the fingertip can lead to a nail bed injury.
Identifying a Nail Bed Injury
A simple fingertip crush can cause a painful collection of blood (hematoma) under the nail. More severe injuries may cause the nail to crack into pieces or result in the nail and/or fingertip tearing off, potentially injuring nearby structures.
Diagnosis of Nail Bed Injuries
The doctor will begin by asking for details about the injury’s cause. X-rays may be recommended to check for associated fractures that may need treatment. The full extent of the injury may not be apparent until the nail bed is examined with magnification.
Nail Bed Injury Treatment
Treatment aims to restore the anatomy of the nail and surrounding structures. Treatment options may include:
- Hematoma drainage: A small hole is made in the nail to relieve pressure and reduce pain.
- Repairs for cuts: The affected areas are realigned to their proper position.
- Bone alignment: If bone fragments are present, alignment and restoration of the fingertip fractures may be required. Larger bone fragments may need pins or splints to heal.
- Nail bed grafts: Missing nail bed areas may be grafted from the same finger or other digits.
- Tendon injuries: Tendon damage may require splinting or pinning.
- Skin flaps: Local skin flaps can replace missing skin, or the area may heal naturally or with a skin graft.
The final appearance and function of the nail and fingertip depend on the restoration of the anatomy. If the injury is sharp and can be repaired, the nail can be restored to normal. However, severe crushing of the nail bed can result in scarring and deformity. Damage to the germinal matrix (the crescent-shaped area at the base of the nail) may lead to deformed nail growth. It generally takes three to six months for the nail to grow from the cuticle to the fingertip.