Nailbed Injuries

                                                                                                                           nail avulsion image by Arteestique

Hey Preppers,

As much as we talk about major injuries on this website, mild injuries can be just as damaging to the effectiveness and efficiency of a member of your survival group.  Although perhaps not as life-threatening as a gunshot wound or a fractured thighbone, nailbed injuries are common; they will be more so when we are required to perform carpentry jobs or other duties that we may not be performing on a daily basis now.

Types of Nailbed Injuries

Your fingernails and toenails are made up of protein and a tough substance called keratin, and are similar to the claws of animals.  When we refer to issues involving nails, we refer to it as “ungual” (from the latin word for claw: unguis).

The nail consists of several parts:

The nail plate (body):  this is the hard covering of the end of your finger or toe; what you normally consider to be the nail.

The nailbed:    the skin directly under the nail plate.  Made up of dermis and epidermis just like the rest of your skin, the superficial epidermis moves along with the nail plate as it grows. Vertical grooves attach the superficial epidermis to the deep dermis.  In old folks like me, the nail plate thins out and you can see the grooves if you look closely.  Like all skin, blood vessels and nerves run through the nailbed.

The nail matrix:  the portion or root at the base of the nail under the cuticle (the cuticle is also called the eponychium) that produces new cells for the nail plate.  You can see a portion of the matrix in the  light half-moon (the “lunula”) visible at the base of the nail plate. This is the germinal matrix (actively makes new nail cells) and determines the shape and thickness of the nail; a curved matrix produces a curved nail, a flat one produces a flat nail.

In a nail “avulsion”, the nail plate is ripped away by some form of trauma.  The nail may be partially or completely off, lifted up off the nailbed.  Ordinarily, depending on the type of trauma, an x-ray would be performed to rule out a fracture of the digit; you won’t have this available if modern medical care is not available, but you can do this:

  • Numb the area by providing a digital block (see our recent article: http://www.doomandbloom.net/how-to-perform-a-digital-finger-block
  • Clean the nailbed thoroughly with saline solution, if available, and irrigate out any debris.  Paint with Betadine (2% Povidone-Iodine solution).
  • Cover the exposed (and very sensitive) nailbed with a non-adherent (telfa) dressing.  Some use a non-adherent dressing with Vaseline  as a covering. Change frequently.  Avoid ordinary gauze, as it will stick tenaciously and be painful to remove.
  • If the nail plate is hanging on by a thread, remove it by separating it from the skin folds by using a hemostat.  You can consider placing the avulsed nail plate on the nailbed as a protective covering (it is dead tissue but may be the most comfortable option).  Avoid scraping off loose edges (called debridement), as it may affect the nailbed’s ability to heal.
  • If the nailbed is lacerated, suture (if clean) with the thinnest gauge absorbable suture available (6-0 Vicryl is good).  Be sure to remove any nail plate tissue over the laceration so the suture repair will be complete.
  • Place a fingertip dressing.  Some will immobilze the digit with a finger splint to protect from further damage.
  • A contaminated wound will require antibiotics

Nailbeds and Crush Injuries

In some crush injuries, such as striking the nail plate with a hammer, a bruise (also called an “ecchymosis”) or a collection of blood may form underneath (a “hematoma”).  A bruise will be painful, but the pain should subside within an hour or two.  A hematoma will continue to be painful, even several hours after the event.  A bruise will likely appear brownish or blueish, but a hematoma may appear a deep blue-black.

                                                                                                                                                          Nail Hematoma – source: nailsmag.com

For a bruised nail, little needs to be done other than given oral pain relief, such as Ibuprofen.  In a significant hematoma, however, some suggest a further procedure called “trephination”.  In this instance, a very fine drill (or a hot 18 gauge needle or paper clip) is used to make a hole in the nail plate large enough to relieve pressure from the blood that has collected under the nail.  It should not be too painful if you don’t go too far in. This will require Betadine, but should not be performed unless absolutely necessary; if you go too deep through the nail, you may further injure the nail bed.  The finger must be kept dry, splinted and bandaged for a minimum of 48 hours afterwards.  Most inexperienced medics should avoid this procedure except in the most severe cases, as the pain will usually decrease over time even if you do nothing.

It’s important to know that damage to the base of the nail (the germinal matrix) may be difficult to completely repair, and that future nail growth may be deformed in some way. In situations where modern medical care is available, a hand surgeon is often called in to give the injury the best chance to heal appropriately.  Even then, a higher incidence of issues such as “ingrown” nails may occur.  A completely torn-off nail will take 4-5 months to grow back.

Remember, don’t try this at home, folks, unless the poop has truly hit the propellor.

Dr. Bones

 

 

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29 Responses to “Nailbed Injuries”

  1. Grossyi says:

      Just wanted to let you know that I read your articles religously.Though I haven’t commented previously I just wanted to let you know that your efforts are truely appreciated.. As an experienced ER RN much of the information is not new to me however anything I learn is extremely helpful especially with a prepper mindset.

    • Dr Bones says:

       Hi Grossyi,

      Thanks for the kind words and support and, especially, thank you for being willing to use your medical training to help us keep people healthy in the event of a collapse.

      all the best,

      Dr. Bones

  2. Rose says:

    Hi!
    My name is Sybol and I have just a couple of questions. Last night at work I hit my nail while cleaning a stove, it was bleeding under neath the acrylic nail I have on top what should I do? My hand is sore and my finger is swollen,
    If you can help me out I would love it!!
    Thanks,
    Sybol

    • Dr Bones says:

      Hi Sybol,
      Our focus is to help people when there is no modern medical help available. I think you should seek medical help immediately, and on the way, please apply ICE and pressure to stop the bleeding. Thanks, Nurse Amy

  3. Alexandra Knickerbocker says:

    Im an exotic dancer and i often wear acrylics. I accidently ripped my acrylic/real nail up from dancing. I could push it all the way back with it seperating from my finger. So with it hanging there i chose to remove it. I was going to pull it off when the edge of it under my skin came up with it. My nail, including my nail bed underneath my skin came off. Will my nail be able to grow back at all? My skin isnt cut. The nail bed literally slid up with it.

    • Dr Bones says:

      Hi Alexandra,

      The nail will, indeed, grow back although it may take close to a year. If you damaged the nail bed (the part under the skin), it’s possible that it may appear a little irregular but shouldn’t have any health effects otherwise.

      Dr. Bones

  4. Melinda says:

    Dr bones, I fell and a small table fell onto my left ring finger , leaving a “dent” on the skin between the cuticle and first knuckle. I iced it, it bruised and got better. The dent grew out thru my nail, however my nail is flattened and my fingertip still looks a tiny bit swollen. No pain even if put pressure on it. Will this ever go back to normal?

    • Dr Bones says:

      Hi Melinda,

      It’s possible that you damaged the nail bed, which is VERY difficult if not impossible to repair. If this is the case, the nail will always appear irregular. I am less certain as to why the fingertip would be swollen, however. Have your doctor take a look at it, perhaps you fractured the very end of the bone? An x-ray will tell. If the area appears red, you could have an infection in the soft tissues and need antibiotic therapy.

      Dr. Bones

  5. Connie says:

    I had my baby toe nails removed as well as the nail beds, how long till I can wear running shoes again?, I deliver mail for Canada post & would like to return to work. This is week 2 & it’s still throbbing, no way can I wear any thing other that my flip flops.

    • Dr Bones says:

      Hi Connie,

      If there is significant redness in the area, it should be evaluated by the doctor who removed them for signs of infection. Once he/she has evaluated the area, he/she can give you a reasonable idea of when you can work.

      all the best,

      Dr. Bones

  6. jamie says:

    here’s what i’m wondering: if the nail was ripped out, even from under the cuticle, so, presumably, the nail matrix, has been ripped out, and as it heals, the cuticle heals over like solid skin to the place where your nail used to be, does that mean the nail won’t grow back after that? or will the nail actually grow out through that scar tissue in 4-5 months? looking at it, i’d say that it looks like the finger has given up on the idea of ever having fingernail right there. but you say 4-5 months to grow back, does that mean until the nail bed is totally covered by nail again? or that’s how long before it’ll start to again push nail up from the cuticle area?

    • Dr Bones says:

      Hi Jamie,

      The matrix produces a thicker tissue than regular skin but not necessarily than scar tissue. I would still think that it would grow through (perhaps painfully) the scar and you would have a nail of sorts, dependent on the damage to the matrix itself.

      all the best,

      Dr. Bones

  7. Jim says:

    I had a crush injury on my thumb about a month ago. The nail is intact but the skin and cuticle at the base was ripped off. The nail root is now exposed. Apart from the fact it looks kind of weird, is it a problem? Will skin grow back here to cover it up?

    • Dr Bones says:

      Hi Jim,

      If the nail bed is damaged, new growth from here on in may appear unusual but it is rarely a health issue (that is, as long as it doesn’t get infected). Make sure you are followed by your physician to see its progress.

      all the best,

      Joe Alton, M.D.

  8. Betty Giesen says:

    I smashed my ring finger in a hinge and cut the cutical away. I did not lose the nail and as the nail grew the black moved to the side of the nail. It has been ten months and the entire end of my finger remains red and swollen.It will get some better and then flare up again. and throb with each pulse beat. How can i get relief . My doctor said just to live with it.

    • Dr Bones says:

      Hi Betty, Although I haven’t seen your finger, it’s possible that the damaged nail has grown into some skin, causing the inflammation. The question is whether the nail should be removed. I would recommend asking your doctor for further evaluation or a referral to a specialist. I wouldn’t “live with it”, at least without seeking other opinions.

      all the best,

      Joe Alton, M.D.

  9. Angela says:

    On May 23rd I dropped a tea cup on my big toe, it hit at the cuticle, Instantly the worse pain I have ever felt. Troubles moving it for 24 hours. Within 72 hours the nail was black but pain subsided. About 3 weeks after it started to bleed, while applying light pressure a gush of blood and fluid came out… but no pain. Went to Dr and he said that it was just the bruise releasing pressure. Now the nail is lifting I can lift about 1/2 the nail up. My question should I cut the part that is lifting off or leave it?
    I am just afraid of catching it on something.

    • Dr Bones says:

      Hi Angela,

      Sometimes the nail is pushed off the nail bed due to pressure from the accumulation of blood. Once off the bed, the nail may have to be removed, or may still serve a protective purpose for the sensitive tissues underneath. Contact your physician to see what he/she thinks is best in your case.

      all the best,

      Joe Alton, M.D.

  10. maurice nesbitt says:

    I crushed my pinky nail fairly severly. the nail was black 85% of the way to the tip within an hr. It swelled the skin got tight and was bruise all the way round the finger. 10 days later the skin pealed of. Now the nail has become very curved. the side are now vertical. will the new nail grow in looking pinched like this? is the anything I can do to have a normal nail?

    • Dr Bones says:

      Hi Maurice,

      If the nail bed was damaged, it will be very difficult to do much about it and all nail tissue issuing from it in the future will look irregular. You should consult with your doctor to see if a specialist may be able to do something, but any results will be uncertain.

      all the best,

      Joe Alton, M.D.

  11. Dorothy says:

    Hi,
    I wear acrylic nails all the time and this is the first time I’ve ripped my nail from its nail bed. My pinky was hit and torn partly from the nail bed but the majority is still in tact. I’m wondering on what I should do? (I have kept it wrapped up with a band- aid during the day and at night I take the band- aid off…) And what would be the best way to remove it?

    • Dr Bones says:

      Hi Dorothy,

      The best way to treat a torn nail is to give it time to grow back, but you have a few options: You can tape the torn part back into position and trim it as the nail begins to grow, you can clip off the torn portion right away at a slight outward angle so the nail grows back normally. If the tear is small, you can apply clear nail polish to the remaining nail to strengthen the area.

      If your nail plate is completely separated from your nail bed, it’s not going to re-attach. Wait for a new nail to grow over time. You CAN tape the nail in place for now, trimming it as needed. Your doctor could remove the separated nail completely and teach you to bandage the exposed nail bed while you heal.

      Feel better!

      Joe Alton, M.D., aka Dr. Bones

  12. Vanessa says:

    Hi Dr. Bones,

    My finger got caught to my car door and my initial reaction was to pull. once i did that, my whole index finger nail ripped off. I went to doctor and was told that i should let the nail breath and not have it wrapped all the time. This injury happened about 5 days ago and im still in pain. Should i keep it wrapped or unwrapped? The first 3 days i had it wrapped but now not sure what should i do

    • Dr Bones says:

      I think it’s fine for it to be unwrapped, but if you bang it against things painfully a lot, you should protect it. In any case, you should heal fine…

      all the best,

      Dr. Bones

  13. Kristi says:

    Hey!
    I always wear acrylic nails and I recently fell over and tore my whole nail, completely off (this was a week ago today) and it’s currently all dry. Up the top, popping out from under the skin, is a soft, squishy pink lump that I’m iffy about. It’s it infected or is that saposto happen?

    • Dr Bones says:

      Hi Kristi.

      keep an eye on it to make sure it doesn’t start getting red and hot, which could be a sign of infection. The nail will eventually grow back, although it might not look exactly symmetrical if you damaged the nail bed. Never hurts to have that lump checked by a physician, you really want this to heal as best as it can.

      Good luck!

      Joe Alton, M.D.

  14. Brianna says:

    Hi. I’ve just got my nails done2 days ago with the artificial nails. Last night I hit my pinky nail hard which caused it to start bleeding at the tip underneath the fake nail. I really want it off asap. How can I please take it off or what can I do to stop it from hurting? Please help me.

    • Dr Bones says:

      Hi Brianna,

      If it’s painful it’s probably due to blood accumulation causing pressure under the nail. Doctors often use a method called trephination in which they make a hole in the nail to release the blood underneath, thus relieving the pain. Get it checked out.

      all the best,

      Joe Alton, M.D.

  15. Melissa says:

    Dr Bones,

    My daughter got her thumb stuck in a car door the 21st of June. The nail finally fell off a week and a half ago but there was a large, purplish/pink ridge of tissue in the nail bed. I saw a hand surgeon and he said it was fine, but I said it was protruding over the nail bed and he said it wasn’t. I think it is. What should I do? I think the tissue need to be removed before the nail grows back. Am I right?

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