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Nail Bed Injuries
A crushed, cut or lifted fingernail is often more than a bruise. The nail bed underneath — the specialised skin that grows the nail — can be injured too, and needs the right care for the nail to grow back looking and feeling normal.
What is it?
The nail bed is the specialised skin beneath the nail plate that produces the fingernail. It is commonly injured by a crush injury, such as a finger caught in a door, a cut, or a fingertip caught during a fall or sporting injury. A nail bed injury is often accompanied by a fracture of the distal phalanx — the small bone at the fingertip just beneath the nail bed — and a build-up of blood under the nail (a subungual haematoma) is a common sign.
At a glance
What is it?
An injury to the nail bed, the specialised skin beneath the nail that produces the fingernail
Common symptoms
Pain, swelling, a bruised or bleeding nail bed, and sometimes a nail that is partly or completely lifted off
Who it affects
Anyone who crushes, cuts or catches a fingertip, commonly in a door, machinery or a sporting injury
Is it serious?
Not dangerous, but an unrepaired nail bed injury can lead to permanent nail deformity
Treatment options
Drainage of a large blood collection under the nail, or repair of the nail bed if it is lacerated or the nail has lifted off
First step
An examination of the nail and fingertip, with an x-ray to check for an underlying fracture
Causes and risk factors
- Crush injuries, such as a finger caught in a door
- A direct blow or cut to the fingertip
- A fingernail caught and torn during a fall or sporting injury
- Often associated with a fracture of the fingertip bone (distal phalanx)
Nail bed injuries are frequently seen alongside a distal phalanx fracture, since a force strong enough to injure the nail bed often fractures the bone beneath it too. The nail itself can act as a natural splint for such a fracture if it is left in place, or replaced after repair.
Symptoms and how nail bed injuries present
Pain and swelling of the fingertip are common, along with a subungual haematoma — a blood collection under the nail — that can be very painful due to the pressure it creates. The nail may be partially or completely lifted off (avulsed). If the nail fold or the germinal matrix (the part of the nail bed that generates new nail) is injured and not repaired, the new nail can grow back ridged, split or deformed.
How are nail bed injuries diagnosed?
Diagnosis is based on examining the nail, nail fold and fingertip. An x-ray is usually taken to check for an associated fracture of the distal phalanx. The nail is often lifted or removed at the time of assessment or surgery so the nail bed underneath can be properly inspected and repaired.
Treatment options for nail bed injuries
A large, tense and painful subungual haematoma can be drained to relieve pressure. A lacerated nail bed is repaired with fine dissolving sutures after removing the nail, and the nail — or a substitute, such as the sterile packaging from the suture material — is often replaced under the nail fold to keep it open while the new nail grows through. An associated distal phalanx fracture is usually stable and heals as the nail bed heals, though it is assessed and managed in its own right.
When to see a hand surgeon
Consider seeing a hand surgeon for a large or very painful haematoma under the nail, a torn or partially avulsed nail, a visibly deformed fingertip, or a wound at the base of the nail. Early repair gives the nail the best chance of growing back normally.
What to expect at your appointment
Our intake form asks you specific questions about how the injury happened and provides the option of uploading a photo of your injury. At your appointment, Dr Tomlinson will examine the nail and fingertip, review your x-ray, and arrange for hospital-based repair of the nail bed if required.
Related conditions and treatments
Nail bed injuries can occur alongside other fingertip trauma, including fingertip slicing injuries and a fracture of the fingertip bone, covered under hand fractures (metacarpal and phalangeal).