How Do You Fix a Laceration on a Nail Bed?

An injury to the nail bed may require a trip to the ER depending on the extent of the injury.

Nail bed injuries are the most common type of fingertip injuries seen in emergency rooms. Such an injury may occur if the nail bed is caught between two objects, gets crushed while hammering at a nail or heavy objects fall on the nail. Nail bed injuries may present as nail bed laceration, nail bed avulsion or other injuries such as fracture of the distal tip of the finger.

Nail bed lacerations may occur when

• Sharp knives or objects land with enough force to penetrate your nail plate causing sharp lacerations.
• Your nail gets crushed between a larger heavy object and your finger bone causes stellate (irregular) laceration.
• Your nail bed gets squeezed between the hard nail and finger bone due to pressure such as between doors resulting in simple or complex lacerations.

Self-inflicted injuries may cause nail bed lacerations such as 

• Nail-biting
• Insertion of artificial nails 
• Improper manicure

Proper and optimal management of these nail bed injuries are essential for fast healing and to prevent complications and avoid late deformities.

If you get injured on your nails, you must

• Remove the ring or jewelry from your hand.
• Wash the injury gently with soap and clean water.
• Cut off rough edges of your nail using a sterile scissor if your nail is torn to avoid further injuries.
• Apply pressure with a clean cloth to stop the bleeding.
• Apply ice to that area and take over-the-counter pain relievers such as acetaminophen to reduce swelling.
• Apply antibiotic ointment and bandages, if necessary.
• Elevate the injured arm or leg above the heart.

Reach out to the emergency room quickly if 

• Your nail is cut or torn and not attached to the nail bed.
• Your nail has a bruise that is more than one-fourth size of your nail.
• Your finger or toe is bent or displaced or deformed.
• Your nail bed wound looks deep and needs suturing.

Your doctor may assess your history including the timing and type of your injury. After examining and evaluating the extent of your injury clinically and after checking the finger bone or toe bone on X-ray reports, your doctor may

• Remove part or your entire nail.
• Cut the nail bed and close it with stitches after administering lidocaine (local anesthesia).
• Make a hole in your nail to drain the blood if it is clotting inside the nail bed.
• Reattach your nail with special glue or stitches.
• Use a special surgical material if reattachment is not possible, which will remain on your nail bed until it heals properly.
• Prescribe some antibiotics (ointment and tablets) to prevent infection.
• Prescribe Tylenol (acetaminophen) or Advil (ibuprofen) to reduce pain and swelling.
• Place a wire or splint inside your finger if you have broken your finger bone. It will keep your finger bone in place.
• Give you a tetanus booster injection to prevent septic conditions.
• Refer you to a plastic surgeon if the loss looks challenging to reconstruct with simple procedures and requires grafts and microsurgical procedures to restore the appearance of your finger or toe.

After the doctor’s treatment, you should

• Apply ice for 20 minutes every two hours on the first day and then three times a day thereafter.
• Keep your hand or foot above the level of your heart to reduce throbbing.
• Take pain relievers as directed by your doctor such as ibuprofen or naproxen. It may also reduce your swelling.
• Change the bandage daily.
• Ask your doctor before using pain relievers if you have heart disease, high blood pressure, kidney disease or a history of stomach ulcers or internal bleeding.

• Your pain and swelling may heal within a week or 10 days. However, it may take several months to grow back a separate nail. Fingernails take four to six months and toenails take 12 months.
• If your finger or toe bone has broken along with the nail bed injury, it may take four weeks to heal.
• If you see any signs of infections such as pus, redness, or a red streak extending from that wound, then see your doctor.
• Your new nail may have grooves or ridges and may remain permanently distorted.