Nail Injury

Nail Injury

If the qualifications for home care are met (See "Self-Care at Home" below), then a visit to the doctor is indicated only in the following cases.

• It has been more than five years since your last tetanus booster shot.
• Infection, redness, or drainage develops at the site of the injury two to seven days later.
• The injured person has diabetes, has poor circulation, AIDS, is on chemotherapy, or has another reason for poor healing or increased risk of infection.

Most nail injuries are best managed in a hospital's emergency department instead of at the doctor's office. You should be seen within six hours and can be transported by private vehicle. Calling an ambulance is unnecessary unless there are other more serious injuries. Anything worse than a small nail bruise should be brought to the emergency department for evaluation and repair. This includes the following examples.

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Home care should begin with initial wound care and evaluation of the injury.

• First, remove all jewelry from the affected hand or foot.
• Stop any bleeding by applying pressure with a clean cloth. When the bleeding has stopped, remove the cloth and examine the injury.

Home care may be appropriate if there is only a subungual hematoma (nail bruise) that you do not want to be drained or that occupies less than 25% of the total nail if the finger or toe is not bent or deformed, and if there are no lacerations or avulsions of the nail. Do not be too concerned if there are some minor scrapes around the nail.

• Keep the hand or foot elevated above the level of the heart. This will help with the throbbing.
• Use acetaminophen (Tylenol) or ibuprofen (Advil) for pain if you are not allergic to these medications.
• Wash any cuts or scrapes in soap and water, then apply a triple antibiotic ointment and bandage.

If there are any lacerations, avulsions, a large nail bruise, or if the finger or toe is bent (deformed), you will need to go to a hospital's emergency department.

• Do not pull at the nail or try to remove it from the nail bed. Wrap any amputated parts in a moist clean paper towel, place in a zip-locked plastic bag, then place the bag in ice. Bring this with you to the hospital's emergency department.
• Wrap hand or foot in a clean towel.
• Check on whether your tetanus immunization is current.

Follow-up

• Any skin stitches or stitches in the nail will need to be removed in seven to 14 days. Any stitches in the nail bed will dissolve by themselves and can be left in place.
• The doctor may want to recheck the wound in three to five days.
• Take any antibiotics as directed.
• Keep the wound clean and dry. Follow any specific wound care instructions given by the doctor.
• Keep the hand or foot above the level of the heart to aid in pain control.
• If the doctor prescribed pain medicine, then take it as directed. Otherwise, acetaminophen or ibuprofen may be used for pain control if there are no allergies to these medications.

Prevention

Although most nail injuries are accidents, some precautions can be taken to reduce the chances of this happening.

• Keep nails trimmed short to keep them from snagging on objects.
• Always keep the supporting hand out of the potential path of a box cutter or other sharp object.
• Be careful around machinery or when using hammers.
• Use door guards to prevent children from accidentally closing doors on their fingers.

Outlook

Even with proper wound care, a permanent deformity of the nail is not uncommon. The nail will grow back, but it may have a groove or dent in it.

If part of the fleshy part of the finger was lost, a hook nail may result. This occurs when the nail grows in a hook over the end of the finger or toe. This can sometimes be corrected later with plastic surgery.

If the nail was removed, or if there is a large nail bruise, then the injured nail will probably fall off as a new nail grows back. It will take four to six months for a new fingernail to grow back, and 12 months for a new toenail.

Infection can occur. This is more common with bite injuries or contaminated wounds. Infection is also a risk for people with diabetes or AIDS, those undergoing chemotherapy, those with poor circulation due to any reason, or those who have other problems that may decrease the ability to fight infection.