Nailbed injuries refer to injuries that affect the nailbed, which is the soft tissue underneath the nail plate that attaches the nail to the finger or toe. These injuries can range from minor to severe and can cause significant pain and discomfort.

Common Symptoms

Common symptoms may be:

• Bleeding or bruising under the nail (subungual hematoma)
• Throbbing pain
• Nail cracking or splitting
• Nail partially or completely torn away from the nailbed (nail avulsion)
• Swelling and redness around the nail

Cause & Anatomy

Common causes for Nailbed Injuries:

• Crushing or pinching of the fingertip or toenail between objects
• Cuts or lacerations from sharp objects like knives or saws
• Repetitive trauma or friction, common in athletes
• Nail-biting (onychophagia)

Anatomy of Nailbed Injuries:

• Nail plate: The hard, visible part of the nail
• Nailbed: The soft tissue underneath the nail plate that attaches the nail to the finger or toe
• Nail matrix: The area at the base of the nail where new nail cells are produced
• Cuticle: The thin layer of skin that overlaps the nail plate at the base

Diagnosis

• Physical examination of the injured nail and surrounding area
• X-rays may be ordered to check for fractures or foreign bodies
• Local anesthesia may be used to control pain and allow examination of the nail more closely

Prevention

• Wearing protective gloves or footwear when working with tools or heavy objects
• Avoiding nail-biting habits

Non-Surgical Treatment

• Draining subungual hematomas by creating a small hole in the nail (trephination) to relieve pressure and pain
• Cleaning and dressing minor lacerations
• Antibiotics to prevent infection may be needed

Surgery

• Nail removal (avulsion): Removal of the entire nail plate to access and repair the underlying nailbed
• Nail bed repair: Stitching of lacerations or reattachment of the nail plate using special glue or stitches
• Fracture fixation or fusion: Stabilizing or joining broken bones in the finger or toe

Rehabilitation

• Keeping the affected area elevated to reduce swelling
• Changing dressings as instructed
• Avoiding strenuous activities until healing is complete
• Physical therapy exercises to regain range of motion and strength

FAQ’s

How long does it take for a nail to grow back after an injury?
It typically takes 3-6 months for a fingernail and 6-12 months for a toenail to fully regrow after removal.

Can nailbed injuries cause permanent nail deformities?
Yes, severe nailbed injuries, especially those involving the nail matrix or cuticle, can lead to permanent nail deformities like hook nails or split nails if not treated properly. Grooves in the nail are common.

Are nailbed injuries more common in certain activities or professions?
Yes, nailbed injuries are more common in manual laborers, athletes, and individuals who frequently use their hands for work or hobbies. The car door can catch a lot of people unexpectedly.