The nail is composed of a nail plate, nail matrix and nail bed. The nail bed is the soft tissue that lies below the nail and is essential for the growth of the nail. Nail bed injuries such as crush and avulsion injuries are commonly associated with injuries to the fingertips or toes.
Generally, nail bed injuries are caused from road accidents, sports activities, crush injuries (while handling tools), cutting (while handling machinery) and when the fingers get jammed in doors. The nail bed gets compressed between the hard nail on top and the finger bone below it.
The symptoms of a nail bed injury are based on the type and severity of injury. A minor injury is characterized by swelling and pain. Moderate level of injury may cause collection of blood under the nail (hematoma) with deeper pain. Severe injuries can result in cutting of the nail, tearing and rupturing of adjacent skin and other structures and even fracture of bones under the nail.
When you present to a clinic with a nail bed injury, your doctor performs a thorough physical examination, sometimes under local anesthetic. Your doctor may order X-ray if the nail bed injury is severe and has led to the fracture of a bone.
The goal of treatment is to restore the normal anatomy of the nail bed and the surrounding structures. A simple blood clot which appears as red or purple in color will fade away gradually. Pain killers and antibiotics may be prescribed to alleviate pain and prevent infection. A hematoma can be drained by drilling a hole in the nail. In cases of severe injuries such as a cut nail or broken bones, surgery may be performed to suture the lacerations and align the bones with the help of splinting. Grafts may be used from another finger to replace the injured portion of the nail bed.
Nail bed injuries are mostly accidental. Care should be taken to avoid injury by handling things safely. Some of the precautions which can be taken to avoid the complications of nail bed injury are:
- Do not pull off or cut the nail after injury
- Apply pressure to stop bleeding
- Wash the area carefully and wrap the wound with a clean cloth
- Get a tetanus immunization