Urgent care centers are generally well-equipped and staffed to manage many common injuries to the fingers and toes, including those that require the removal of the nail plate. This procedure, known as nail avulsion, is a frequent minor trauma intervention that falls within the scope of practice for most urgent care facilities. Staff can typically assess the extent of the damage, determine if the underlying nail bed is affected, and perform the necessary steps to relieve pain and prevent infection. Seeking prompt urgent care for a painful or severely damaged nail is a practical choice, avoiding the extended wait times often found in an emergency room.
Nail Injuries Appropriate for Urgent Care
A significant reason for nail removal is a subungual hematoma—blood pooling underneath the nail, usually caused by a crush injury. If this collection covers more than 50% of the nail area, or if it is causing intense, throbbing pain due to pressure, the nail may need partial or complete removal to drain the hematoma and inspect the nail bed for lacerations. Urgent care providers can often perform a trephination (draining the blood) or a full avulsion as needed to relieve this pressure.
Urgent care is also appropriate for cases of partial nail avulsion, where the nail plate has been traumatically torn and is partially detached. A partially detached nail can snag on objects, causing further pain and potentially introducing bacteria to the exposed nail bed. Removing the remaining jagged section is necessary to create a clean wound that can heal correctly.
Another common issue addressed in this setting is severe infection, such as chronic paronychia or an ingrown toenail that has progressed beyond simple home treatment. If an infection has tracked deep into the nail folds or under the nail plate, partial removal may be necessary to access and drain the infected tissue. These types of localized, non-life-threatening injuries are routinely managed by urgent care staff.
Details of the Removal Procedure
The process of surgically removing a nail plate, or nail avulsion, begins with ensuring the patient is comfortable and free of pain. Before the procedure can start, the provider administers a digital block, which involves injecting an anesthetic, typically lidocaine, into the base of the finger or toe. This injection numbs the entire digit, allowing the procedure to be performed without causing further distress.
Once the area is fully numb, the provider cleans and prepares the digit using sterile techniques to minimize the risk of infection. A tourniquet may be placed temporarily at the base of the digit to control bleeding and provide a clear field of view. The actual removal is performed using specialized instruments, such as a nail elevator or a small hemostat, which are carefully slid underneath the nail plate to gently separate it from the nail bed.
The extent of the removal depends on the injury; for a simple ingrown nail, only a sliver might be removed, while a crush injury may require complete removal. After the nail is removed, the nail bed and surrounding tissue are inspected for lacerations that may require small sutures to repair. Finally, an antibiotic ointment is applied to the exposed nail bed, and a protective, sterile dressing is placed over the wound.
Post-Procedure Care and Healing
Following the nail avulsion procedure, proper home care is important to ensure the nail bed heals correctly and reduce the chance of complications. For the first 24 to 48 hours, the injured digit should be kept elevated above the heart level to help minimize swelling and throbbing pain. Patients are typically advised to keep the initial bulky dressing clean and completely dry.
After the initial period, the provider will instruct the patient on how to perform dressing changes, which often involve gently washing the area with soap and water. The wound should then be covered with a non-stick dressing and a layer of antibiotic ointment or petroleum jelly to keep the sensitive nail bed moist and protected. Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be used to manage residual soreness.
The nail bed itself typically heals within a few weeks. A fully removed fingernail generally requires approximately four to six months to completely grow back. Toenails grow at a much slower pace, and a complete avulsion may require a full 12 to 18 months for the nail to fully regenerate.
When to Seek Emergency Room Treatment
While urgent care is suitable for many nail injuries, certain situations require the advanced resources of a hospital emergency room. If the injury involves high-force trauma, the patient should seek the ER immediately, especially if there is an obvious deformity of the finger or toe, which suggests a possible fracture of the distal phalanx (fingertip bone). X-ray imaging and specialized orthopedic consultation are often necessary in these cases.
The emergency room is also the appropriate destination if the trauma resulted in:
- Extensive tissue loss.
- Deep lacerations that might involve tendons or nerves.
- Major vascular damage.
- Uncontrolled, persistent bleeding that cannot be stopped with firm pressure.
- Signs of a spreading systemic infection, such as high fever, red streaking extending from the wound, or rapidly worsening swelling.
These symptoms indicate a severe infection that requires immediate, comprehensive hospital care.