Trauma to a fingernail, often sustained from a crushing event like slamming a car door or striking the finger with a hammer, results in a painful injury requiring immediate attention and long-term care. The nail, composed of keratin, protects the underlying soft tissue of the nail bed and the growth center called the nail matrix. Healing involves reducing initial inflammation, managing internal pressure, and patiently waiting for the body to regrow the damaged structure.
Immediate First Aid Response
Immediate actions after a crush injury limit pain and swelling. Begin by gently cleaning any broken skin or cuts around the nail using mild soap and water to minimize infection risk. If the area is bleeding, apply light pressure with a clean cloth or sterile gauze until the bleeding stops.
Inflammation and throbbing pain can be reduced by applying a cold compress or ice pack, wrapped in a thin cloth, to the injured finger for 10 to 20 minutes at a time. Avoid applying ice directly to the skin to prevent cold injury. Elevating the injured hand above the heart also helps decrease the throbbing sensation and reduce swelling by slowing blood flow.
For pain management, over-the-counter pain relievers such as acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen can be taken following package directions. These medications help manage discomfort while also reducing the initial inflammatory response.
Understanding Subungual Hematoma and Pressure Relief
A crush injury often causes capillaries in the nail bed to rupture, leading to a collection of blood beneath the nail plate, known as a subungual hematoma. This trapped blood is caught between the rigid nail and the sensitive nail bed, resulting in intense, throbbing pain due to significant pressure buildup. The hematoma is visible as a dark purple or black discoloration under the nail.
If the pressure is severe, a procedure called nail decompression or trephination may be necessary to relieve pain and potentially save the nail from detaching. This involves creating a small, sterile hole through the nail plate, allowing the trapped blood to drain and providing immediate relief.
Any procedure involving puncturing the nail should be performed by a medical professional. Attempting drainage at home carries a high risk of introducing bacteria into the nail bed, which can lead to a serious infection or further damage to the nail matrix. A healthcare provider ensures the procedure is done safely with sterile equipment and can assess for other associated injuries, such as a bone fracture.
Managing the Healing Process and Regrowth
Long-term recovery begins after the initial pain subsides and focuses on protecting the underlying tissue while waiting for a new nail to grow. If the subungual hematoma is large, the pressure or trauma may cause the old, damaged nail to eventually detach from the nail bed. This detachment can take several weeks to a few months as the new nail pushes the damaged one out.
Manage the partially detached nail by keeping it trimmed short to prevent snagging, which could cause further pain or damage. Once the old nail falls off, the exposed nail bed is extremely sensitive and requires careful protection. This area should be kept clean and covered with a sterile, non-stick dressing or bandage until the new nail fully protects the underlying tissue.
Fingernails grow at an average rate of approximately 3 millimeters per month. Complete regrowth of a new fingernail typically takes three to six months. Preventing re-injury to the sensitive nail matrix, the area beneath the cuticle where nail growth originates, is important to ensure the new nail grows back smoothly and without permanent deformation.
When Professional Medical Attention is Necessary
While many smashed fingernail injuries can be managed at home, certain signs indicate a serious underlying issue requiring immediate medical evaluation. Seek professional help if you suspect a fracture of the finger bone (distal phalanx), suggested by severe pain, deformity, or an inability to move the finger normally.
A doctor should examine the injury if there are deep lacerations or cuts around the nail or cuticle that may require stitches. Uncontrollable bleeding that does not stop with direct pressure requires an urgent visit. Watch for signs of infection developing in the days following the injury, including increasing redness, warmth, excessive swelling, pus discharge, or a fever.
If the nail is completely torn off or visibly displaced from the nail bed, a medical professional must assess the nail bed for lacerations that may need surgical repair. Prompt evaluation and treatment are important for relieving pain and ensuring the best outcome for future nail growth.