Trauma to a finger or toe can injure the nail unit, often leading to concern that the nail plate will detach completely. Separation occurs when the force of impact, such as a crush injury, damages the connection between the nail plate and the nail bed underneath. The primary mechanism driving the nail off is usually a subungual hematoma—bleeding trapped beneath the nail that creates intense pressure and pushes the nail away. While not every injured nail can be saved, swift and appropriate care can increase the chances of the nail remaining attached long enough to protect the new nail growing beneath it.
Immediate First Steps After Injury
The first few hours following a nail injury are important for mitigating damage and managing pain. Immediately after the trauma, gently clean the injured digit with mild soap and water to remove debris and reduce the risk of bacterial contamination, especially if the skin around the nail is broken.
To minimize swelling and pain, elevate the injured hand or foot above the level of the heart. Apply a cold compress or ice pack wrapped in a thin cloth for 10 to 20 minutes at a time. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can also help manage discomfort.
If the pain is severe and throbbing intensely, or if the subungual hematoma covers more than 25% to 50% of the nail plate, immediate medical attention is necessary. A healthcare provider may perform nail trephination to drain the trapped blood, which relieves pressure and provides instant pain relief. Professional care is also necessary if the injury involves deep lacerations, signs of a fracture, or a complete tear of the nail plate from the nail fold. Prompt assessment can help determine if the nail bed needs repair to ensure proper regrowth.
Strategies for Protecting the Injured Nail Plate
After the initial assessment and necessary medical treatment, the focus shifts to ongoing protection to keep the existing nail plate stable. The goal is to maintain the nail plate as a natural dressing for the sensitive nail bed underneath until a new nail begins to grow.
If the nail is only partially detached, trim away any loose, hanging fragments that could catch on objects and cause further tearing. Cover the remaining nail with a clean, non-stick dressing to cushion it from impact and prevent snagging. Avoid using adhesive tape directly on the injured nail, as removing the tape can cause additional trauma.
Maintaining a clean and dry environment is essential to prevent infection. Change the dressing daily or whenever it becomes wet or soiled, and always wash your hands before and after handling the injury site. Avoid activities that place direct pressure or repetitive stress on the injured digit, such as wearing tight shoes or gripping heavy tools. Monitoring the area for signs of infection is necessary, including:
- Increasing redness
- Warmth
- Pus
- Streaks extending from the injury
Understanding When Nail Loss Is Inevitable
Despite efforts to preserve the nail, certain injuries make detachment highly likely due to the extent of the trauma. A significant indicator that the nail will eventually fall off is a large subungual hematoma that covers more than half of the nail surface. This volume of trapped blood causes extensive separation and damage between the nail plate and the underlying nail bed.
Another sign pointing toward inevitable loss is complete separation of the nail plate at the matrix, the area under the cuticle where the nail grows from. If the original nail is entirely loose or significantly displaced, it has lost its structural connection and will not reattach. The nail plate typically begins to loosen visibly a few days to weeks after the injury and often detaches completely within several weeks to a few months. This occurs as the new nail grows beneath it, pushing the old, damaged structure out.
Caring for the Exposed Nail Bed and Regrowth
Once the injured nail plate has fully detached or been removed by a healthcare professional, the focus shifts entirely to protecting the exposed, sensitive nail bed. The nail bed is vulnerable to pain and infection because it is rich in nerves and blood vessels.
The exposed area should be kept clean. Apply a non-stick dressing with a thin layer of antibiotic ointment—if recommended by a medical provider—to create a protective environment. This covering should be changed daily to keep the bed clean and dry until the new nail has grown out enough to cover the sensitive skin.
Patience is necessary during the regrowth phase, as the process takes a considerable amount of time. Fingernails typically require about six months to fully regrow, while toenails can take up to 18 months, especially following a severe injury. The new nail may temporarily appear misshapen, discolored, or ridged if the nail matrix sustained minor damage, but it should eventually return to a normal appearance.