A nail is the hard covering at the end of the dorsal side of your fingers and toes. The nail is composed of a nail plate, nail matrix (a tissue that protects nails) and nail bed. The nail plate is a hard, translucent part of the nail composed of a protein called keratin. The nail bed is the skin that is present below the nail plate. Nail bed injuries are very commonly associated with hand injuries or fingertip injuries.
Generally, nail bed injuries are caused during road accidents, crush injuries (while handling tools), cutting (while handling machinery) and when the fingers get jammed between doors.
The symptoms of a nail bed injury are based on the type of injury. A minor injury will be characterised with swelling and pain. Moderate level of injury may cause clotting of blood associated with deeper pain. Severe injuries can result in cutting of the nail, tearing and rupturing of adjacent structures and even fracture of bones under the nail.
The presentation of nail bed injuries are obvious and does not require diagnostic tests most of the time. Professor Bain might recommend X-ray if the nail bed injury is severe and has led to the fracture of a bone. Blood tests are not usually recommended unless other factors apply.
The goal of the treatment is to restore the normal anatomy of the nail and the surrounding structures. A simple blood clot which appears as red or purple in colour will fade away gradually. Pain killers and antibiotics may be advised to alleviate the pain and prevent infection. In case of severe injuries such as a nail cut and broken bones, surgery may be recommended. Restoring the finger alignment with the help of splinting and using nail bed grafts to replace the injured portion of the nail can heal the damage effectively.
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
- Possibly antibiotics
- Get a tetanus immunisation