Nail bed laceration

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Nail bed laceration
Other names: Nail bed injury
A nail bed laceration may present with blood under the nail
SpecialtyEmergency medicine
SymptomsPain, blood under the nail[1][2]
ComplicationsTuft fracture, Seymour fracture[3][4]
CausesCut, crush injury[3]
Diagnostic methodBased on symptoms and examination, X-rayss[1][5]
TreatmentDrainage of blood from the nail, sutures, glue[6][1]
PrognosisImproves over 2 to 4 months[7]
FrequencyRelatively common[1]

A nail bed laceration is a type of injury to the nail bed.[1] Symptoms may include pain and blood under the nail.[2][1] It may be associated with a tuft fracture or Seymour fracture.[3][4]

It may occur due to a cut or crush injury, such as by a door or hammer.[3][8] Types include simple, stellate, and crush.[9][2] Diagnosis is based on symptoms and examination.[1] X-rays are done to look for underlying bone fractures.[5]

Small injuries without disruption to the nail generally do not require specific treatment; though, blood under the nail may be drained.[6][10] Otherwise management may involve closing with sutures.[3] It the injury is a simple cut, the nail may be left on and sutured through.[11] In a crush injury the nail may be removed and the nail bed closed with absorbable sutures.[3] There is no evidence that placing material to hold open the nail fold following repair is needed.[12] A ring block and finger tourniquet may help with management.[1]

Nail bed lacerations are relatively common.[1] Young males are most often affected.[1] While the best way to manage a nail bed lacerations has been poorly studied, removal of the nail and suturing is more expensive.[13] For a fingernail to grow out requires about 2 months while for a toenail 4 months is needed.[7]


Repair may be carried out after a ring block using lidocaine or lidocaine/epinephrine.[1] While the best way to manage nail bed lacerations has been poorly studied, removal of the nail and suturing is more expensive.[13] If the nail is removed, there is no evidence that placing material to hold open the nail fold following repair is needed.[12][14]

Preventative antibiotics are generally not required, even if an underlying fracture is present; exceptions to this are animal bites.[2]

Glue, specifically 2-octyl cyanoacrylate, is another option to sutures.[1]


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Mattison, Gennaya L.; Leis, Amber R. (July 2019). "Nail Bed Injury". Operative Plastic Surgery: 911–930. doi:10.1093/med/9780190499075.003.0090.
  2. 2.0 2.1 2.2 2.3 "Fingertip and nail injuries – Emergency Department". Retrieved 24 February 2024.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Wang, QC; Johnson, BA (15 May 2001). "Fingertip injuries". American family physician. 63 (10): 1961–6. PMID 11388710.
  4. 4.0 4.1 S, A. "Seymour fracture | Radiology Reference Article |". Radiopaedia. Archived from the original on 27 September 2023. Retrieved 24 February 2024.
  5. 5.0 5.1 "Nail Bed Laceration". Archived from the original on 28 November 2022. Retrieved 24 February 2024.
  6. 6.0 6.1 "Fingertip Fractures - Injuries; Poisoning". Merck Manuals Professional Edition. Archived from the original on 23 March 2023. Retrieved 24 February 2024.
  7. 7.0 7.1 "Nail Trauma". Harvard Health. 19 December 2018. Archived from the original on 24 February 2024. Retrieved 4 March 2024.
  8. Bharathi, RR; Bajantri, B (May 2011). "Nail bed injuries and deformities of nail". Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. 44 (2): 197–202. doi:10.4103/0970-0358.85340. PMID 22022029.
  9. Venkatesh, A; Khajuria, A; Greig, A (January 2020). "Management of Pediatric Distal Fingertip Injuries: A Systematic Literature Review". Plastic and reconstructive surgery. Global open. 8 (1): e2595. doi:10.1097/GOX.0000000000002595. PMID 32095403.
  10. Chen, F; Kalainov, DM (March 2017). "Phalanx fractures and dislocations in athletes". Current reviews in musculoskeletal medicine. 10 (1): 10–16. doi:10.1007/s12178-017-9378-7. PMID 28185123.
  11. MD, Michelle Lin (6 January 2010). "Trick of the Trade: Finger nailbed laceration repair". ALiEM. Archived from the original on 2 October 2023. Retrieved 23 February 2024.
  12. 12.0 12.1 Hawken, JB; Giladi, AM (February 2021). "Primary Management of Nail Bed and Fingertip Injuries in the Emergency Department". Hand clinics. 37 (1): 1–10. doi:10.1016/j.hcl.2020.09.001. PMID 33198909.
  13. 13.0 13.1 Fieg, Edward L. (15 May 2002). "Management of Nail Bed Lacerations". American Family Physician. 65 (10): 1997a–1998. Archived from the original on 28 June 2022. Retrieved 24 February 2024.
  14. Jain, A; Greig, AVH; Jones, A; Cooper, C; Davies, L; Greshon, A; Fletcher, H; Sierakowski, A; Dritsaki, M; Nguyen, TTA; Png, ME; Stokes, JR; Dakin, H; Cook, JA; Beard, DJ; Gardiner, MD; NINJA, Collaborative (30 March 2023). "Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial". The British journal of surgery. 110 (4): 432–438. doi:10.1093/bjs/znad031. PMID 36946338.