A nail injury can be received at any time and in the most unexpected place. Sometimes even a slight blow to the thumbnail is enough to turn it blue and show signs of detachment. Of course, no one wants to walk for several months with such a cosmetic defect, and even more so for the fair sex.

To avoid the unpleasant consequences of injury, we will consider how you can save a nail after a blow and what to do if independent actions do not bring results.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

The total work experience is over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitology, in 1997 he completed his residency in Traumatology and Orthopedics at the Central Research Institute of Traumatology and Orthopedics named after V.I. N.N. Prifova.

Depending on the strength of the injury, several degrees of injury severity are distinguished:

• mild - the nail plate gets minor damage. The pain usually goes away in the first minutes after injury. The nail may twitch slightly, but there are no visible changes, no hematoma is formed;
• moderate severity - soft tissues are slightly disturbed, the nail is injured, but the integrity of the plate is preserved. This is often the case with a toenail injury, such as in children playing football. The plate may flake off at the edge or get minor damage on the side. As a rule, in this case, the nail can be cut off, and the soft tissue damage can be disinfected and lubricated with brilliant green;
• severe damage is characterized by blue discoloration of the nail plate after injury. Literally before our eyes, the color from light pink turns dark blue due to the release of a certain amount of blood under the nail. In parallel, the integrity of the nail plate can be violated outside the boundaries of adhesion to the soft tissues. Such damage is most often obtained with plane impacts;
• very severe damage - pathology occurs with severe mechanical injuries, and according to statistics, damage to the nail on the hand is more common. It can be hands or fingers getting into the mechanism. In this case, the nail receives severe destructive damage, the nail plate can be completely destroyed, and its parts can be pressed into the soft tissues. As a rule, injuries are characterized not only by problems with the plate - soft tissues are significantly damaged, open wounds appear, the finger can be dislocated or broken.

How the patient is treated depends on determining the severity of the injury.

When to see a doctor

Proper first aid is essential if fingers are injured. In many ways, this will help not only to relieve the patient of pain, but also to save the nail, to prevent its convergence.

First aid for a bruised nail is applying cold to the damaged area.You can use a block of ice, a cold object, or place a bruised finger under running cold water. If the skin around the nail is damaged, it needs treat with an antiseptic solution(hydrogen peroxide, alcohol, iodine, etc.). To reduce pain, you should give the victim a pill of any pain reliever... After that, if there is a suspicion of a fracture or dislocation of the finger, you need deliver the patient to the emergency room.

Seeing a doctor is mandatory for trauma of the third and fourth severity.

In this case, the doctor will examine the nail plate, anesthetize the finger and, if necessary, carry out manipulations to remove the blood accumulated under the nail. To remove blood, a small hole is drilled on the surface of the plate, and blood flows freely from there. You need to see a doctor as soon as possible, before the blood clots.

If a nail detachment occurs during an injury, in most cases it is necessary to remove the nail partially or completely. Removal of the nail takes place with local anesthesia, the procedure does not take much time. After the manipulations, the doctor will apply an antibacterial bandage and give recommendations for further treatment.

Home treatment

If the damage is minor and the nail has not turned black, then the treatment can be carried out at home. To do this, you must perform the following activities:

1. Rest the injured finger for the first time.
2. Apply cold compresses to the plate surface, replacing them one by one when heating. This will help relieve swelling and relieve pain. If small vessels are damaged, the cold will help prevent bleeding. If pain persists, you can anoint the nail and the surface of the skin around it with menthol ointment - it will create a cooling effect and reduce pain.
3. If the soft tissues around the plate are damaged, there are cracks and wounds with minor bleeding, then the surface must be treated with hydrogen peroxide, cover your finger with a dry bandage, if necessary, you can apply Levomekol ointment for the prevention of suppuration.
4. With the formation of soft tissue edema, but in the absence of visible damage, you can draw an iodine grid on your finger - it will help eliminate swelling.
5. Anesthetize the finger for severe discomfort you can if you take a pill of Paracetamol or Ketorol. For a while, the victim will no longer feel the pain of the injury. If the pain is strong you can apply a compress to your fingerfor which mix Dimexide + Novocainecombined one to three. In the resulting solution, several layers of gauze are abundantly soaked and a gauze swab is applied to the nail itself, or the entire finger is wrapped with it. After a while, the pain subsides.

At home, a badyag will help to cure an injury. The badyagu, diluted to a pasty consistency, can be used as applications on the nail plate. After compresses used heparin ointment - it will eliminate puffiness, help to avoid bruises.

The anti-inflammatory effect is provided by an ointment from bruises of the nail based on the medicinal plant arnica. The tool has the same name - Arnica. You need to lubricate the damaged finger several times a day. The Zhivokost ointment has a similar effect, which can also be used if the fingers are damaged.

Complications and consequences

In some cases, even after careful treatment of the injury site at home, complications arise. The most serious consequences for the finger are if the nail comes off or peels off over time.If there is no suppuration, you should not worry in this case - except for a cosmetic defect, the victim does not threaten the injury. The nail plate can be removed by itself absolutely painlessly, or it will simply grow back to its normal state at the place of discharge. You can observe how the light spot will gradually move to the edge of the nail, and then completely disappear.

Much more serious consequences occur with suppuration after a blow.If you skip this moment, the inflammatory process will not just separate the nail from the soft tissues, it can contribute to their suppuration and cause the development of felon. You can notice suppuration by the characteristic aching pain, which then turns into twitching of the finger. The finger will turn red, you can see a yellow-green spot under the nail - signs of pus. The pain increases so much that it prevents the patient from sleeping at night. In the active phase, pus is released from under the nail bed.

In the event of such consequences of injury, it is imperative to see a doctor immediately.

The restoration of nails does not occur in a few days.

As a rule, it takes several months for the bruise to heal for the nail plate to grow back and the nail to acquire a healthy pink color.

The growth rate of the plate is approximately 1 mm per week, so the recovery time can be predicted in advance by measuring the width of the bruise formed on the nail.

The restoration of the nail plate takes a little longer when the nail completely comes off, but you should not worry - it will actively grow, quickly regenerate, and soon there will be no trace of the injury. The most important thing at the recovery stage is to protect the nail from new damage.so that the nail plate grows even and beautiful.

How can you help yourself at home with a bruised nail

Anyone can face such a nuisance as a nail injury. It does not depend on age, or on the state of health, or on other characteristics and characteristics of a person.

The reasons

The main cause of nail injuries is accidents. Inaccurate handling of doors, falling of a heavy object or improper manicure or pedicure are the most common causes of damage to the nail plates.

In addition, even the desire to follow fashion can cause damage to the nail. Wearing shoes that are too narrow, strongly compressing the feet, can not only lead to calluses and abrasions, but also injure the nail plates.Sometimes, a bad habit, for example, the habit of biting nails (), which is very difficult to get rid of, can become the cause of nail injuries.

Types of damage and their manifestations

In case of negligence, a person can get injured, including injury with damage to the nail plate. What are the most common nail injuries?

Injury

Bruising is the most common injury to the nail.

Perhaps the most common nail injury is contusion. Anyone can get such an injury. For example, if a heavy object falls to your toes or if you handle a hammer carelessly.

A typical manifestation of a bruised nail is the formation of a hematoma under it. The bruised nail begins to turn blue quickly, and becomes black when more serious injury is received. Of course, it is not the nail plate itself that changes color after injury, it is just that a blood accumulation forms under it.

Like all other bruises, a bruised nail is accompanied by pain. The severity of the pain syndrome depends on how severe the injury was. In addition, swelling may form on the injured finger, and the skin becomes hot. With serious bruises of the nail, a general increase in temperature is also possible.

Important! The most difficult thing is for those patients who have received a bruised toenail. Since, due to severe pain, it becomes difficult for them to wear shoes and walk.

After a bruised nail, the damaged nail plate often falls off, since due to injury, nutrition can be impaired, and the nail is already dead tissue, not living tissue. A new nail plate begins to grow in place of the fallen nail. At the first stage, it will most likely look unhealthy - wavy and uneven, but over time it will take on a normal appearance.

However, in the event that the injury to the nail becomes chronic, it is possible that the new nail will not acquire a healthy look, but will remain curved, as, for example, with.

Squeezing

Wearing tight and uncomfortable shoes can lead to serious enough damage to the nails and further. Outward signs of nail squeezing injury tend to resemble bruised symptoms. The nail first turns black and then begins to flake off. However, the pain and swelling associated with such an injury is usually less severe.

Break and cut

A broken nail is a serious injury.

A broken nail is not only a damaged manicure, but also quite serious damage. Of course, if the scrap fell only on the regrown part of the nail, then nothing terrible happened. In this case, there is no pain or other unpleasant sensations.

It is much worse if, due to injury, the nail plastic is cracked on the part adjacent to the nail bed. Such damage causes severe pain, and possibly hematoma formation.

Manicure (pedicure) injuries

Damage to the nail and improper care can also occur. For example, if sharp metal objects are used for cleaning instead of special tools. In this case, it is enough just to damage the delicate skin, which can lead to infection and cause serious inflammation.

Often, nail injuries occur with careless cutting of the cuticle. In case of rough action, it is easy to damage the nail roller or cut the nail plate. Incorrect filing of the nail can cause the plate to delaminate and lead to increased brittleness. Failure to follow the rules of hygiene during manicure can lead to the development of fungal diseases, for example, to.

First aid

Providing first aid for nail injury, it is necessary to apply cold to stop the bleeding.

In case of nail injury, first aid should be provided immediately. The main task at this stage is to stop bleeding. Probably everyone knows that heat accelerates blood flow, while cold, on the contrary, slows down the movement of blood. Therefore, a cold object should be applied to the bruised finger as soon as possible.

You can just put your finger under the running cold water, but if possible, it is better to use ice. Place the ice in a clean plastic or cloth bag. The use of ice not only reduces the intensity of bleeding, but also relieves pain, so the injured person will feel immediate relief.

Important! Do not hold the ice for too long. After 10 minutes of exposure to cold, you need to take a short break and, if the pain persists, you can repeat the application of cold several times.

In case of a serious injury to the nail, when the nail plate immediately begins to recede, a squeezing bandage should be applied to the sore finger and the injured person should be urgently referred to a doctor.

If the nail plate is cut or deep fracture is present, a sterile bandage should be applied to the finger and a surgeon should be consulted.

Treatment

The first step is to remove the hematoma under the plate.

To save the injured nail and prevent further, it is necessary to remove the hematoma under the plate. If this is not done, then the increasing hematoma will lead to a malnutrition of the plate and its rejection.

Removal of a hematoma is performed by tingling the nail at the site of blood accumulation. Through the hole made, the blood will be released and the nail will be saved. This operation is recommended to be carried out in a polyclinic or trauma center. But, as a last resort, you can do it yourself.

To do this, take a needle or paper clip and heat it in a fire. Then with a red-hot needle, you need to burn a small hole in the damaged nail (the plate should be disinfected before performing the operation). You should act very carefully so as not to inflict even more serious injury on the victim and not cause the development of pathology of the nail plate ().

Then you need to remove the blood by lightly pressing on the nail. After that, a bandage should be applied to the finger or the place of damage should be sealed with a bactericidal plaster.

It must be remembered that self-removal of a subungual hematoma should be carried out only as a last resort, when there is no way to go to a medical institution. Since the operation is carried out in unsuitable conditions, there is a risk of infection, which can lead to very serious consequences.

In case of an injury associated with a dissection of the nail, it is usually necessary to remove the entire nail, or part of it. This is a rather serious operation that requires subsequent stitching of the skin; it is carried out in a medical institution, otherwise the nail may grow incorrectly in the future. Sometimes cutting the nail is the cause of the development.

Forecast and prevention

The prognosis for a nail injury is generally good. If all the necessary, therapeutic measures have been taken, then complete healing occurs within 2-4 weeks. In the event that the nail plate delaminates, then recovery will occur after a new nail grows back. This can take 2-4 months, as the nails (especially on the feet) grow rather slowly.

Prevention of nail injury consists in observing safety measures in the workplace and at home. When performing nail care procedures, use only a special tool and be very careful.

Nail plate... It is a tissue derivative arising from three zones of the nail bed. Fully grows in length in 70-160 days.

Nail bed... Consists of three parts: the dorsal sheath, the germinal matrix (also known as the ventral fundus) and the sterile matrix (also known as the ventral nail bed). The proximal end of the nail plate originates between the dorsum and the hermentative matrix of the nail bed, which is U-shaped.

Nail fold (eponychial fold)... The proximal part of the nail plate is located under the nail fold. The skin on the back of the nail fold is the nail fold (it sits on top of the back covering of the nail bed). A thin plate extending from the nail fold to the back of the nail plate is called eponychium. Lunula is a curved opaque strip on the nail distal to the eponychium at the junction of the hermentative and sterile matrix.

Hyponychium... This is an accumulation of keratin between the distal part of the nail plate and the nail bed. Thanks to its strong bonding, it is resistant to infection.

Blood supply... The dorsal branch of the terminal trifurcation of the digital artery.

Function

• Fingertip soft tissue support (hyponychium)
• Used as a tool (scratching, plucking, scraping, grasping and lifting, etc.).

Damage to the nail bed

• Usually occurs as a result of a strong blow, which results in squeezing and damage to the (soft tissue) nail bed between the (hard) nail phalanx and the nail plate.
• It is necessary to perform radiographs in the frontal and lateral projection.

Subungual hematoma

The nail bed is well supplied with blood. A closed nail injury causes bleeding under the nail plate with the formation of a tense hematoma, with a characteristic throbbing pain.

Subungual hematoma treatment

Closed lesions (usually a hematoma, less than 25% of the visible nail bed) can be evacuated by perforating the nail plate with a hot needle or paper clip. If a rupture of the nail bed is suspected, a revision is required.

Rupture of the nail bed

It can be simple, stellate (resulting from explosive trauma), or crushing (causing fragmentation of the nail bed). The nail plate may shift from under the nail roller.

Refusal of revision in the acute period after trauma with these injuries leads to the development of late complications, such as deformation of the nail plate or its detachment from the nail bed.

Treatment of ruptures of the nail bed

• Ring block using local anesthetics
• Peel off the nail plate (save for use as a splint)
• Tip: use a small mucosal elevator or anatomical blunt scissors to slide them between the nail plate and the nail bed, then peel off the nail plate with a thin vascular clamp.
• Wash off the sterile matrix.
• Carefully reconstitute the sterile matrix (6/0-7/0 absorbable suture) using a magnifying glass.
• The sterile matrix defect can be replaced with a split skin graft or a split nail bed graft (from an adjacent injured toe or from the first toe).
• If the nail bed is ripped out from under the nail fold, it should be adjusted and hemmed (if possible) or fixed in place using a splint.
• Use the nail plate to splinter the nail fold.
• In young children, the replanted nail plate can take root and begin to grow.
• If the nail plate is missing or too damaged, you can use the silicone plate or foil from the suture packaging to splinter the nail fold.

Ruptures of the nail bed with a fracture of the nail phalanx

In almost 50% of cases, damage to the nail bed is combined with a fracture of the nail phalanx. The presence of a tear in the nail bed makes the fracture open.

Treatment of ruptures of the nail bed with a fracture of the nail phalanx

The following are guidelines for treating nail bed ruptures. Additionally:

• Intraoperative administration of antibiotics intravenously and oral administration in the postoperative period.
• Abundant lavage before fracture reduction.
• Fractures without displacement can be treated conservatively after rinsing and repairing the nail bed. They are splinted with soft tissues.
• In case of fractures with displacement, thin (0.8-1 mm) needles are used for fixation, except in cases with many small fragments, then it is better to splinter bone fragments with soft tissues without fixation with needles.
• Tip: Draw 2-3 mm Kirschner wire below the hyponychium to achieve precise placement in the nail phalanx.
• Check the position of the wire on the lateral X-ray image - it is easy to miss and not hit the nail phalanx!
• Seymour fracture - epiphyseolysis of the nail phalanx with a displacement of its distal part to the rear in combination with a rupture of the nail bed. The nail also displaces from under the eponychial fold (see chapter 5).

Impaired nail growth after injury

Within 21 days after the injury, the nail stops growing in length, and its thickening appears proximal to the injury site. This causes the nail to stick out as it continues to grow. After that, the growth of the nail accelerates compared to the norm for 50 days, and then slows down for 30 days, and only after that the growth becomes normal. Reconstruction of the nail complex

Reconstruction of the nail complex is difficult and often imperfect even in the most experienced hands. Possible reconstruction options are presented below. Problems often overlap and the choice of treatment should be approached individually.

Detachment of the nail plate from the nail bed

• Scarring of the underlying part of the nail bed due to the lack of fusion with the nail plate.
• Keratin builds up under the nail and this can be mistaken for a fungal infection.
• Treatment:
• Excise scars.
• If possible, take in.
• Replace the defect with a split nail bed graft, usually taken from the first toe.

Splitting the nail

• The cause is the scars in the dorsal coating / germ matrix / sterile matrix complex.
• Treatment:
• Excision of scars and restoration of sterile matrix.
• Excision of a portion of the herment matrix and replace with a full-layer complex graft of the hermenative matrix from the 2nd toe with acceptable but not perfect results.
• Removal of the herment matrix in severe cases.

Nail spicula (thorn)

• Usually the remainder of the herment matrix complex after distal amputation.
• Treatment:
• Raise the eponychium flap
• Dissect the spicula and the remainder of the herment matrix.

Hook nail (deformity in the parrot beak)

• It occurs as a result of suturing the fingertip with tension during distal amputation or when the bone support for the nail bed is lost.
• Treatment:
• Excision of the scars on the tip of the finger
• Raise the nail bed
• Replace a bone defect with a bone graft (may dissolve)
• Replace the soft tissue defect with a local relocatable flap
• Microsurgical transplant of a part of the toe (difficult solution)

Lack of

• Congenital or post-traumatic.
• Treatment:
• Excise skin or nail-like scars and replace with a full-thickness skin graft
• Microsurgical transplantation of the nail bed.

A bruised nail is a common problem encountered in trauma practice. This is an unpleasant and very painful damage that occurs due to a violation of the integrity of the nail plate. In some cases, after damage, the nail peels off, however, if the necessary rules of first aid are followed, this may not happen.

ICD 10 is the name of the international classification of injuries and illnesses, adopted in 2016.

Contusion of the nail plate belongs to the block "Superficial injury of the wrist and (S60)", which includes external injuries of tissues and segments of the hand and wrist.

Contusion of the nail is classified under a separate subsection “S60.1 - Contusion of the finger (s) of the hand with damage to the nail plate”.

The reasons

Most often, a bruise of a nail on a hand is considered a household trauma that occurs due to an unfortunate combination of circumstances or through a person's negligence.

The most common causes of nail injury include:

• hitting the fingers against a hard object or falling of a heavy object on the finger (90% of all cases of damage);
• pinched fingers;
• susceptibility to injury during an active lifestyle.

It is believed that fractures and bruises in the area of \u200b\u200bthe phalanges of the fingers are most often found in children, therefore, when walking with a child or playing games, it is recommended not to leave the baby unattended. A small child lives in a world of large objects, and his coordination of movements is just beginning to develop - this makes him more susceptible to nail damage and bruises.

Symptoms

Damage to the finger and nail is a painful injury, often accompanied by rejection of the nail plate.

Signs of bruised fingernails:

• swelling in the area of \u200b\u200bthe injured finger;
• the appearance of pain syndrome (pain of a pulsating nature up to the loss of consciousness of the victim);
• decreased functional ability of the site of injury (phalanxes of the fingers);
• heaviness and discomfort of the entire arm or the area of \u200b\u200bthe nail plate;
• blood flow and redness of the tissues of the damaged area of \u200b\u200bthe finger;
• the formation of a hematoma under the nail (black or blue nail in the area of \u200b\u200binjury);
• the resulting injury is characterized by partial or complete discharge of the injured nail plate;
• the appearance of severe headache;
• an increase in the temperature of the body or tissues in the area of \u200b\u200bthis damage up to 38 degrees;
• nausea, signs of general malaise.

Getting a serious injury is accompanied by a small dark bruise and very severe pain.

It should be noted that the appearance of cyanosis in the area of \u200b\u200binjury occurs some time after the injury (period from 8 to 12 hours).

Symptoms of a bruised nail include signs of an inflammatory process that occurs after injury (treatment methods have a large selection of ways to reduce hematoma, but are used only after completion of the diagnosis).

First aid

Providing first aid for a bruised nail on the hand is an important stage of treatment that allows you to preserve the nail plate and speed up recovery. It is not difficult to help yourself or provide assistance to the victim, for this you need to follow the instructions.

What to do with a bruise

What to do if a bruised fingernail is formed? If, due to severe pain, you can get confused and miss the time at which it is necessary to do actions important for the affected organ.

First aid rules for a bruised finger on the hand:

1. The first stage of first aid is to cool the affected area of \u200b\u200bthe limb. Cooling helps to reduce the formation of bruises and reduce pain symptoms. This procedure is recommended using ice wrapped in a handkerchief or gauze. The method of anesthesia is used for 5 minutes, after which the compress must be removed, repeated every 15 minutes, if no other methods have been taken (the total time of ice application can reach 2 hours). In addition to ice, any other cold item (bags of food from the refrigerator and freezer) will do.
2. If the bruise is accompanied by the appearance of wounds and bleeding, the next stage of first-aid care is the disinfection of the injury site with an iodine solution, a cotton swab is soaked in liquid and the surface under and above the nail is treated. If the nail turns blue and characteristic signs of edema appear, it is possible to reduce the manifestation of symptoms.
3. After carrying out pre-medical treatment, it is necessary to contact a medical institution in order to avoid more serious consequences than hematomas and edema.

What should not be done with a bruised nail? It happens that in order to preserve the nail plate, some patients press down on the nail and bandage it tightly. This method is contraindicated and ineffective, as excessive pressure makes blood flow even more difficult after injury. If you do not interfere with the healing process, puffiness and bruises will begin to dissolve much faster.

Diagnostics and treatment

Diagnosing and treating any disease or injury is an important step on the road to recovery. Treatment of a bruised nail on the hand begins only after finding out the cause and degree of damage, in addition, a consultation with a traumatologist and an X-ray is necessary to identify the accompanying one.

It is to identify the true cause of the appearance of pathological signs that it is necessary to go through several stages of diagnosis:

1. Finding out the cause and circumstances in which the nail plate was bruised.
2. Palpation.
3. Taking an X-ray (the damaged area of \u200b\u200bthe body is removed with an X-ray to detect internal damage to the bone tissue).

These procedures allow you to identify the extent of damage to the fingers and apply the necessary measures to treat the bruised nail.

Diagnostics are carried out:

• traumatologist;
• surgeon.

Also, these specialists write out directions for the passage of X-rays.

How to treat a bruised nail

Treatment of a bruised nail is divided into several stages to prevent and reduce the risk of complications.

1. To reduce the risk of suppuration under the nail plate, dressings with antibiotic ointments are used (the dressing should be regularly replaced with a new one).
2. With a severe bruise of the nail, you can observe the appearance of pronounced edema, to reduce the manifestations of which, a three-time reception of salt baths is used.
3. To reduce the severity and size of bruises with bruises, heparin ointment is used, and for disinfection in case of large hematomas, Levomekol ointment.
4. Also, for a quick recovery, it is recommended to apply 0.25% novocaine (in a ratio of 1: 3). The compress has analgesic and anti-inflammatory effects.
5. In order to quickly cure a severe nail injury, it is recommended to use a castor oil emulsion. This drug has anti-inflammatory properties and promotes rapid tissue regeneration.
6. If there is a slow rejection of the nail, there is a danger of damage and inadvertent "removal" of the nail through negligence. To fix the position of the nail plate, it is advised to apply a bandage or fix the nail with an adhesive plaster, so it will be rejected longer, but less painful.

Unfortunately, despite the various symptoms, the problem of determining nail fungus and how to distinguish its bruises often arises (the doctor helps to recognize it, or you can diagnose it yourself). The main difference between a nail fungus and a bruise is that in the case of a fungal disease, there is no pain syndrome and the color change of the plate occurs much more slowly.

How to treat a bruise at home

Among the methods of removing edema and inflammation, there are various methods developed at home.

A dangerous method is self-piercing of the nail, violation of the punctured plate can entail serious consequences, since such an operation should only be performed by an experienced specialist in a sterile hospital environment.

One of the good treatments is plantain and celandine.

For application it is necessary:

• take leaves of plantain and celandine in a ratio of 1: 1;
• pour the dry mixture with 50 ml of hot water;
• insist for 3 hours;
• put a thick mixture of herbs in cheesecloth, so that you get a bag;
• apply to the bruised finger.

Herbs are a natural source of health that can help your body heal faster. Unfortunately, the effect of using traditional methods does not appear on the first day and most often has a cumulative effect. In addition, before using any method of traditional medicine, it is recommended to consult a doctor in order to avoid the consequences and violations of the treatment method, since the use of agents such as a compress with vinegar or ammonia can harm an open wound resulting from the passage of the nail plate.

"How long does it grow back and is it worth waiting for the nail to grow back?" - it is important to know that the nail will grow, even after the nail plate has completely fallen off (the growing tissues grow slowly, possibly a temporary change in shape).

If there is a discharge of the nail, it is worth waiting until it completely moves away (the nail leaves at different speeds depending on the degree of injury), it is advisable not to disturb the detached plate.

Complications and consequences

A bruised fingernail has unpleasant consequences if treatment and care is delayed or interrupted.

Complications after a bruised nail:

• severe swelling of the fingers and adjacent tissues;
• the formation of pus (when bacteria enter or the development of a fungus);
• gangrene (finger amputation).

To reduce the manifestation of complications and consequences after an injury, it is necessary to take care of the condition of the injured limb as soon as possible and apply the most effective methods of therapy.

Conclusion

Damage to the nail plate can occur as a result of everyday activities due to an unfortunate set of circumstances. However, with the use of effective methods and timely access to a doctor to diagnose, complications can be avoided and the nail plate can be saved from falling off.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you experienced a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

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The nail plays an important role in the function of the finger. First of all, it gives the flesh of the distal phalanx a firm grip, and in the absence of a nail, the tip of the finger becomes shapeless. Second, the nail protects the tip of the toe from injury. Thirdly, the nail plate plays an important role in the perception of sensitivity when grasping small objects. Finally, it plays an important cosmetic role.

There are three main areas of soft tissue located around the nail and playing different roles in its regeneration (Fig. 27.8.1).

Fig. 27.8.1. Areas of the soft tissues surrounding the nail that play a different role in the regeneration of the nail plate.
a - nail roller (matrix roof); b - lower matrix; in the nail bed (explanation in the text).

The nail roll (matrix roof or upper matrix) under normal conditions provides the dorsal-proximal part of the nail, but this role is insignificant, since, ultimately, normal regeneration of the nail is possible without this area of \u200b\u200bsoft tissues. It has been proven that the dorsal ridge and roof of the matrix prevent the uncontrolled growth of the nail up and to the sides, guiding it distally.

The lower matrix (Fig. 27.8.1, b) is the most vulnerable area of \u200b\u200bsoft tissues that provides nail growth. When it is damaged, the growth and shape of the nail plate are disturbed, and to the greater extent, the more significant the injury.

The nail bed (Fig. 27.8.1, c) is covered with a smooth layer of epithelial cells and plays an essential role in the formation of a nail of normal size and shape, as it ensures the advancement of the nail plate during its growth. Violation of the relief of the nail bed with fractures of the distal phalanges with unrepaired displacement of bone fragments leads to subsequent deformation of the nail plate. Scarring of the nail bed with a change in its relief can also change the shape of the nail.

The nail grows at an average rate of 0.1 mm / day, or 3-4 mm / month. This indicator can vary significantly: in summer, notes grow faster than in winter; part of the nail plate - faster than the whole; on long fingers faster than on I.

After nail injury, there is a 3-week delay in its advancement in the distal direction. But then the nail grows again at the same rate. As a result of a pause proximal to the site of injury, a thickening of the nail forms, which persists for about 50 days and then gradually (over the next month) becomes thinner. Thus, after injury, it takes about 100 days before a normal nail plate is formed.

Treatment of damage to the nail and surrounding tissue

According to E. Zook et al., The following damage to the nail plate is most common: simple (36.4%), stellate (27%), multiple and circular injuries of the nail bed (22%), scalped and avulsion injuries with loss or detachment tissue of the nail bed by more than one third (15%).

The subungual hematoma is the most common of the simple injuries and is clinically manifested by the accumulation of blood under the nail plate, as well as severe pain syndrome, in which the pain can be pulsating. A simple and effective method of treatment is perforation of the nail plate in the area of \u200b\u200bthe hematoma with any sharp instrument or the end of a paper clip hot on a fire (Fig. 27.8.2). This procedure is painless and immediately relieves pain.

Fig. 27.8.2. Stages of removal of a subungual hematoma.
a - creating a hole in the nail plate using an injection needle; b - evacuation of hematoma; c - bandage application.

Tears off the nail or part of it (without damaging the nail bed). Taking into account the important role of the nail plate in the function of the finger, it can be returned to its place after processing (if necessary, with resection of the damaged area).

This is highly advisable for the following reasons:
- the nail plate is a natural splint for the injured distal phalanx;
- the replanted nail acts as a natural conductor for the new nail;
- the nail plate ensures the healing of the tissues of the nail bed with minimal scarring and, which is very important, with the formation of a smooth surface;
- the nail bed closed by the nail plate does not require dressings, and if they are nevertheless needed, then the dressing is changed painlessly.

If the nail is lost or unsuitable for use, it is replaced with an artificial nail. The latter can be made of a sufficiently thin polymer plate with a corresponding curvature. An artificial nail (like the nail plate) is sutured with transverse mattress seams (Fig. 27.8.3).

Fig. 27.8.3. The scheme of fixing the nail plate (or its prosthesis) with mattress sutures (explained in the text).

Wounds of the nail fold, lower matrix and nail bed are the most complex injuries and are subject to precision primary surgical treatment with the obligatory use of microsurgical techniques.

The accuracy of the comparison of soft tissue fragments plays a decisive role in this. During the operation, suture material 7/0-8/0 is used. After the completion of this stage of the operation, the wound surface is closed with a nail plate or its prosthesis.

In case of defects in the tissues of the nail bed, when areas of the bone are exposed, it is advisable to perform cross-skin plastic surgery with a de-epidermis flap from the adjacent finger. If this is not possible, an insular fatty flap can be formed on the peripheral pedicle, which is one of the own palmar vascular bundles.

Damage to the nail bed with open fractures of the distal phalanges. With an unrepaired significant displacement of the bone fragments of the distal phalanx, there is always damage and deformation of the nail bed, which lead to impaired growth of the nail plate. In this situation, during the initial surgical treatment, the nail can be temporarily removed, after which the largest bone fragments are aligned and fixed with thin wires. Then micro-sutures are applied to the tissue of the nail bed and the operation ends with replantation of the nail plate.

Defects in the tissues of the matrix zone can be closed by one of the above methods, and after the healing of the wound, plastic of the nail bed is performed.

Dissections in the area of \u200b\u200bthe nail phalanx. The surgeon's tactics are determined by three main factors: the level, direction and plane of separation. As you know, normal growth of the nail is possible only if the proximal third of the nail plate is preserved. But even when this condition is met, claw-like deformity of the nail often develops, to prevent which reconstructive surgery is necessary.

The tactics of the surgeon and his capabilities vary significantly depending on the level of distal phalanx dissection.

Dissection of the distal third of the phalanx. In case of guillotine dissection, replantation of the cut tissues is carried out without suturing vessels and nerves. When crushing tissues, when their replantation is impossible, the content of the operation depends on the plane of tissue separation.

For transverse dissection, a palmar or two lateral sliding triangular flaps are used. In case of oblique palmar detachment (when the plane of the wound surface is facing the palmar side), the amount of skin on the palmar surface during plastic surgery with a sliding triangular flap may be insufficient. Therefore, a lateral sliding flap or a palmar finger sliding flap is used.

In case of oblique dorsal separation (when the plane of the wound surface is turned to the back side), while preserving the fatty tissue of the pulp of the finger, plastic can be performed with a split skin graft. Otherwise, cross grafting with a flap from an adjacent toe is shown.

Dissections at the level of the middle third of the distal phalanx. In these cases, the nail root remains intact. In case of palmar oblique dissection, it is advisable to use a cross finger flap to close the wound surface without shortening the phalanx. With dorsal oblique dissection, attempts to save the nail usually end in its significant deformation, requiring repeated operations.

Dissections at the level of the proximal third of the nail phalanx. Only replantation of detached tissues with stitching of vessels and nerves can preserve the length of the finger and, in some cases, the nail plate. If the level of separation passes through the matrix zone, then deformation of the nail plate during its growth is inevitable. Therefore, excision of the remaining tissues of the lower matrix may be quite justified.

Foreign bodies under the nail plate. When foreign bodies are deeply located, the easiest way to remove them is using an operating microscope and appropriate instruments. In difficult cases, it may be necessary to resect a minimal area of \u200b\u200bthe nail under conduction anesthesia.

Treatment results. When assessing the results of treatment of patients with damage to the nail and nail bed, the following indicators are taken into account:
- nail shape (normal, shorter, narrower, with a longitudinal or transverse groove);
- fusion of the nail plate with the surrounding tissues (complete, by two thirds, from one to two thirds, by one third or less);
- the condition of the tissues around the nail (normal, impaired, tissue defects);
- the surface of the nail (normal, somewhat uneven, with significant irregularities, with the presence of longitudinal or transverse ribs, the presence of a groove);
- splitting of the nail (present or not).

Using the above principles in the treatment of damage to the nail and nail bed allows you to get excellent and good results even with severe injuries. Even the presence of a fracture of the distal phalanx has little effect on the final result in the surgical removal of the displacement of the fragments.

IN AND. Arkhangelsky, V.F. Kirillov