It seems like a rite of passage: a smashed finger… a crushed fingernail. In happens to most kids at some point, as they grow up. Typically some ice or a bandage is all that’s required… but not always.
Nine-year-old Carolina smashed her thumbnail while she was at school.
Since Carolina is developmentally delayed, she’s not able to explain exactly how it happened. But the doctor has a pretty good idea. “Most likely a doorway. Perhaps a commode seat,” says Dr. Cedric Miller, an Emergency Pediatrics physician at Children’s Healthcare of Atlanta. “Something that either squeezed or crushed the tip of her finger popped the bottom of her nail out and above the skin. And this is what we call a partial nail evulsion.”
When a nail is smashed, often the nail falls off… only to grow back again. But Carolina’s injury is to the base of her nail.
“The base of the nail separates and protects the area where that nail growth occurs,” explains Dr. Miller. “So that if the base of the nail has been removed, the tissue that normally would regenerate a nail, may not be able to adequately regenerate that nail.”
That’s why the doctor reattaches the nail to the finger… using stitches.
“Now we have repaired the nail bed. We have repaired the cut so it is not separated. The next thing we’ll do is replace the nail, so it can splint the bed,” he says during the procedure. “Her nail’s back in place, and it’s stable enough that even with a little tugging, it’s not going to come out.”
If your child smashes a finger or toe, you may not have to come to the hospital.
“But if there is bleeding that occurs,” warns Dr. Miller, “especially if it’s more than 50-percent of the nail, and there’s blood under the nail. If there is an associated laceration --any other part of the finger is cut or lacerated-- if there’s bleeding that doesn’t look like it’s going to stop with simple pressure, or if there’s any significant crush injury to the finger, it should probably be evaluated.”
Bringing Carolina to the emergency room was a good idea. In time, she will grow a brand new nail.
“That nail that we replaced will not stay there. But it will act as a splint, and act as a guide for that new nail to come up,” explains Dr. Miller. “And by repairing it this way, we give her the best chance of having a nice, cosmetic nail at the end.’