Fingertip Injury: First Aid and Treatment

First aid for fingertip injuries

1. Stop the bleeding: press firmly with a clean cloth for 10 minutes and raise the hand above the heart.
2. Clean the wound: rinse under running tap water. Do not scrub deep tissue.
3. Cover it: apply a clean, non-stick dressing.
4. Reduce pain and swelling: ice wrapped in a cloth for 15 minutes at a time, keep the hand raised, and take acetaminophen (paracetamol) or ibuprofen following the label dose.
5. Remove rings from the injured hand before it swells.

If a fingertip is cut off

• Call 911 or go straight to the ER.
• Rinse the amputated part gently with water or saline.
• Wrap it in damp gauze or a damp clean cloth.
• Put it in a sealed plastic bag.
• Place the bag in a container of ice and water. Do not put the part directly on ice or in water, which damages tissue.
• Bring it with you, even if it seems too damaged to reattach.

Types of fingertip injury

Blood under the nail (subungual hematoma)

A crush causes bleeding under the nail, which turns purple or black and throbs intensely as pressure builds. A clinician can make a small hole in the nail (trephination) to release the blood, giving immediate pain relief, ideally within 48 hours. If the nail is intact and still attached, removing it is usually not needed, even when the hematoma is large.

Nail bed injuries

A cut or burst nail bed, the tissue under the nail that grows it, may need repair with fine stitches or tissue glue to prevent a ridged, split or deformed nail. See nail trauma.

Fingertip fractures

A crush often breaks the tuft, the small end of the bone. These usually heal well with a protective splint for 2 to 3 weeks. Fractures with a cut over them (open fractures) need antibiotics. See finger fracture.

Cuts and lacerations

Fingertip skin is thick and heals well. Deeper cuts may need stitches. Damage to the nerve causes numbness of one side of the fingertip, and tendon damage prevents normal bending or straightening. See open wound of the finger.

Fingertip amputations

Partial or complete loss of the fingertip. Treatment depends on the level and angle of the injury and whether bone is exposed:

• small losses without exposed bone often heal by themselves with dressings, regrowing remarkably well, especially in children
• larger losses may need trimming of bone and closure, a skin graft, or a local tissue flap
• reattachment (replantation) is occasionally possible for larger amputations, especially in children and for the thumb

Mallet finger

A blow to the tip of a straight finger can tear the tendon that straightens the end joint, so the fingertip droops. It needs continuous splinting, usually for 6 to 8 weeks. See mallet finger.

How fingertip injuries are assessed

The clinician will ask how the injury happened and check:

• circulation, sensation and movement of the fingertip
• the nail and nail bed
• whether bone or tendon is exposed or damaged
• tetanus vaccination status

An x-ray shows fractures or foreign bodies. Wounds are cleaned under a local anesthetic finger block.

Treatment

• cleaning and dressing, with regular dressing changes
• trephination of a painful subungual hematoma
• nail bed repair, sometimes replacing the nail as a splint
• splinting fractures and mallet injuries
• closure of wounds with stitches, grafts or flaps
• antibiotics for open fractures, bites or contaminated wounds
• a tetanus booster if you have not had one in the last 5 years for dirty wounds (10 years for clean wounds)

Recovery

• Keep the hand raised for the first few days to limit throbbing.
• Move the other joints of the finger to prevent stiffness, unless told otherwise.
• A lost nail takes about 4 to 6 months to regrow.
• Sensitivity, cold intolerance and numbness are common for several months and usually improve over time. Gently tapping and massaging the fingertip (desensitization) helps.
• A hand therapist can help if stiffness or sensitivity persists.

Frequently asked questions

Should I go to the ER for a crushed finger?

Go if the finger is bleeding heavily, the tip is cut off, bone is visible, the nail is torn off or split, the finger looks crooked, or there is a large painful collection of blood under the nail. Minor bruising with normal movement can be managed at home.

What should I do if blood is trapped under my fingernail?

If it is very painful or covers a large part of the nail, see a clinician within 48 hours. They can make a small hole in the nail to release the blood and relieve pressure. Do not try to pierce the nail yourself with a heated pin.

Will my fingernail grow back after an injury?

Usually, yes, if the nail bed and the nail base (matrix) are intact or properly repaired. A new fingernail takes about 4 to 6 months to grow. If the nail bed was badly damaged, the new nail may be ridged or split.

How long does a crushed fingertip take to heal?

Soft tissue and minor crush injuries usually heal in 2 to 3 weeks. Tuft fractures take about 3 to 4 weeks. The nail takes months to regrow, and tenderness or cold sensitivity can last several months.

Can a cut-off fingertip be reattached?

Sometimes. Reattachment is more likely for clean cuts, larger amputations, thumbs and in children. Many small fingertip losses heal better without reattachment. Keep the part cool and dry in a sealed bag on ice water, and go to the ER immediately.