Treating Smashed Fingers

Dr. Greene, my 15-month-old recently got her finger smashed in the door by her 2-year-old sister. I kept an eye on the nail and noticed it got yellowish, and within a week or so it had fallen off and was just attached at the cuticle. I trimmed it down as far as I could. There is a very thin nail coming in underneath. Do I keep this fingernail covered up somehow or let it breathe? How long until a new, normal, strong nail comes in?
Osmond, Nebraska

Treating Smashed Fingers

Dr. Greene’s Answer:

Slam! Smash! Slam! I vividly remember three separate finger-in-the-door episodes from my childhood. In one instance I was the culprit, inadvertently slamming a door on my friend Fernando’s finger. Twice I was the “smashee” – once with my finger caught in the door of my parents’ Chevy Nova and once in my own bedroom door.

It’s not hard to recall the shock of pain, the subsequent dull throbbing, the curious sight of the nail later falling off, and the fascination of a new, healthy nail replacing the old one. I wish the sequence could go that smoothly for all children. It doesn’t.

In the great flurry of childhood activity (don’t you wish you had some of their energy?), smashed fingers and toes are common and memorable events. Whether trapped in doors, banged by hammers, or hit by bricks, some nails re-grow beautifully while others are permanently misshapen.

With most of these accidents, swelling and bruising of the soft tissues and underlying bones are the only injuries.

Home Treatment

Soaking the finger or toe in cold water immediately after the trauma can reduce both pain and swelling. Acetaminophen or ibuprofen administered right away can also help prevent some of the pain. While taking care of these things (and administering a few hugs and kisses for good measure), you can decide whether or not your child needs to see a doctor.

Smashed fingers

When to see a Doctor

  • Blood collects under the nail, causing increasing pain.
  • The finger or toe can’t be straightened and bent easily.
  • The injury causes immediate damage to the nail, such as a visible tear below the “quick”.
  • The skin is open and may need stitches.
  • There is dirt in the wound you can’t wash out.

Sometimes blood collects under the nail — what we call a subungual hematoma. When handled properly, this does not increase or decrease the odds of the nail healing well. If enough blood is trapped to cause painful throbbing, the nail should be evaluated.

Should Your Doctor Pierce the Nail?

Often the physician will pierce the nail to relieve the pressure. The physician might use a red-hot paper clip, an 18-gauge needle, or an electrocautery machine. While the procedure sounds gruesome (and looks dramatic when the blood starts to spurt from the hole), most children feel great relief and no discomfort. The hot tool glides through the nail like butter.

Fractures of the bone in the fingertip are not common with this type of injury, but need special treatment if they are present. They are considered open fractures (as if the bone had come through the skin) and require treatment with antibiotics. You might suspect a fracture from the force of the blow, the appearance of the finger or toe, a lack of mobility, or persistent pain for more than three days.

Will the Nail Fall Off?

As happened with your daughter, the nail will sometimes fall off days or weeks after the injury. What happens when the nail falls off? One group of investigators found that the nail grew back with excellent or very good results in 85% of those studied, with poor results in only 2%. Sometimes the new nail will look different from the original nail no matter what has been done to treat it. But, if the nail is visibly torn at the time of injury, the nail bed might need stitches. Suturing a nail bed that has been torn can dramatically increase the odds of the nail healing well.

The new fingernail will grow at an average of 1 mm per week (0.5-1.2 mm). Toenails grow at one-third to one-half this rate. Overall, four months is the average time for complete re-growth of a fingernail. Re-growth of a nail in a toddler or preschooler may only take a month or two.

In the meantime, you have done well to keep the nail remnant trimmed to avoid it catching and tearing. Be sure to keep it clean. Exposing it to the air is good, but when your daughter is playing where she might get the nail bed dirty, cover it with a lightweight bandage (perhaps with a little Betadine). See the doctor if there is any sign of infection (redness, pus, swelling, or increasing pain). While your daughter’s finger is healing, get some pictures of the process. These will help to recall the event and to marvel over the way our bodies heal.

If you have further questions about treating a smashed finger or toe, feel free to leave a comment below.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Dolly

    Hi Doc,
    I slammed my thumb on my car door 3 days ago. Now its getting gray color. I am taking ibuprofen 800mg — my left over meds before. I can still move, but pain still there. What should I do? Hate hospital possible.

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  2. juanita

    When a child gets their fingers smashed does their finger become extended and deformed when they become older if its not treated on time

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  3. Linda miller

    Smashed left big toe over yr ago nail has grown but it really hurts on the top don’t know what to do doesn’t look like ingrown nail

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  4. Joaquin

    Hi, thank you for sharing this great article. If the nail hasn’t grown so far after 4 months and still seems uniform grow and abnormal look, what doctor is the best option to visit? a general doctor? a podiatry? is there any specialty? I am afraid my daughter caused her a fungal infection as she has been biting the old nail to try to remove it and accelerate the process. Any guidance will be highly appreciated!

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  5. Rohan

    Recently I was having fun at park and was playing at the swings.Unfortunately I fell down and my finger had might struck with a brick and now the blood is collected under nail.It is looking little purplish.Also something like puss is coming out.What shall I do now?Yes,it hurts.

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  6. steven

    i smashed my thumb while playing hockey and cut it right under the nail. Nail is black and thumb swollen. How do I go to sleep without rolling on it? Please help! It hurts since 9am and its 11pm ahhhhhh

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  7. Dave

    I crushed my finger at work,breaking my finger tip.

    I had blood under my nail, but no real need to release the blood (no pain from the nail), just my break. Anyway, now my nail is coming off just hanging on by the skin at the bottom of the nail. My question is, my nail bed has a lump of skin, is this normal? As I just assumed it would be flat bed. Also do I cover up my finger to stop my nail being caught, and if so what would you recommend?

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    • Ancil Mohammed

      I’m seeing the same thing…any choices or cures here? What should i do?

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  8. yuri

    I slammed my thumb with my car door, as of right night my thumb is swollen. It’s been like this for three days. I can fold it, but my nail looks gray from the inside, what should I do?

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  9. Diamond

    I slammed my pinky in my car door sometime in January. The pain was impeccable, and it stung. I looked online and read blogs and most of them said, puncture your nail with a hot tool, such as a needle or safety pin and the other said it will fall off in a couple weeks.

    I didn’t want a weird looking finger nail so I decided to let it fall off. I waited and waited and waited into the third week in February. I hit my pinky on a light switch and it cut the nail down really far, I saw the old dry blood and was disgusted that I walked around for a month or so with the dry blood in my nail.

    I wasn’t thinking and took a safety pin to clean the dry blood. Almost my whole nail was covered in blood. I did this about two to three weeks ago and my nail is shockingly still attached, although I dettached it from the nail bed without thinking. Will my nail fall off? Will it reattached to my nail bed? How do I keep it clean? I’m so worried, I’ll get an inffection. I read on a blog that as the nail grows out, it’ll start to reattach, but it could take months. Please help!! I don’t know if I should go to the doctor. Thanks.

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  10. clarissa

    My nail was smashed about 2months ago…
    It is currently black and red, I’d assume the black is dry blood. It has started to bother me & stings.
    Any recommendations?

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  11. Ashley

    I slammed the car door on the tip of my index finger a few hours ago. At first, I couldn’t feel it, but it was throbbing like crazy. When the numbness went away a few minutes after, it started to hurt and swell at the pad of my finger. The nail isn’t cracked, and I don’t think there’s blood, but purple bruising and redness are present. I’ve been keeping an ice pack on it, going outside to be in the cold air, and holding my hand up above my heart to relieve some of the pain and throbbing. I also took a few ibuprofen.

    What’s concerning me is how difficult it is for me to move the finger without feeling 1) tingling throughout the finger and down to my wrist 2) hottness, like a burn, but not as intense and it hits me in waves 3) tightness, like the skin under my nail is swelling maybe? Is this normal? Another thing is the nail colour.. even though I’m sure that’s normal, I just want to be sure. I actually felt like I lost the tip of my finger at first because the door completely shut on it. I had to get my boyfriend to look for me because I was terrified. This is the first time this has happened so I’m sorry if I’m just being paranoid.

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    • Claire

      Hi Ashley. I experienced the exact same thing a week before you… Only I was alone at the time. What’s happened with yours? Mine is fractured-comminuted meaning split in more than 2 pieces, at the distal tuft of the Middle finger. My nail appears now to be lifting up & I’m freaking out!!! I am still experiencing strange nerve pain in the adjoining fingers & numbness in the middle finger from the nail up.

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  12. bell

    If your finger was crused by the window will it be okay with ice pack?

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  13. Allison M

    I smashed my finger in the car door around November and blood collected under the nail. I never drained the nail instead waiting for it to either fall off or grow out. Currently it’s growing out as my new nail under it is growing in. The issue I’m having is that there is a large gap or ridge between the two nails. It appears as though there is a hole in the nail.

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  14. y2kbytz

    What happens if blood is trapped under the nail, but a doctor’s visit is never attended?

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  15. Morgan

    My sister has a Vaseline rstrip stuck from her previous incident within the nail it is trying to take the skin off and I need answers her nail is completely off and I need answers fast plz help

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  16. christina

    I had an encapsulated infection on my index finger. They ended up surgically removing it.

    My question — I still have my finger nail. It is yellow and loose and I can clearly see the new nail underneath it. There is pressure as well.

    What do I do? Leave the old nail, trim it, pull it off, see my Dr.? The finger has been injured since October, pre-surgery.

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  17. Andre

    I slammed my thumb in car door and now my nail is purple and swollen and throbbing I think it has pus. How can I drain it?

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  18. Brandi

    My boyfriend smashed his pinky really bad in car door. It has swollen 3 times the normal size. The nail is all purple and blue. But the skin is turning white. What does he need to do?

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  19. Tristan lannom

    How long would it be to lose your fingernail if you dropped an 80 inch box TV on it December 11, 2014?

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  20. Meagan Beilstein

    I am a 45 year old woman that has smashed her finger last month and getting married in a month and it happens to be the finger next to my ring finger. Currently the nail bed is almost completely black but does not hurt. My question is I have been using gel nails is this ok or should I have not been wearing anything so that it can get more air to heal faster? Lastly, should I have a Dr. remove the nail as it is cracking at the bed I hope in receiving a new nail? Please email me. Many thanks!

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    • nick

      You need to put a hole in your nail to relieve pressure before the nail dies. By putting wraps or paint on your nail you are doing the opposite and it sounds like your nail may already be dead.

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    • Don

      I trapped my finger in a door and took my nail off. It was not very nice it ripped my nail straight off my little finger. I went to the doctor.

      To be honest all I would do is leave it alone and keep it covered up till your nail grows back. I would use gel nails for your wedding day. I would put a flesh colour covering on it. It will still get fresh air to it even if it’s covered up.

      I asked at the doctor — I’ve had mine covered up for 3 months now and it’s been healing fine, just waiting for my nail to grow back. I would say just leave it alone it will heal on its own just keep it covered up till its fully healed. It’s worked for me up to now. Try and do all your other nails with gel to make them look good. Hope this helps.

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  21. Bianca Williams

    I smashed my finger on an onion chopper and i have artificial nails. Help!!

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  22. amber

    I smashed my pinkie finger on my left hand a little bit of blood has build up under the nail but it’s not black or blue it’s on the other side of my finger that has turned purple and swollen I don’t think I got the bone but it does hurt and numb what can I do?

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    • Amber

      Ice it as much as you can.

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  23. Tracey Marie Smitt

    My son was with his babysitter and a few days ago, her two year old daughter “smashed his finger in the door.” She didnt tell me about it and I didnt find out until I happened to notice it myself. It looked like a burn. Not like his thumb had been smashed. So I asked her about it but she said it was smashed. In the past few days, the swelling has gone down and he seems to using it normally now. However, his thumb skin is peeling profusely all over. He doesnt seem to be in pain, but is the peeling normal?

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    • Eric Kovak

      She lied. That is a burn. Peeling should not be a result of trauma to a finger.
      If it is smashed, you should see swelling going down after about a week, and continued bruising/coagulated blood under the nail, but no peeling.
      What this sounds like is a first degree burn. Any number of things could have happened, but I would re-address your babysitter with the knowledge she is lying.

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      • Ummna

        That is not true. So, before you accuse your sitter of lying, know that my 20 month old had his finger smashed in the door almost a year ago. It never grew back the same and it did peel. I clipped this nail 3 days ago and it began peeling again!

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        • Eric Kovak

          What I was focusing more on was the lack of swelling, despite the continual peeling. Your child’s finger, from what I can see in the picture, is indeed still swollen and obviously looks like a smashed finger (damage to the nail, etc.)
          I recognize now that yes, peeling is a possible result of a smashed finger.
          Peeling as a result of trauma is caused when the skin becomes so taught and swollen from edema that some of the skin cells die. This layer of dead skin then peels away.
          I will agree that it is possible that the baby sitter is telling the truth, but due to the fact that the mother is so highly suspicious of the incident, and identified the finger as looking like it was burnt, I suspected that it was something else and should be addressed with the sitter. I also listed a nice account of other symptoms of a smashed finger, and if any of those were present, a burn is increasingly less likely. If Ms. Smitt’s child’s finger looks like the one posted above, you got a nice smashed finger on your hands.

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          • Ummna

            Good point! And it’s always better to go with your instinct when it comes to a child.

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  24. Theresa

    I got my finger mashed in between wood and metal while chopping wood. . The pad of my finger I now extremely swollen and engorged. It is swollen to capacity. What should I do to alleviate the discomfort?

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    Dr. Greene would love to answer every question that is asked, but he can’t (so many great questions). He can answer one question a day and he’s decided to let our readers decide which question they would most like to see answered.

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    Check it out — http://www.drgreene.com/askdrgreene/ — and let us know what you think.

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    • Jeanne carter

      Two days ago a heavy table with connected bench seats slammed down on the tips of my middle and ring finger they almost immediately turned black on one side with blood forming under the nail on other side they are swollen twice their normal size and numb.
      Is it possible to break the very tips of fingers? Should I go to doctor? Is there really anything that can be done.?

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  26. Breka Thurman

    my smashed my finger alost a month ago now i can see where the nail is coming off underneath but its still attached on the sides but its green by the cuticle is this normal. An its hurting pretty bad.

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  27. Anomalia

    I smashed my finger in a door, it cut the tip of the finger badly enough for it to bleed for the remainder of the day. Two days later and it’s still very stiff, moves strangely, and I have limited sensation in the entire area.

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  28. Ana Maria Maritnez

    My 6 yr old son smashed his pinky on a stall door at a store. I didnt know how serious it was so I took him to the emergency room. The doc pierced the nail with an electrical machine to release the blood. Its going on to three weeks his nail has not fallen but it is pale white in color and at the edge of the nail from where it is growing it looks GREEN! Should we be concerned? Please advise.

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    • Breka Thurman

      so what happen was everything okay cuz my is like that right now

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  29. Renee Adams Taylor

    I am a 47 year old woman, who smashed her right index fingernail at the cuticle portion while replacing our water meter’s concrete lid. It was two months ago. Blood collected underneath my nail & wasn’t drained, so it dried under my nail. It is black in color. As it has grown, the injured area is moving downward & I see a new nail pushing it along, but there is a small separation between the old, injured nail & the new one. I have 3 questions: 1. How do I treat it? 2. What should I expect? 3. Is it common for there to be a separation between the two nails? The new nail does look healthy but bigger than the old one. Please email me a response to my questions, many thanks! :)

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  30. Mary

    My daughters finger was smashed three weeks ago. I took her to the doctor and she was in antibiotics fir ten days because it was infected. Now I noticed the nail is peeling off on one side. Will it grow back? I snipped off the corner edge that was sticking up in hope to prevent it from getting snagged on anything…?

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