All it takes is an instant. One careless or clumsy moment in time when a slammed door, a descending hammer or a dropped item smashes a finger or even a toe, leaving a painful, swelling, colourful symbol of ineptitude. At least that's what it feels like. And it doesn't happen in slow motion, either. One moment everything is fine and the next it's a world of pain. Quick treatment of a smashed nail can reduce the swelling and discolouration, not to mention the agony. And while "drilling a hole" through your nail may sound dangerous and painful, it will actually prove a relief.
Dunk your smashed nail immediately into a bowl of ice water and hold it in there, or apply an ice pack for around 20 minutes. The ice helps reduce swelling as the blood -- called a subungual hematoma -- collects underneath the nail. The cold also helps numb your finger or toe to numb slightly.
Elevate your hand or foot, as the case may be, so the smashed nail is above your heart level. Elevation helps decrease the flow of blood, thus diminishing swelling.
Take a dose of painkiller appropriate for your age and weight. An anti-inflammatory such as ibuprofen is best, but use acetaminophen if ibuprofen is unavailable.
Assess the injury carefully. Try bending the toe or finger to check if it is broken; if it looks deformed or will not move easily, consult a physician. If bone shows through the skin or you note any traumatic damage, seek medical attention immediately.
Dry your nail and finger or toe thoroughly. Use a soft, clean cotton cloth and work gently to avoid further pain or damage.
Swab the finger or toe generously with a liquid topical antiseptic such as iodine. Use a cotton swab or cotton ball and cover the area below, completely around and above the smashed nail. This prevents the spread of any possible bacteria on your skin through the puncture hole you create.
Grasp a needle or an unbent paper clip with a pair of needle-nose pliers. Keeping a firm grip, heat the needle or paper clip over a stove burner flame or even using a cigarette lighter. You want to get the instrument red hot; this not only sterilises the instrument but also allows you to melt the nail as you drill through it. Do not allow the sterilised and heated needle or paper clip to touch anything once you remove it from the flame.
Position the instrument over the centre of the hematoma. Touch the needle or paper clip to the nail to begin melting through the surface. Twirl the instrument slightly as it sinks into the nail to drill through.
Work slowly and carefully, reheating the instrument if needed. Stop near the middle of the nail depth, when blood begins to well from the hole. Pull your instrument back out and put it to the side.
Squeeze gently around the finger or toe, on either end of the nail, to encourage blood flow. As the blood leaves the trephination site -- the formal name for the hole you created -- the pressure lessens and the pain generally subsides.
Apply a dab of antiseptic cream and cover with a clean, dry bandage. Keep your nail clean and dry for the next two or three days; the hole provides an entry for bacteria.
Soak your toe or finger in warm water mixed with several drops of disinfectant, allowing it to remain in the solution for 15 to 20 minutes. Do this four times daily for the next two to three days. This helps promote healing and avoid infections.
While the sight of blood and the thought of the process may seem gruesome, the actual procedure will come as a relief. Drill through the nail only until you feel no resistance -- somewhere in the middle of the nail material. Penetrating through the entire nail may result in piercing the skin beneath the nail, which could prove painful.
Tips and warnings
- While the sight of blood and the thought of the process may seem gruesome, the actual procedure will come as a relief.
- Drill through the nail only until you feel no resistance -- somewhere in the middle of the nail material. Penetrating through the entire nail may result in piercing the skin beneath the nail, which could prove painful.
- Dr. Greene.com; Treating Smashed Fingers; Dr. Alan Greene
- Nails Magazine; What Is Subungual Hematoma?; Michelle Pratt; May 2010
- AskDrSears.com; Finger Crush Injuries/Fingers or Hands Stuck in Door; William Sears MD
- eMedicineHealth: Subungual Hematoma (Bleeding Under Nail)
- Medline Plus: Smashed Fingers
- Medscape; Hand, Subungual Hematoma Drainage; Oliver Mayorga, MD