Nail avulsion


  • Generally results from blunt trauma
A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

Clinical Features

Full nail avulsion. The lunula and nail bed are exposed. The lunula is pinkish-white in color with a smooth surface. The nail bed is bright red in color with longitudinal dermal ridges stretching from the lunula to the distal groove.
  • Nail completely or partial removed from nailbed
  • May present with concomitant nailbed laceration

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger injuries


  • Clinical diagnosis
  • Obtain xray to check for fracture, dislocation, and foreign body
  • Detailed neurovascular exam noting sensation and capillary refill


(a) Fingernail avulsion; (b) polypropylene nail substitute; (c) clinical result at 12 months.
  • For partial avulsion, gently lift nail but do not remove to inspect nail bed for laceration
  • For complete avulsion:
    • Repair any nailbed laceration
    • Replace nail into nailfold after cleaning nail and suture into place
    • If no nail, place a non-adherent, petroleum containing gauze into nail fold. Can Also use aluminum wrapping of suture package as pseudo-nail to allow appropriate spacing for new nail to grow in. This should be left in place for 2-3 weeks.
    • Wound should be re-evaluated in 3-5 days and gauze replaced[1]


  • Discharge

See Also

External Links


  1. Lammers, R.L. and Smith, Z.E. Chapter 35: Methods of Wound Closure. In: Roberts, J ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine. Elsevier; 2014:644-689