The fingertip is the part of the finger past the last joint, and it is the part of the hand that gets hurt most often, in doors, on knives and in machinery. The tip is a small space packed with structures that matter: the pulp that pads the finger, the nail and the nail bed beneath it, the end of the bone, and the nerves that give the fingertip its sense of touch. Most fingertip injuries heal well. What decides the result is whether the nail bed is repaired properly and the tip is left padded and able to feel, which is what we aim for.
What is a fingertip injury?
A fingertip injury is any wound past the joint nearest the nail, the DIP joint. It ranges from a bruise under the nail to loss of the whole tip.
The pulp pads the front of the tip. The nail plate sits on the nail bed, which makes the nail and holds it down, and the last bone supports both. The nerves end here in a dense network, which is why the fingertip is so sensitive.
The common patterns are blood trapped under the nail after a crush, a cut in the nail bed with the nail lifted or torn away, a crack in the end of the bone, pulp sheared off the tip, and amputation of the tip. Nail bed injuries matter most in the long term, because a nail bed that heals with a scar grows a split, ridged or lifted nail for life. See our nail deformity page.
Symptoms
What varies between injuries is what has been damaged:
- Throbbing pain under the nail, with a dark area of blood beneath it
- A nail lifted at its base or torn off
- A wound on the pad that keeps bleeding through pressure
- Exposed bone or fat at the end of the finger
- Numbness on one or both sides of the tip, or a tip that droops
Causes and risk factors
Doors. The single most common cause in children, usually a car door or a house door closed on a hand holding the frame.
Kitchen blades, power tools and machinery. Knives and mandolines cause clean slicing injuries. Saws, planers and mowers cause combined crush and cutting injuries that are harder to reconstruct.
Smoking, diabetes, poor circulation and some medications slow healing, and we plan the repair around them.
How it is diagnosed
By examination, and nearly always with an X-ray for a fracture or for glass or metal left in the wound. We look at how much skin and pulp has been lost, whether bone is exposed, whether the nail bed is cut, whether the tip has normal feeling and colour, and whether the tendons that move the end of the finger still work.
Where the nail is lifted at its base, or there is blood under most of it, a nail bed cut is likely underneath even if the nail looks intact, and that is a reason to remove the nail and look. Nail bed repair is most reliable within the first 24 to 48 hours.
Non-surgical treatment
Wound care
Small clean wounds on the pulp with no exposed bone heal on their own with dressings over two to three weeks, and the result is often better than any repair. This suits pulp losses smaller than about 1 cm across. Our nurses manage the dressings in the rooms.
A painful collection of blood under the nail is relieved by making a small hole in the nail plate, which takes seconds in the rooms. Where the blood covers less than about half of the nail and the nail is firmly attached, that is all that is needed.
Hand therapy
Our hand therapists manage the swelling, keep the DIP joint moving while the tip heals, and run desensitisation for a tender tip. Therapy is on site and starts the same week.
We check your tetanus cover. Antibiotics are used only where the wound is contaminated, bone is exposed or there is an open fracture.
Surgery
Surgery is advised where the nail bed is cut, a fracture is displaced or open, bone is exposed, or part of the tip has been lost and can be reconstructed.
The operation
It is a day surgery procedure using sedation with a local anaesthetic to the finger, so you do not feel the operation. It usually takes 30 to 60 minutes, depending on what is being repaired.
Nail bed repair. The nail plate is lifted off, the nail bed is repaired with fine dissolving sutures under magnification, and the nail plate or a foil splint is put back under the nail fold to shape the new nail. A fracture is set at the same time, and an unstable one is held with a fine wire for three to four weeks.
Fingertip reconstruction. Where pulp has been lost and bone is exposed, the tip is covered with a local flap: skin and fat moved across from the same finger, a neighbouring finger or the palm with its own blood supply. Where the loss is too large for a flap, the bone is shortened by a few millimetres and the tip is closed with your own skin, giving a slightly shorter but padded finger that can feel.
Sutures close the skin, and a tape bandage covers the wound under a soft finger dressing.
Recovery, week by week
Indicative. Recovery varies with what was injured and what was repaired.
Day of surgery. The finger is numb for two to three days because of the local anaesthetic. Keep the hand raised to limit throbbing and swelling.
Days 1 to 5. Keep the dressing clean and dry. The first dressing change is at 3 to 5 days, with the nurse in the rooms.
One to two weeks. Dressings are changed once or twice a week. A nail bed repair sits under the replaced nail or splint and is left alone. Sutures dissolve or are removed at two weeks.
Two to six weeks. Wounds have healed over. A wire, if used, is removed at three to four weeks. A flap has settled by six weeks. The tip stays swollen, tender and sensitive to cold for some months.
Three to six months. A new nail has grown out to the fingertip, and this is the first time its final shape can be judged. Full use of the tip is back for most people by three months.
Driving and work. Driving and office work at about one week. Light manual work at two to four weeks, heavy work at four to six weeks, longer after a flap or a wire.
The nail grows about 3 mm a month and takes three to six months to replace itself from the fold to the tip.
Risks and complications
Fingertip repair is routine and most people recover a useful, comfortable tip. Complications can include:
Infection. Uncommon, more likely after crush injuries and open fractures, treated with antibiotics and sometimes a washout.
Nail deformity. A split, ridged, hooked or lifted nail where the nail bed has scarred, even after a good repair. Some can be improved later by nail revision surgery.
Numbness, hypersensitivity and cold intolerance. The tip may stay numb, painful to touch or aching in the cold for months, and improves slowly over one to two years. Desensitisation helps, and a tender nerve ending occasionally needs further surgery.
Stiffness of the end joint, which is why we move it early, and partial failure of a flap, which then heals with dressings over a few more weeks.
When to be seen sooner
Contact us, or go to an emergency department, if you have:
- A fingertip that has been amputated, with or without the part
- A tip that has turned white, blue or cold after an injury or a repair
- Increasing pain, redness, pus or a smell from under the dressing, or a fever
- Blood under most of the nail, or a nail lifted at its base, within the first day or two
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
Will my nail grow back normally?
Usually, if the nail bed was repaired well and the injury was not a severe crush. The new nail takes three to six months to grow out and often looks rough and ridged at first. Judge the final nail when it has reached the fingertip, not before.
Should I remove the loose nail myself?
No. A loose nail is a useful splint for the nail bed under it. Leave it in place, cover it with a clean dressing and have it looked at. Blood under a nail is released through a small hole in the plate, not by pulling the nail off.
Can a fingertip be reattached?
Sometimes. A cleanly cut tip in a young child will occasionally take when stitched back as a graft. In adults, replantation under the microscope is possible only where the vessels are large enough to join, which is uncommon right at the end of the finger. More often the better operation is a flap or a short closure that gives a padded tip within weeks. Bring the part in moist gauze in a sealed bag, with the bag on ice, not in it.
When can I drive and go back to work?
Driving once the dressing is small and you can grip the wheel safely, often at about one week, and office work at the same time. Light manual work at two to four weeks, heavy work at four to six weeks, longer where a flap or a wire was used. There is no legislation covering surgery and driving, so the test is whether you can control the car safely. We will give you a realistic estimate for your job, and a certificate.
What does the surgery cost?
You receive a written quote after the consultation setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution, before anything is booked.
Do I need a referral?
Yes. A consultation with one of our surgeons needs a referral from your GP or another specialist, which also lets you claim the Medicare rebate. Hand therapy does not need a referral. Acute injuries are seen promptly: phone the rooms on (08) 7127 0365.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 8 November 2026