Sharp forceful injuries that penetrate the nail plate will usually continue through the bony phalanx and result in fingertip amputation.

However, the majority of fingertip injuries are due to crushing between two hard and blunt objects. This mechanism causes the nail plate to buckle and compress the nail plate against the terminal phalanx bone. Depending on the force of the crushing injury, the nail bed may sustain a simple or stellate laceration. A very high energy crush can shatter both the terminal phalanx bone and nail bed into many fragments.