Nails

Subungual Hematoma

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Subungual Hematoma, Nail Trephination

  • See Also
  1. Nail Injury
  2. Nail Bed Laceration
  3. Finger Laceration
  4. Fingernail
  5. Nail Abnormality
  6. Subungual Foreign Body
  7. Finger Tip Injury
  8. Tuft Fracture
  • Pathophysiology
  1. Bleeding develops between nail and phalanx
  2. Typically caused by crush injury to the nail and distal fingertip
  • Symptoms
  1. Severe, throbbing digital pain
  • Signs
  1. Discoloration of nail
  2. Tip of digit swollen and tender
  • Associated conditions
  1. Nail Bed Laceration
  2. Distal Tuft Fracture
  • Imaging
  1. XRay AP, lateral and Oblique XRay of digit
    1. Indicated for Subungual Hematoma involving >50% of the nail bed
    2. Assess for distal Tuft Fracture
  • Management
  • Drainage (Nail Trephination)
  1. Contraindications
    1. Phalanx Fracture
    2. Nail Bed Laceration
    3. Large Subungual Hematomas (>50% of nail)
      1. Previously recommended to suture Nail Bed Laceration in large Hematomas
      2. However, in practice, reasonable to leave nail in place, and trephinate large Subungual Hematomas
  2. Technique
    1. Precaution
      1. Avoid lunula (and underlying nail matrix)
    2. Gently drill 2-3 small holes into nail
      1. Number 11 blade or
      2. Spin 18 gauge needle between fingers or
      3. Heated paper clip
    3. Splint fingertip (e.g. AlumaFoam Splint)
      1. Apply for up to 3 days until pain subsides
  • Management
  • Large Subungual Hematoma (>50%)
  1. See Nail Bed Laceration
  2. Standard teaching is to remove nail, repair Nail Bed Laceration, and replace nail
  3. Study demonstrated no benefit in children to nail bed repair over trephination in large Subungual Hematoma
    1. Roser (1999) J Hand Surg Am 24(6): 1166-70 +PMID:10584937 [PubMed]
  • References
  1. Brandenburg (1996) Consultant p.331-340
  2. Calmbach (1996) Lecture in Minneapolis
  3. Dvorak (1996) Lecture in Minneapolis
  4. Lillegard (1996) Lecture in Minneapolis
  5. Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
  6. Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]