Subungual Hematoma

Aka: Subungual Hematoma

1. See Also
   1. Fingernail
   2. Nail Abnormality
2. Pathophysiology
   1. Bleeding develops between nail and phalanx
3. Causes
   1. Crush injury to nail
4. Symptoms
   1. Severe, throbbing digital pain
5. Signs
   1. Discoloration of nail
   2. Tip of digit swollen and tender
6. Associated conditions
   1. Nail Bed Laceration
   2. Distal Tuft Fracture
7. Radiology: AP, lateral and Oblique XRay of digit
   1. Assess for distal Tuft Fracture
8. Management: Drainage
   1. Contraindications
      1. Phalanx Fracture
      2. Nail Bed Laceration
      3. Large Subungual Hematomas (>50% of nail)
         1. Requires Nail Bed Laceration suturing
   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
9. 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. Wang (2001) Am Fam Physician 63(10):1961-66