II. Pathophysiology
- Bleeding develops between nail and phalanx
III. Causes
- Crush injury to nail
IV. Symptoms
- Severe, throbbing digital pain
V. Signs
- Discoloration of nail
- Tip of digit swollen and tender
VI. Associated conditions
- Nail Bed Laceration
- Distal Tuft Fracture
VII. Imaging
- XRay AP, lateral and Oblique XRay of digit
- Indicated for Subungual Hematoma involving >50% of the nail bed
- Assess for distal Tuft Fracture
VIII. Management: Drainage (Nail Trephination)
- Contraindications
- Phalanx Fracture
- Nail Bed Laceration
- Large Subungual Hematomas (>50% of nail)
- Requires Nail Bed Laceration suturing (see exception below)
- Technique
- Precaution
- Avoid lunula (and underlying nail matrix)
- Gently drill 2-3 small holes into nail
- Number 11 blade or
- Spin 18 gauge needle between fingers or
- Heated paper clip
- Splint fingertip (e.g. AlumaFoam Splint)
- Apply for up to 3 days until pain subsides
- Precaution
IX. Management: Large Subungual Hematoma (>50%)
- Standard teaching is to remove nail, repair Nail Bed Laceration, and replace nail
- Study demonstrated no benefit in children to nail bed repair over trephination in large Subungual Hematoma
X. References
- Brandenburg (1996) Consultant p.331-340
- Calmbach (1996) Lecture in Minneapolis
- Dvorak (1996) Lecture in Minneapolis
- Lillegard (1996) Lecture in Minneapolis
- Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
- Wang (2001) Am Fam Physician 63(10):1961-66 [PubMed]
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Related Studies
| Concepts | Injury or Poisoning (T037) |
| SnomedCT | 211513004, 269219004 |
| Dutch | subunguaal hematoom |
| French | Hématome sous-unguéal, Hématome sublingual |
| German | subunguales Haematom |
| Italian | Ematoma subungueale |
| Portuguese | Hematoma subungueal |
| Spanish | Hematoma subungueal, hematoma subungueal (trastorno), hematoma subungueal |
| Japanese | 爪下血腫, ｼｮｳｶｹｯｼｭ, ｿｳｶｹｯｼｭ |
| English | subungual hematoma (diagnosis), subungual hematoma (physical finding), subungual hematoma, nails subungual hematoma, hematomas subungual, hematoma subungual, subungual haematoma, Subungal hematoma, Subungal haematoma, Subungual haematoma, Subungual hematoma, Subungual hematoma (disorder) |
| Czech | Podnehtový hematom, Subunguální hematom |
| Hungarian | Subungualis haematoma |
