Management of Subungual Hematomas
Subungual hematomas, sometimes referred to as a fingernail or toenail blister, occur following direct blunt trauma to the digit. Examples of mechanism might include dropping something on your tie, slamming your finger in the car door or stubbing your toe. Subsequently, there is bleeding under the nail and hematoma formation. Most patients will report throbbing toe/finger pain with some form of discoloration of the nail. On exam there will be dark or purple discoloration under the nail with some degree of tenderness. It is important to evaluate for other injuries.
A) Evidence of infection
B) Displaced fracture
C) Extensive nail bed injury
D) Isolated subungual hematoma
After Care & Prognosis
Following trephination, the athlete should keep the toe dry and clean. It can continue to drain for 24-48 hours. Patients should be counseled to return if there is reaccumulation of the hematoma or evidence of infection.
|↑1||Simon RR, Wolgin M. Subungual hematoma: association with occult laceration requiring repair. Am J Emerg Med. 1987 Jul;5(4):302-4.|
|↑2||Meek S, White M. Subungual haematomas: is simple trephining enough? J Accid Emerg Med. 1998 Jul;15(4):269-71.|
|↑3||Roser SE, Gellman H, Comparison of nail bed repair versus nail trephination for subungual hematomas in children, J Hand Surg 24(6):11661170, 1999.|
|↑4||Seaberg DC, Angelos WJ, Paris PM. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991 May;9(3):209-10.|