Subungual hematoma: Difference between revisions
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==Background== | ==Background== | ||
*Collection of blood under the nail | |||
*There is a strong association with distal phalanx fractures. | |||
*In the past, complete nail removal and exploration and closure of possible nail bed lacerations was performed. A prospective study of 52 children supports management with trephination alone for any size hematoma.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref> | |||
*Types | |||
*#Simple - no nailbed dislocation or evidence of open fracture | |||
*#Complex - associated with fracture or nail plate disruption | |||
[[File:Subungal hematoma.jpg|thumb|Subungal hematoma]] | [[File:Subungal hematoma.jpg|thumb|Subungal hematoma]] | ||
[[File:Post trephonation.jpg|thumb|All blood has been expelled through the trephination hole]] | [[File:Post trephonation.jpg|thumb|All blood has been expelled through the trephination hole]] | ||
==Clinical Features== | ==Clinical Features== | ||
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==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | *Clinical diagnosis | ||
*Evaluate percentage of nail bed involved, test extensor/flexor tendons and distal cap refill | |||
==Management== | ==Management== | ||
===Simple=== | ===Simple=== | ||
*Trephination | |||
# | *#Cleanse with povidone-iodine solution (not flammable alcohol) | ||
# | *#Handheld cautery works best - no anesthesia is required | ||
# | *#Alternatively a needle spun in a drilling fashion | ||
# | *#Sharp object (i.e. safety pin) heated with flame in an austere environment | ||
*If a fracture is present, the digit should be splinted | |||
*Instruct patients to soak affected finger in warm water BID-TID x7d | |||
*Prophylactic antibiotics are not needed after trephination of uncomplicated hematomas <ref name="Incision and Drainage">Holtzman L. Incision and Drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref> | |||
===Complex=== | ===Complex=== | ||
*Nail removal only recommended if there is associated [[nail avulsion]] or nail fold disruption<ref>Seaberg DC, ANgelos WJ, et al. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991; 9(3):209-210</ref> | |||
*Repair [[nailbed laceration]] using absorbable sutures | |||
==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
*[[ | *[[Hand and finger diagnoses]] | ||
*[[Nailbed laceration]] | *[[Nailbed laceration]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 07:58, 4 July 2017
Background
- Collection of blood under the nail
- There is a strong association with distal phalanx fractures.
- In the past, complete nail removal and exploration and closure of possible nail bed lacerations was performed. A prospective study of 52 children supports management with trephination alone for any size hematoma.[1]
- Types
- Simple - no nailbed dislocation or evidence of open fracture
- Complex - associated with fracture or nail plate disruption
Clinical Features
- Blood trapped under nail
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- Clinical diagnosis
- Evaluate percentage of nail bed involved, test extensor/flexor tendons and distal cap refill
Management
Simple
- Trephination
- Cleanse with povidone-iodine solution (not flammable alcohol)
- Handheld cautery works best - no anesthesia is required
- Alternatively a needle spun in a drilling fashion
- Sharp object (i.e. safety pin) heated with flame in an austere environment
- If a fracture is present, the digit should be splinted
- Instruct patients to soak affected finger in warm water BID-TID x7d
- Prophylactic antibiotics are not needed after trephination of uncomplicated hematomas [2]
Complex
- Nail removal only recommended if there is associated nail avulsion or nail fold disruption[3]
- Repair nailbed laceration using absorbable sutures
Disposition
- Discharge
See Also
References
- ↑ Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.
- ↑ Holtzman L. Incision and Drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
- ↑ Seaberg DC, ANgelos WJ, et al. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991; 9(3):209-210