Subungual hematoma: Difference between revisions
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*There is a strong association with distal phalanx fractures. | *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> | *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: Aassociated with fracture or nail plate disruption | |||
[[File:Subungal hematoma.jpg|thumb|Subungal hematoma]] | [[File:Subungal hematoma.jpg|thumb|Subungal hematoma]] | ||
Revision as of 18:07, 25 February 2018
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: Aassociated 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
Contraindications
- electrocautery
- Presence of acrylic nails secondry to fire risk. Remove acrylic nails before using electrocautery tool.
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