Subungual hematoma

Background

• Consider intervention for hematoma >50% of nail bed

Subungal hematoma

All blood has been expelled through the trephination hole

Types

• Simple - no nailbed dislocation, no e/o open fracture
• Complex - beyond simple

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

Management

Simple

1. Trephination
   1. Handheld cautery works best - no anesthesia is required
2. If a fracture is present, the digit should be splinted
3. Instruct pts to soak affected finger in warm water BID-TID x7d

Complex

1. Nail removal only recommended if there is associated nail avulsion or nail fold disruption

See Also

• Radiograph-Negative Hand and Finger Injuries
• Nailbed laceration

Source

• Tintinalli