Should i drain subungual hematoma

Close Back. Sign in. Join now. Follow us on:. Search PracticeUpdate Cancel. However, this procedure can be very painful, requires local anesthetic and a heat source, and creates a small hole which can be easily clogged. The authors recommend using a disposable curette or punch biopsy tool at a tangential angle to drain the hematoma. This sharper tool creates a hole without squeezing the nail and causing pain, and the hole is also large enough to prevent clogging.

This simple technique using instruments easily available can be less painful for patients and equally or more effective. Dermatology Written by. Robert T. Surgical pearl: prompt treatment of subungual hematoma by decompression. J Am Acad Dermatol. The nail extends towards the tip of the digit over the nail bed or nail matrix Marieb, The nail bed has a very good arterial blood supply, which gives the nail its pinkish colour Heim et al, There is also a very good nerve supply to the area, which allows us to feel all sorts of sensations, especially in our fingertips.

Trauma to the nail damages the tiny blood vessels and the resultant bleeding that can occur under the fingernail puts pressure on the many nerve endings in the nail bed, causing considerable local pain. The nail is firmly attached to the nail bed and the two apposing surfaces are ridged to strengthen this bond Goodman et al, There is no subcutaneous fat in the nail bed to cushion any trauma and because it is so close to the underlying distal phalanx the bones of the fingers and toes , concurrent trauma to the bone is not uncommon.

A subungual haematoma causes marked tenderness as blood accumulates under tension in the nail bed Goodman et al, Patients often present in acute care settings with pain caused by these injuries.

Views differ as to how these haematomas should be treated. The most common treatment is to trephine, or make a hole, in the nail to release the blood, reduce the pressure, and thus relieve the pain Fig 2. Kukula and Fell suggest that haematomas only need to be drained if they cover 25 per cent or more of the nail.

They suggest leaving them to resolve spontaneously if they are smaller than this. A number of authors, including Wang and Johnson , recommend that when the haematoma covers 50 per cent of the nail or more, the nail should be removed and the nail bed repaired.

Batrick et al reviewed papers to see whether research demonstrated that this additional intervention improved cosmetic and functional results. They conclude that there are insufficient studies to support nail removal and nail-bed repair, and that treatment by trephining gives a good cosmetic and functional result in adults and children who have a subungual haematoma but no other significant fingertip injury.

Buttaravoli and Stair suggest that splinting a lacerated nail bed by its own nail may be superior to suturing. They recommend that if there are obvious lacerations with open haemorrhage or broken nails, a digital block should be performed and the nail should be lifted for inspection of the nail bed and repair of any lacerations. Nails that have become loose at a nail fold, whether at the sides or the root, should be resited Purcell, These authors suggest that treatment with simple trephining is effective even if the haematoma is large.

There is a debate as to whether trephining should be used when the underlying terminal phalanx is fractured. Purcell reminds us that fracture should be excluded, as trephining a nail over such an injury will technically turn the fracture from a closed to an open one. This increases the risk of infection tracking down to the bone and causing osteomyelitis. There are a number of treatment options but perhaps the best advice is that given by Buttaravoli and Stair They suggest that trephining a nail with an underlying fracture should only be carried out when there is sufficient pain to justify it.

If trephining is used, the patient should understand the potential risk of developing osteomyelitis, as well as the need to keep the finger clean and dry.

Some authors recommend the use of prophylactic antibiotics, but there is little empirical evidence to support their use. Avulsion tearing of the extensor tendon from the distal phalanx of the digit is another possible complication that must not be overlooked Buttaravoli and Stair, Buttaravoli and Stair suggest that 24 hours after the injury the pain will have subsided anyway so trephining may not significantly improve discomfort, but will expose the patient to the risk of infection.

It's caused by hitting the nail with an object such as a hammer. Or it can happen if you pinch it in a door or drawer. The hematoma can cause throbbing pain in the hurt finger or toe. Your doctor may have relieved the pain by making a small hole in the nail. This lets the blood drain out. You may have had a shot to prevent a tetanus infection.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

If your doctor told you how to care for your wound, follow your doctor's instructions. If you did not get instructions, follow this general advice:. Call your doctor or nurse call line now or seek immediate medical care if:.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:.