Management of Subungual Hematomas Introduction Subungual hematomas, sometimes referred to as a fingernail or toenail blister, occur following direct blunt trauma to the digit.
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.
Case Vignette A 34 year old patient presents to your clinic for toe pain. She states she hit her big toe really hard on the nightstand the previous evening. She states her nail is really painful and the toe is swollen and blue.
Which of the following injury patterns would be the best candidate for trephination? A) Evidence of infection B) Displaced fracture C) Extensive nail bed injury D) Isolated subungual hematoma Simple hematomas can be defined as occuring in isolation. However, many are associated with other injuries such as nailbed lacerations, fingertip avulsions and fractures.
One study of subungual hematomas in fingers found about 1/3 were associated with phalanx fractures and nailbed lacerations. The presence of other injuries can change management.Initial management will routinely, but not always involve radiographs depending on mechanism and exam.
If you are experiencing symptoms that may be related to subungual hematoma management, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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