From the Research
The management of a subungual hematoma involves drainage of the trapped blood under the nail to relieve pain and pressure, with trephination recommended for larger hematomas or those causing significant pain, as supported by the most recent study 1. The goal of treatment is to reduce pressure on the sensitive nail bed, alleviate pain, and prevent potential complications.
Key Considerations
- For small hematomas (less than 25% of the nail bed), simple observation may be sufficient if pain is tolerable.
- For larger hematomas or those causing significant pain, trephination is recommended using a heated paperclip, electrocautery device, or specialized trephine needle to create a small hole in the nail plate to allow blood drainage.
- Prior to the procedure, clean the nail with antiseptic solution and consider digital nerve block with 1% lidocaine for pain control.
- After drainage, apply antibiotic ointment and a sterile dressing.
- Nail removal is generally reserved for cases with significant nail disruption, suspected nail bed laceration, or underlying fracture. Some key points to consider in the management of subungual hematoma include:
- Elevate the affected digit to reduce swelling.
- Use ice for the first 24-48 hours to reduce pain and inflammation.
- Take over-the-counter pain medications like acetaminophen or ibuprofen as needed.
- Monitor for signs of infection such as increasing pain, redness, or purulent drainage, which would require medical follow-up, as noted in 2.
Special Considerations
- In patients with haemophilia, early collaboration between haematology and surgical teams is important, and nail trephination or surgical intervention may be considered following factor replacement, as discussed in 1.
- The management of subungual hematoma in patients with haemophilia may require a more individualized approach, taking into account the patient's specific condition and medical history.