From the Guidelines
For a subungual hematoma, especially if painful or large, drainage within the first 48 hours is recommended to relieve pressure and reduce pain, and in cases of severe or painful lesions, or when associated with a pressure hematoma or subungual abscess, removal of the nail plate may be necessary, as suggested by recent guidelines 1. When considering the management of a subungual hematoma, it's crucial to assess the severity and impact on the patient's quality of life. The hematoma can cause significant pain and discomfort, potentially affecting daily activities.
- For small, non-painful hematomas, conservative management with pain relief using acetaminophen or ibuprofen and ice application may suffice.
- However, for larger or painful hematomas, intervention is necessary to alleviate pain and prevent further complications.
- Drainage of the hematoma, ideally within 48 hours of the injury, can be performed using a heated paperclip, sterile needle, or electrocautery device to create a small hole in the nail, allowing the trapped blood to escape and relieving pressure.
- After drainage, applying antibiotic ointment and covering the area with a bandage for a short period can help prevent infection.
- In more severe cases, where the hematoma is associated with significant pain, subungual abscess, or severe nail damage, nail plate removal may be required, as indicated by guidelines for managing onycholysis and subungual lesions 1. This approach not only addresses the immediate issue but also promotes nail reattachment and prevents long-term nail bed complications.
- It's essential to monitor for signs of infection and seek medical attention if there's no improvement, worsening of symptoms, or if the nail is severely damaged, as these situations may necessitate further intervention, including antibiotics or more extensive medical care 1.
From the Research
Treatment Options for Subungual Hematoma
- The treatment for a subungual hematoma may involve drainage of the hematoma, as seen in a case where a 64-year-old male underwent the procedure and achieved complete resolution of his pain 2.
- Fluid evacuation can also alleviate pain caused by subungual hematoma, especially in cases of sports-related acute nail trauma 3.
- The management of subungual hematoma may include the trephination procedure, although potential complications, although rare, should be reviewed 2.
Medical Intervention
- There is no evidence available to indicate whether antibiotic prophylaxis is necessary after trephining of a subungual haematoma 4.
- In some cases, subungual hematoma may be an indicator of a serious and chronic systemic disease, such as diabetic microangiopathy 5.
- A careful history and differential diagnosis are necessary to distinguish between subungual hematoma caused by trauma and other conditions, such as subungual melanoma 3.