From the Guidelines
Full nail hematoma treatment should prioritize prompt relief of pain and prevention of nail loss, with nail trephination being a recommended approach to drain the blood and alleviate pressure. According to the provided evidence, there is no direct guidance on the treatment of full nail hematoma, but the management of taxane-induced onycholysis and nail reactions can provide some insight 1.
For the treatment of nail hematoma, the following steps can be taken:
- Perform nail trephination by creating a small hole in the nail to drain the blood, using a sterilized paperclip, sterile needle, drill, or electrocautery device.
- Clean the nail with antiseptic solution before the procedure and apply antibiotic ointment like bacitracin or polysporin afterward, covering with a bandage.
- Change the dressing daily and monitor for signs of infection such as increasing pain, redness, or pus.
- For pain relief, consider acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours).
- For large hematomas covering more than 50% of the nail or those with associated fractures, seek medical attention.
It's essential to note that the provided evidence focuses on the prevention and management of dermatological toxicities related to anticancer agents, and the guidance on nail reactions is based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 1. However, in the context of real-life clinical medicine, prioritizing the relief of pain and prevention of nail loss is crucial, and nail trephination is a recommended approach to achieve this goal.
From the Research
Treatment Options for Full Nail Hematoma
- Subungual hematoma is a collection of blood beneath a finger or toe nail, often caused by a crush injury or repetitive trauma 2
- Treatment options for subungual hematoma include:
- Hand-held cautery, a cost-effective and precise method that decreases the likelihood of unnecessary delay in nail regrowth and secondary dystrophy 3
- Nail trephination, a procedure that involves burning a small hole in the nail plate to allow for evacuation of the hematoma, which can provide relief of pain without cosmetic or infectious complications 4
- Simple trephination for pain relief, which may be sufficient for treating subungual hematomas 5
Management of Nail Bed Injuries
- Nail bed injuries can be classified into subungual hematomas, simple or stellate lacerations, crush injuries, and avulsions 6
- The management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial, with debate surrounding the necessity of removing the nail plate for repair of a nail bed laceration versus trephination alone of a large subungual hematoma 6
- Appropriate management of acute fingertip and nail bed injuries is critical for optimizing patient outcomes, and mismanaged injuries can lead to chronic pain and deformity 5