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#1
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06-28-2014, 06:07 PM
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Subungual Hematoma
A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail (black toenail). It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition. It is sometimes known as runner's toe or tennis toe. How do subungual haematomas present: •Subungual haematomas occur when there is bleeding beneath the nail. •Generally caused traumatically by getting it caught between to hard surfaces. •The haematoma becomes trapped between the rigid structures of the nail above and the distal phalanx below. •The space occupying mass causes intense pain secondary to increased pressure against the very sensitive nail bed and matrix. What are the treatment options for Subungual Haematoma? Wait and See: •Patients who are not experiencing significant pain at rest, should not have trephination performed, and can be treated with simple analgesia, rest, ice, and a protective splint. Trephination: •Trephination gives good cosmetic and functional result in both adults and children as long as no other fingertip injury is present. •Trephination makes a closed wound open, and introduces the risk of bacteria entering causing infection, once procedure completed and haematoma evacuated no need to further soak digit, and a protective dressing should be applied for 7-10 to prevent infection. Trephination Methods: •Hot Cautery: •This method involves applying a heated metal point to the nail, to relive the haematoma; this can be easy as heating paper clip, or using specially designed devices. •Drilling: •This involves using a specially designed drill or a wide bore needle to penetrate the nail to relive the haematoma. Points to consider: •Ring blocks are generally not indicated, as once the pressure is released pain subsides considerably •The digit needs to be soaked in antibacterial solution before attempting trephination to decrease bacterial load. •Caution needs to be taken in order not to penetrate to far, and traumatise the nail bed. •It’s generally not necessary to remove nail to inspect nail bed |
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#7
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07-25-2014, 04:57 AM
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Re: Subungual Hematoma
I dropped an axe on my toe when i was younger and my whole big toe did this, i refused to have that burning needle thing done (ive had splinters up under my nail and that was painfull so i didnt want a freakin needle up there |