Subungual haematoma trephination

Following on from Bone and Joint Bamboozler 006 we outline a simple method for drainage of the Subungual haematoma

Subungual Haematoma Drainage 1

Treatment options

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 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.


This involves using a specially designed drill or a wide bore needle to penetrate the nail to relive the haematoma.

Hot Cautery Option

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
Subungual Haematoma drainage success
Most, but not all attempts to drain the subungual haematoma will be successful!!

See one, do one…




Bone and Joint Bamboozler

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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