Subungual haematoma trephination
Following on from Bone and Joint Bamboozler 006 we outline a simple method for drainage of the 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 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.
- 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
See one, do one…
- Bonistereel, P. (2008). Trephining subungual hematomas. Canadian Family physician. 54, 693.
- Guthrie K. The Half Moon Nail. LITFL
- Sherman, S. Simon’s Emergency Orthopedics 7e
- Purcell, D. Minor Injuries A Clinical Guide 3e
Bone and Joint Bamboozler
Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM 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 |