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Subungual Hematoma Removal: Treatment Procedures

 Subungual Hematoma Removal

  • Subungual hematomas are blood clots beneath the fingernail or toenail that are frequently caused by direct crushing damage to the digit, resulting in nail bed bleeding. 
  • Pain and discolouration of the nail are common complaints among patients. A direct hit to the distal causes the damage. 
  • The majority of subungual hematomas can be treated with trephination, which involves drilling a small hole in the nail. 
  • The patient may endure considerable discomfort unless the pressure is released.  
  • This article goes through how to evaluate and treat nailbed injuries.

What Causes Bleeding Under the Nail?

  • These injuries can occur in different situations. We mention, for example:
    • Hitting the finger in the door or window
    • A heavy object falls on the finger like a hammer
    • Leg hitting the wall

What Are Subungual Hematoma Symptoms?

  • Most patients feel a sharp throbbing pain. This can be explained by the blood pressure pooling between the nail and the nail bed.
  • The patient also feels a dark discoloration (red, maroon, or purple-black) under all or part of the affected nail.
  • The patient may feel swelling in the tip of the affected finger or toe.

How Is a Subungual Hematoma Diagnosed?

  • Broken bones or substantial damage to the nail bed and surrounding tissues are possible after a violent blow to a finger or toe. 
  • If you are experiencing any of the following symptoms, contact your doctor:
    • Distortion in the finger or in the foot.
    • The presence of severe and persistent pain.
    • Injury to a joint close to the nail.
    • Discoloration of more than a quarter of the nail.
    • The appearance of pus and redness around the nail
    • A hay fever.
  • Your doctor will examine your nail and, if necessary, order an x-ray to see if you have a broken bone or other injury.

What Happens During Subungual Hematoma Recovery?

  • In most cases, the infected nail will fall off on its own several weeks after the injury because the blood that collects under the nail has separated and pushed the nail away from the nail bed.
  • After the old nail falls off, a new one will grow in 8 weeks.
  • In some cases such as injury to the nail bed and/or surrounding tissue, a new nail may not grow completely for about 6 months.
  • Even with the best medical repair, there is a chance that the new nail will not grow back normally and may not look normal. 
  • As for the hematoma, it will progress over the coming weeks. In the event that it does not progress, the patient should see a dermatologist for a thorough examination due to the presence of other diagnoses, such as melanoma.

How Is Bleeding Under the Nail Treated?

  • In a first stage, the doctor cleans the finger with a sterile solution such as chlorhexidine or betadine solution. If there are fractures in the affected finger. The pain may be more when the nail is sterilized.


  • Trephination treatment is preferred over nail removal if the nail is healthy and the nail is painful.
  • The doctor punches holes in the nail plate to drain blood from under the tongue that relieves pain and promotes healing of the nail bed. This can be achieved by using a variety of methods, including electrocautery, insertion of a sterile needle, or a handful biopsy. The doctor should avoid penetration too deeply into the nail bed, and blowing should be limited to the nail. 
  • Once a hole is created in the nail, blood is expected to drain from the hematoma, and most of the pain experienced by the patient will disappear. The process may require more than one trephination in order for the blood to drain completely and spontaneously through the holes.
  • After the drilling process, the grout should be kept dry and clean and should not be soaked.

Nail Removal

  • This technique is used especially for subungual hematomas with nail bed wounds.
  • If the nail plate is healthy, then this method is not the best.
  • When the subungual hematoma exceeds 25-50% of the nail plate surface, removal of the nail plate is no longer recommended as there is no difference in the level of treatment result either at the short or long term level.

Preventive antibiotics

  • Antibiotics should not be used prophylactically to avoid infections. 
  • Subungual hematomas associated with an open fracture of the bone may require preventive antibiotics in order not to worsen the patient's condition. 
  • The type of medication and duration of treatment is determined by the doctor according to the case.

Prophylaxis against tetanus

  • Patients with a subungual hematoma with a cut like this should have their tetanus immunization status checked:
    • Dirty, feces-infested, and saliva-infested wounds
    • Wounds caused by punctures
    • Avulsions
    • Crushing wounds, burns, and foreign object injuries

Recommendations after treatment of subungual hematoma 

  • The patient should not soak the finger in water because this can cause the entry of fungi.
  • The patient should also know that the blood coming out through the holes may continue to ooze from the hole in the nail for one to two days.
  • The patient should also see a doctor if signs of inflammation such as warmth, redness, increased swelling, fever, and hematoma re-accumulation with pain.
  • Non-displaced distal phalanx fractures should also be cast in a cast within the necessary period and a physician specializing in hand surgery should be consulted.


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