Diferencia entre revisiones de «Subungual hematoma»
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*Complex - associated with a fracture or a nail plate disruption | *Complex - associated with a fracture or a nail plate disruption | ||
== | ==Clinical Features== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{Hand and finger injury DDX}} | {{Hand and finger injury DDX}} | ||
==Diagnosis== | |||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
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#Nail removal only recommended if there is associated [[nail avulsion]] or nail fold disruption<ref>Seaberg DC, ANgelos WJ, et al. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991; 9(3):209-210</ref> | #Nail removal only recommended if there is associated [[nail avulsion]] or nail fold disruption<ref>Seaberg DC, ANgelos WJ, et al. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. 1991; 9(3):209-210</ref> | ||
#Repair [[nailbed laceration]] using absorbable sutures | #Repair [[nailbed laceration]] using absorbable sutures | ||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
Revisión del 11:48 24 nov 2015
Background
Subungual hematoma is a collection of blood under the nail and and the nail bed. There is a strong association with distal phalanx fractures. In the past, complete nail removal and exploration and closure of possible nail bed lacerations was performed. A prospective study of 52 children supports management with trephination alone for any size hematoma.[1]
Types
- Simple - no nailbed dislocation, no evidence of an open fracture
- Complex - associated with a fracture or a nail plate disruption
Clinical Features
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Diagnosis
- Clinical diagnosis
Management
Simple
- Trephination
- Handheld cautery works best - no anesthesia is required
- Alternatively a needle spun in a drilling fashion
- Sharp object (i.e. safety pin) heated with flame in an austere environment
- If a fracture is present, the digit should be splinted
- Instruct pts to soak affected finger in warm water BID-TID x7d
Complex
- Nail removal only recommended if there is associated nail avulsion or nail fold disruption[2]
- Repair nailbed laceration using absorbable sutures
Disposition
- Outpatient