Subungual haematomas: is simple trephining enough?

Meek S, White M. J Accid Emerg Med 1998 Jul;15(4):269-71.

OBJECTIVES: To determine the outcome of treating subungual haematomas by simple trephining, in terms of nail appearance and function, and to identify factors associated with a poor outcome. METHODS: Patients with subungual haematomas attending an accident and emergency department over a 12 month period were identified; 5-13 months after injury a telephone and postal survey of patient’s assessment of their own outcome was made using a proforma. Outcome was graded according to published criteria. RESULTS: 123 patients with 127 subungual haematomas were identified and 74% were followed up; 85% achieved an “excellent” or “very good” result, with 67% reporting no residual abnormalities. A “poor” outcome occurred in only 2% owing to nail splitting. No correlation was found between adverse outcome and haematoma size, presence of fracture, or infection. CONCLUSIONS: Treatment of subungual haematomas by simple trephining gives an acceptable result in the majority of patients and those with a poor outcome cannot be predicted at presentation. The findings suggest that only simple trephining for symptomatic relief is required for subungual haematomas and that aggressive surgical treatment is unnecessary.

Trauma to the nail unit including occupational sports injuries.

Mortimer PS, Dawber RP. Dermatol Clin 1985 Jul;3(3):415-20.

Trauma to the nail unit is one of the most common causes of onychodystrophy and may be acute (a single overwhelming injury) or chronic (repeated minor injury). Immediate effects of acute trauma include splinter hemorrhages, subungual hematomas, and nail shedding. Delayed deformities include splits and ridges, pterygium, hook nails, pigment bands, and ectopic nail. Also discussed are the results of chronic trauma, including self-inflicted injury and repeated indirect injury.