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Subungual Hematoma (Bleeding Under Nail) (cont.)

Subungual Hematoma Prognosis

  • After the subungual hematoma is drained, the pressure beneath the nail is relieved, and the pain decreases significantly.
  • The hole formed in the nail will remain and grow out at the rate that the nail normally grows.
  • One possible risk and long-term complication of a subungual hematoma is a nail bed laceration (cut).
    • If trauma is severe (for example, an subungual hematoma of the surrounding soft tissue including the nail and nail bed), the nail bed laceration can be stitched closed after the nail is partially or completely removed.
    • If the skin beneath the nail is lacerated, similar to any other skin cut, it may not heal properly.
    • This complication can result in deformity of the nail and the nail growth.
    • The deformity may be temporary and go away after the nail grows out, or it may be permanent, and you may have an obviously deformed nail forever.
    • If you do not seek medical attention at all for a subungual hematoma (not recommended), and sometimes even if you do, and a significant injury occurs under the nail, the nail may completely fall off as it grows out as part of the natural healing process.
    • Despite best efforts by doctors and yourself at home, nail deformity and permanent abnormalities can result from such injuries.

Subungual Hematoma Pictures

A thumb after it was hit with a large hammer. Notice that the dark discoloration beneath the nail takes up more than 75% of the area. This is blood. This hematoma required drainage to relieve the pressure.
A thumb after it was hit with a large hammer. Notice that the dark discoloration beneath the nail takes up more than 75% of the area. This is blood. This hematoma required drainage to relieve the pressure. Click to view larger image.

The battery-operated cautery unit and its tip when it is activated. Notice the red hot area used to burn the hole in the nail.
The battery-operated cautery unit and its tip when it is activated. Notice the red hot area used to burn the hole in the nail.Click to view larger image.

The process of burning a hole in the nail to relieve the hematoma. Notice the blood draining from the hole after the hole was formed with the cautery unit's hot tip. The finger has been numbed prior to this procedure.
The process of burning a hole in the nail to relieve the hematoma. Notice the blood draining from the hole after the hole was formed with the cautery unit's hot tip. The finger has been numbed prior to this procedure. Click to view larger image.

The same thumb after it has been drained. Notice the hole in the nail and the blood draining from the hole. The large dark area beneath the nail (the hematoma) is practically gone.
The same thumb after it has been drained. Notice the hole in the nail and the blood draining from the hole. The large dark area beneath the nail (the hematoma) is practically gone. Click to view larger image.

An example of a nail with a subungual hematoma that occupies less than 25% of the nail area. This hematoma did not require drainage.
An example of a nail with a subungual hematoma that occupies less than 25% of the nail area. This hematoma did not require drainage. Click to view larger image.

The same subungual hematoma three-and-one-half weeks after the original injury.
The same subungual hematoma three-and-one-half weeks after the original injury. Click to view larger image.

A paperclip opened for use in draining a subungual hematoma. The open end would be heated to allow it to make a hole in the nail.
A paperclip opened for use in draining a subungual hematoma. The open end would be heated to allow it to make a hole in the nail. Click to view larger image.

Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCES:

Bope, Edward T., and Rick D. Kellerman. Conn's Current Therapy 2012. 1st ed. Philadephia: Elsevier, 2012.

Roberts, James R., and Jerris R. Hedges. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia: Saunders, 2009.


Medically Reviewed by a Doctor on 5/18/2016
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Hand, Subungual Hematoma Drainage »

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