Subungual hematoma - Revision history

Rossdonaldson1 at 20:26, 29 April 2020

2020-04-29T20:26:46Z

← Older revision		Revision as of 20:26, 29 April 2020
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	===Types===		===Types===
	~~[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]~~
	#Simple: No nailbed dislocation or evidence of open fracture		#Simple: No nailbed dislocation or evidence of open fracture
	#Complex: Aassociated with fracture or nail plate disruption		#Complex: Aassociated with fracture or nail plate disruption
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	==Clinical Features==		==Clinical Features==
			[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]
	*Blood trapped under nail		*Blood trapped under nail

Lisayee25: /* Simple */

2019-04-14T07:41:40Z

Simple

← Older revision		Revision as of 07:41, 14 April 2019
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	*#Alternatively a needle spun in a drilling fashion		*#Alternatively a needle spun in a drilling fashion
	*#Sharp object (i.e. safety pin) heated with flame in an austere environment		*#Sharp object (i.e. safety pin) heated with flame in an austere environment
			*Indicated for acute sublingual hematomas (less than 24 to 48 hours old)
	*If a fracture is present, the digit should be splinted		*If a fracture is present, the digit should be splinted
	*Instruct patients to soak affected finger in warm water BID-TID x7d		*Instruct patients to soak affected finger in warm water BID-TID x7d

ZKhesbak: /* Background */

2018-09-28T00:59:43Z

Background

← Older revision		Revision as of 00:59, 28 September 2018
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	*There is a strong association with distal phalanx fractures.		*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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>		*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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>
			*Atraumatic subungual hematoma may be caused by melanoma or Kaposi's sarcoma

	===Types===		===Types===

Rossdonaldson1 at 18:57, 25 February 2018

2018-02-25T18:57:28Z

← Older revision		Revision as of 18:57, 25 February 2018
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	#Simple: No nailbed dislocation or evidence of open fracture		#Simple: No nailbed dislocation or evidence of open fracture
	#Complex: Aassociated with fracture or nail plate disruption		#Complex: Aassociated with fracture or nail plate disruption

			{{Fingertip anatomy}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1 at 18:08, 25 February 2018

2018-02-25T18:08:19Z

← Older revision		Revision as of 18:08, 25 February 2018
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	===Types===		===Types===
			[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]
	#Simple: No nailbed dislocation or evidence of open fracture		#Simple: No nailbed dislocation or evidence of open fracture
	#Complex: Aassociated with fracture or nail plate disruption		#Complex: Aassociated with fracture or nail plate disruption

	~~[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]~~
	~~[[File:Post trephonation.jpg\|thumb\|All blood has been expelled through the trephination hole]]~~

	==Clinical Features==		==Clinical Features==
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	==Management==		==Management==
	===Simple===		===Simple===
			[[File:Post trephonation.jpg\|thumb\|All blood has been expelled through the trephination hole]]
	*Trephination		*Trephination
	*#Cleanse with povidone-iodine solution (not flammable alcohol)		*#Cleanse with povidone-iodine solution (not flammable alcohol)
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	===Contraindications===		===Contraindications===
	*~~electrocautery~~		*Electrocautery
	**Presence of acrylic nails secondry to fire risk. Remove acrylic nails before using electrocautery tool.		**Presence of acrylic nails secondry to fire risk. Remove acrylic nails before using electrocautery tool.

Rossdonaldson1: /* Background */

2018-02-25T18:07:08Z

Background

← Older revision		Revision as of 18:07, 25 February 2018
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	*There is a strong association with distal phalanx fractures.		*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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>		*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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>
	*Types
	*#Simple ~~- no~~ nailbed dislocation or evidence of open fracture		===Types===
	*#Complex ~~- associated~~ with fracture or nail plate disruption		#Simple: No nailbed dislocation or evidence of open fracture
			#Complex: Aassociated with fracture or nail plate disruption

	[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]		[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]

Johnbhill.iv: Added contraindication for acrylic nails when using electrocautery

2018-02-02T05:31:37Z

Added contraindication for acrylic nails when using electrocautery

← Older revision		Revision as of 05:31, 2 February 2018
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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

			===Contraindications===
			*electrocautery
			**Presence of acrylic nails secondry to fire risk. Remove acrylic nails before using electrocautery tool.

	==Disposition==		==Disposition==

Mholtz at 07:58, 4 July 2017

2017-07-04T07:58:25Z

← Older revision		Revision as of 07:58, 4 July 2017
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	==Background==		==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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>		*Collection of blood under the nail
			*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.<ref>Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg. 1999;24(6):2266-1170.</ref>
			*Types
			*#Simple - no nailbed dislocation or evidence of open fracture
			*#Complex - associated with fracture or nail plate disruption

	[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]		[[File:Subungal hematoma.jpg\|thumb\|Subungal hematoma]]
	[[File:Post trephonation.jpg\|thumb\|All blood has been expelled through the trephination hole]]		[[File:Post trephonation.jpg\|thumb\|All blood has been expelled through the trephination hole]]

	~~===Types===~~
	*Simple - no nailbed dislocation, no evidence of an open fracture
	*Complex - associated with a fracture or a nail plate disruption

	==Clinical Features==		==Clinical Features==
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis
	**Evaluate percentage of nail bed involved, test extensor/flexor tendons, distal cap refill		*Evaluate percentage of nail bed involved, test extensor/flexor tendons and distal cap refill

	==Management==		==Management==
	===Simple===		===Simple===
	#Trephination		*Trephination
	#*Cleanse with povidone-iodine solution (not flammable alcohol)		*#Cleanse with povidone-iodine solution (not flammable alcohol)
	#*Handheld cautery works best - no anesthesia is required		*#Handheld cautery works best - no anesthesia is required
	#*Alternatively a needle spun in a drilling fashion		*#Alternatively a needle spun in a drilling fashion
	#*Sharp object (i.e. safety pin) heated with flame in an austere environment		*#Sharp object (i.e. safety pin) heated with flame in an austere environment
	#If a fracture is present, the digit should be splinted		*If a fracture is present, the digit should be splinted
	#Instruct patients to soak affected finger in warm water BID-TID x7d		*Instruct patients to soak affected finger in warm water BID-TID x7d
	#Prophylactic antibiotics are not needed after trephination of uncomplicated hematomas <ref name="Incision and Drainage">Holtzman L. Incision and Drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>		*Prophylactic antibiotics are not needed after trephination of uncomplicated hematomas <ref name="Incision and Drainage">Holtzman L. Incision and Drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>

	===Complex===		===Complex===
	#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==		==Disposition==
	*~~Outpatient~~		*Discharge

	==See Also==		==See Also==
	*[[~~Radiograph-Negative~~ Hand and ~~Finger Injuries~~]]		*[[Hand and finger diagnoses]]
	*[[Nailbed laceration]]		*[[Nailbed laceration]]

	==References==		==References==
	<references/>		<references/>

	[[Category:Orthopedics]]		[[Category:Orthopedics]]
	[[Category:Trauma]]		[[Category:Trauma]]

Ted Fan: minor details, ref

2017-04-14T16:16:02Z

minor details, ref

← Older revision		Revision as of 16:16, 14 April 2017
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis
			**Evaluate percentage of nail bed involved, test extensor/flexor tendons, distal cap refill

	==Management==		==Management==
	===Simple===		===Simple===
	#Trephination		#Trephination
			#*Cleanse with povidone-iodine solution (not flammable alcohol)
	#*Handheld cautery works best - no anesthesia is required		#*Handheld cautery works best - no anesthesia is required
	#*Alternatively a needle spun in a drilling fashion		#*Alternatively a needle spun in a drilling fashion
Line 28:		Line 30:
	#If a fracture is present, the digit should be splinted		#If a fracture is present, the digit should be splinted
	#Instruct patients to soak affected finger in warm water BID-TID x7d		#Instruct patients to soak affected finger in warm water BID-TID x7d
			#Prophylactic antibiotics are not needed after trephination of uncomplicated hematomas <ref name="Incision and Drainage">Holtzman L. Incision and Drainage. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>

	===Complex===		===Complex===

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T16:55:52Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 16:55, 25 July 2016
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	{{Hand and finger injury DDX}}		{{Hand and finger injury DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis