Simon RR and Wolgin M, 1987, USA | 47 consecutive patients presenting to an emergency department with subungual haematoma >25% nail bed. +/− fracture of distal phalanx | Prospective observational study | Association of SUH size and repairable laceration. | 16/27 patients with haematoma >50% had nail bed laceration requiring repair | Often quoted paper but no follow up of patients and no control group |
| Digital block, nail removed and lacerations of nail bed greater than 2–3 mm repaired using vicryl and nail replaced | | | | |
Seaberg DC et al, 1991, USA | 48 patients presenting to an emergency department with subungual haematoma | Prospective observational study | Pain relief, infection and cosmetic appearance | 94% follow up. All reported a reduction in pain. No infective complications or major nail deformities regardless of SUH size or fracture | Major nail deformities not clearly defined |
| Nail and nail margin intact. +/− distal phalanx fracture | | | | No control group |
| Electrocautery nail trephination | | | | |
| Follow up at least 6/12 | | | | |
Meeks S and White M, 1997, UK | 123 patients presenting to emergency departments treated by simple trephining | Retrospective | Functional and cosmetic appearances | Excellent ie no residual abnormality or very good in 85% of those followed up. | Retrospective |
| | | | | Coding inadequate |
| 94 followed up for 5–13 months | | | 2% poor outcome caused by nail splitting. Major nail abnormality defined by Zook’s criteria occurred in 11% | No control group |
| | | | | Loss of patients to FU |
| | | Infection | Infection in 5 patients. No correlation between adverse outcome and haematoma size, presence of fracture or infection | |
Roser SE and Gellman H, 1999, USA | 53 finger injuries in children with intact nail and nail margin, +/− tuft fracture. | Sequential study | Cosmetic deformity of nail and functional deficit | Operative and non-operative- nil at long term FU | No randomisation |
| Formal nail bed repair v simple trephining/ conservative. | | Infective complications | No infective complications in either group | |
| FU at least 4/12 | | Costs | Costs significantly higher in operative group | |