Subungual hematoma: Association with occult laceration requiring repair

doi:10.1016/0735-6757(87)90356-1

The American Journal of Emergency Medicine

Volume 5, Issue 4, July 1987, Pages 302-304

https://doi.org/10.1016/0735-6757(87)90356-1 Get rights and content

Abstract

Subungual hematomas are one of the most common injuries involving the hand. On conducting a literature search, we were unable to find any studies that investigated the association between subungual hematomas, fractures, and the presence of an occult laceration of the nail bed requiring repair. Fortyseven consecutive patients who presented to the emergency department with subungual hematoma involving more than one fourth of the nail bed were included in this study. In these cases, radiographs were taken, and the nail was lifted to look for a laceration. In the subgroup of patients who had subungual hematoma associated with a fracture, all of them had a laceration requiring repair. Patients with a subungual hematoma greater than one half of the size of the nail bed had a 60% incidence of a laceration requiring repair. The authors believe that patients presenting with a subungual hematoma involving greater than one half of the nail surface and a fracture of the distal phalanx should have the nail lifted and the nail bed explored and repaired.

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Citation Excerpt :
Although isolated nail plate injuries are inconsequential beyond temporary discomfort, damage to the underlying nail bed can result in scarring and permanent deformity to the regenerating nail.18,21,22 Simon and Wolgin23 demonstrated that isolated subungual hematomas with less than 50% involvement of the nail surface were unlikely to involve the underlying nail bed, whereas isolated subungual hematomas with greater than 50% involvement of the nail surface or those with an underlying phalanx fracture most often had an underlying nail bed laceration. In this setting, there has been controversy over the management when comparing nail plate removal with underlying nail bed repair versus simple decompression through nail trephination.
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Repair of the nail bed and plate after distal phalanx trauma remains controversial. The aim of this study was to determine whether simple approximation of the nail bed flaps maintained by tension band suture of the nail plate is sufficient to prevent nail dystrophies. Our series gathered 27 fingers in 25 patients with a mean age of 36 years. In 15 cases (Group I), the nail plate was fixed in a single layer by a point in a frame, and in 12 cases (Group II), the bed and the plate were fixed layer-by-layer using the wound adhesive, 2-octylcyanoacrylate. At the last follow-up, the Zook score was excellent and very good in 100% of Group I patients, and in 83.3% of Group II patients. Within 8 days, the average pain was 1/10 in Group I, and 2.5/10 in Group II. There was one infection in Group I and four hematomas in Group II. The Quick DASH score was 1.13/100 in Group I and 0 in Group II. Our results show that in the case of a traumatic nail bed injury, suturing the nail bed and applying 2-octylcyanoacrylate adhesive is less effective than simple approximation of the nail bed flaps by tension band suture of the nail plate.
La réparation du lit et de la tablette unguéaux dans les traumatismes de la phalange distale est controversée. Le but de cette étude était de montrer si le simple rapprochement des lambeaux de lit de l’ongle maintenus par fixation par haubanage en un plan de la tablette unguéale est suffisant pour prévenir les dystrophies unguéales. Notre série comportait 27 doigts chez 25 patients d’âge moyen 36 ans. Après rapprochement des lambeaux du lit de l’ongle, dans 15 cas (groupe I), la tablette était fixée en un plan par un point en cadre, dans 12 cas (groupe II), le lit et la tablette étaient fixés par application plan par plan de 2-octylcyanoacrylate. Au dernier recul, le score de Zook était de 100 % d’excellents et très bons résultats dans le groupe I, et 83,3 % dans le groupe II. Dans les 8 jours, la douleur moyenne était de 1/10 dans le groupe I, et 2,5/10 dans le groupe II. On notait 1 infection dans le groupe I et 4 hématomes dans le groupe II. Au dernier recul, le score Quick DASH était de 1,13/100 dans le groupe I, et 0 dans le groupe II. Nos résultats démontrent qu’en cas de lésion traumatique du lit de l’ongle, la suture du lit de l’ongle et la colle au 2-octylcyanoacrylate sont inutiles et moins efficaces que le simple rapprochement des lambeaux de lit de l’ongle maintenus par la fixation par haubanage de la tablette unguéale.

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Brief reportSubungual hematoma: Association with occult laceration requiring repair

Abstract

Surg Clin North Am

Hand

Primary Care

Hand

Lancet

Surg Clin North Am

Brief report
Subungual hematoma: Association with occult laceration requiring repair