a. General Considerations. A subungual hematoma is a collection of blood outside the blood vessels (hematoma) in which the blood is located beneath the nail of a toe or finger.

This is a common type of fingertip crush injury, such as when the patient catches his finger in a door. This type of injury may be associated with soft tissue injury and fracture of the fingertip.

The most common complaint is pain. Treatment, if needed, is drainage of the hematoma. Treatment does not require anesthesia and usually produces relief from pain.

b. Treatment of Subungual Hematoma. Treat subungual hematoma using the steps given below.

(1) Obtain x-rays of the fingertip to rule out fracture.

(2) Make a hole through the nail over the hematoma. To do this, you may use a paper clip heated with a match or a hot tip of a disposable cautery unit. You may also make a window with a #11 scalpel blade.

(3) Drain the hematoma within the first few hours after the injury has occurred. If drainage is delayed 24 hours or more, the attempt to drain the hematoma will be useless because the hematoma will have solidified.