Subungual hematoma

Basic Anatomy of Nails~






   - nail plate:
         - comprised of concentrated, adherent interdigitating cells which have no nuclei or organelles; 

    - germinal matrix:
         - comprised of cells which contribute to 90% growth of the new nail;
         - distal edge of the germinal matrix is demarcated by the edge of lunula;
         - there is minimal adherence of germinal matrix to the nail;
   
 - sterile matrix:
         - extends distal to the lunula;
         - responsible for adherence of nail to nail bed; 

Subungual hematoma


 Is a collection of blood underneath a toenail or fingernail. Sometimes known as runner's toe or tennis toe.

Causes:

• Slamming your finger in a car door or house door.
• Hitting your finger with a heavy object such as a hammer.
• Dropping a heavy object such as a dumbbell on your toe.
• Stubbing your toe on a hard surface.

In some cases, a tumor under the nail can cause a darkened area that can resemble a subungual hematoma. If you have a darkened area under a nail, and no history of trauma to the nail, you should have it evaluated by your health care provider. The spot will grow out with the nail if it is a subungual hematoma. It will stay in the same spot under the nail if it is a tumor.

Treatment :

• Cautery. A heated wire (electrocautery device) is used to burn the hole or holes during a painless procedure that takes only a few seconds.
• Paper-clip method. A heated paper clip is placed over the center of the hematoma to melt a hole into the nail.
• Needle. A large-diameter needle is used to perforate the nail.

• Treatment of a Complicated Subungual Hematoma

  If a subungual hematoma affects at least 50% of the nail surface, the nail bed is likely to have significant injury. In these cases, nail removal may be necessary, along with stitches to the nail bed.