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Subungual hematoma: nail bed repair or nail trephination? A systematic review

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Abstract

Background

Nail bed injuries are a major cause of presentation in the emergency department, accounting for 15 to 24% of all fingertip injuries, but management lacks consensus. Different methods have been published for the treatment of subungual hematoma, which leads to an important controversy among hand surgeons. The objective of this study was to conduct a systematic review to compare nail trepanation with nail avulsion and matrix repair, deciding which is the most appropriate according to each injury pattern.

Methods

We carried out a systematic review of the literature using MEDLINE via PubMed, Virtual Health Library, Embase, and Cochrane Library through September 2021. Inclusion criteria were journal articles published in the last 11 years (2010–2021) in English, French, Portuguese, and Spanish and conducted in humans. Case reports, case series studies, and pre-clinical studies were excluded, in addition to those which are still in progress, did not report primary outcome or full-text was not available.

Results

The search resulted in the screening of 599 records. Of these articles, 16 were eligible for the review. As shown in some literature reviews, the traditional approach to subungual hematoma is to remove the nail, analyze the sterile matrix, and repair the injury. According to many authors, this can depend on the size of subungual hematoma and if there is any fracture associated. On the other side, subungual hematomas also can be relieved by simple trephination, yielding good pain relief and satisfactory nail plate regeneration.

Conclusions

With our review, we can determine more accurate recommendations regarding the possible treatment for ungual complex injuries with subungual hematomas. In this sense, nail trephination alone is recommended whenever possible and nail removal with matrix repair is better when there is fracture or hematoma covers greater than 50%. In addition, small non-painful bruises do not require intervention, as knowing that it is incorporated into the nail and progressively migrates to the free edge of the nail plate.

Level of evidence: Not ratable.

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References

  1. Reid S, Duncan MJ (2016) Interventions for treating fingertip entrapment injuries in children. Paediatr Child Heal 21:17–28. https://doi.org/10.1093/pch/21.1.27

    Article  Google Scholar 

  2. Edwards S, Parkinson L (2019) Is Fixing Pediatric Nail Bed Injuries With Medical Adhesives as Effective as Suturing? A Review of the Literature. Pediatr Emerg Care 35:75–77. https://doi.org/10.1097/PEC.0000000000000994

    Article  PubMed  Google Scholar 

  3. Mignemi ME, Unruh KP, Lee DH (2013) Controversies in the treatment of nail bed injuries. J Hand Surg Am 38:1427–1430. https://doi.org/10.1016/j.jhsa.2013.04.009

    Article  PubMed  Google Scholar 

  4. Patel L (2014) Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care 30:742–745. https://doi.org/10.1097/PEC.0000000000000241

    Article  PubMed  Google Scholar 

  5. Weir Y (2018) Fingertip injuries in children: A review of the literature. Emerg Nurse 26:24–27. https://doi.org/10.7748/en.2018.e1795

    Article  Google Scholar 

  6. Ramirez EG, Sue HK (2016) Management of hand injuries: Part II. Adv Emerg Nurs J 38:266–278. https://doi.org/10.1097/TME.0000000000000128

    Article  PubMed  Google Scholar 

  7. Lee DH, Mignemi ME, Crosby SN (2012) Fingertip injuries: An update on management. J Am Acad Orthop Surg 21:756–766. https://doi.org/10.5435/JAAOS-21-12-756

    Article  Google Scholar 

  8. Tarallo M, Fino P, Ribuffo D, Casella D, Toscani M, Spalvieri C et al (2018) Liposuction aspirate fluid adipose-derived stem cell injection and secondary healing in fingertip injury: A pilot study. Plast Reconstr Surg 142:136–147. https://doi.org/10.1097/PRS.0000000000004506

    Article  CAS  PubMed  Google Scholar 

  9. Capstick R, Giele H (2016) Interventions for treating fingertip entrapment injuries in children. Paediatr Child Heal 21:17–28. https://doi.org/10.1093/pch/21.1.27

    Article  Google Scholar 

  10. Shaw A, Findlay J, Kulkarni M (2011) Management of fingertip and nail bed injuries. Br J Hosp Med (Lond) 72(8):M114–8. https://doi.org/10.12968/hmed.2011.72.sup8.m114.

  11. Martin-Playa P, Foo A (2019) Approach to Fingertip Injuries. Clin Plast Surg 46:275–283. https://doi.org/10.1016/j.cps.2019.02.001

    Article  PubMed  Google Scholar 

  12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, The PRISMA et al (2020) statement: an updated guideline for reporting systematic reviews. TheBMJ 2021:372. https://doi.org/10.1186/s13643-021-01626-4

    Article  Google Scholar 

  13. Dean B, Becker G, Little C (2012) The management of the acute traumatic subungual haematoma: a systematic review. Hand Surg 17:151–154. https://doi.org/10.1142/S021881041230001X

    Article  PubMed  Google Scholar 

  14. Loréa P (2013) Primary care of nail traumas. Chir Main 32:129–135. https://doi.org/10.1016/j.main.2013.02.021

    Article  PubMed  Google Scholar 

  15. Tos P, Titolo P, Chirila NL, Catalano F, Artiaco S (2012) Surgical treatment of acute fingernail injuries. J Orthop Traumatol 13:57–62. https://doi.org/10.1007/s10195-011-0161-z

    Article  CAS  PubMed  Google Scholar 

  16. Hawken JB, Giladi AM (2021) Primary Management of Nail Bed and Fingertip Injuries in the Emergency Department. Hand Clin 37:1–10. https://doi.org/10.1016/j.hcl.2020.09.001

    Article  PubMed  Google Scholar 

  17. Venkatesh A, Khajuria A, Greig A (2020) Management of pediatric distal fingertip injuries: A systematic literature review. Plast Reconstr Surg Glob Open 8(1):e2595. https://doi.org/10.1097/GOX.0000000000002595

  18. Vergara-Amador E, Castillo-Pérez S, Tovar-Cuellar W (2016) Recommendations on treatment of nail and fingertip injuries in children. Cases series and literature review. Rev Fac Med 64:499–504. https://doi.org/10.15446/revfacmed.v64n3.54201.

  19. Sindhu K, DeFroda SF, Harris AP, Gil JA (2017) Management of partial fingertip amputation in adults: Operative and non operative treatment. Injury 48:2643–2649. https://doi.org/10.1016/j.injury.2017.10.042

    Article  PubMed  Google Scholar 

  20. Pannier S, Dana C, Journé A, Péjin Z, Glorion C (2013) Les traumatismes distaux des doigts chez l’enfant. Chir Main 32:S39-45. https://doi.org/10.1016/j.main.2013.02.020

    Article  PubMed  Google Scholar 

  21. Robert N, Chassat R, Couturier C, Delpit X, Masmejean E (2015) ““Reposition-flap”: A therapeutic alternative in fingertips amputations. Ann Chir Plast Esthet 60:299–304. https://doi.org/10.1016/j.anplas.2014.06.002

    Article  CAS  PubMed  Google Scholar 

  22. Bennett N, Choundhary S (2000) Why climb a ladder when you can take the elevator? Plast Reconstr Surg 105(6):2266. https://doi.org/10.1097/00006534-200005000-00062

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Funding

The authors received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. School of Medicine, Pontifical Catholic University of Rio Grande Do Sul, Av. Ipiranga 6681, Partenon, Porto Alegre, RS, 90619-900, Brazil

    Jefferson Braga Silva, Alice Scalzilli Becker, Bruna Leiria Meréje Leal, Catarina Velllinho Busnello, Elisa Hartmann Kist & Natália Dias Koff

  2. Service of Hand Surgery and Reconstructive Microsurgery, São Lucas Hospital, Av. Ipi-ranga 6690, Centro Clinico PUCRS, Suite 216, Porto Alegre, RS, 90610-000, Brazil

    Jefferson Braga Silva

  3. Service of Hand Surgery and Reconstructive Microsurgery, Pontifical Catholic University of Rio Grande Do Sul Hospital São Lucas, Av. Ipiranga, 6690, Centro Clinico PUCRS, Suite 216, Porto Alegre, RS, 90610-000, Brazil

    Jefferson Braga Silva

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Correspondence to Jefferson Braga Silva.

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Jefferson Braga Silva, Alice Scalzilli Becker, Bruna Leiria Meréje Leal, Catarina Velllinho Busnello, Elisa Hartmann Kist, and Natália Dias Koff declare no competing interests.

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Silva, J.B., Becker, A.S., Leal, B.L.M. et al. Subungual hematoma: nail bed repair or nail trephination? A systematic review. Eur J Plast Surg 46, 157–161 (2023). https://doi.org/10.1007/s00238-022-02003-7

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  • DOI: https://doi.org/10.1007/s00238-022-02003-7

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