Subungual Hematoma Research Articles

Conservative Treatment for Subungal Hematoma with Tuft Fracture

Management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial. This article presents a 30-year-old case admitted to emergency department (ED) due to subungual hematoma with tuft fracture. The nail was partially loose, and the nail bed seemed more or the less intact. Rest of hand examination was normal. Plain radiographs showed fracture of the distal phalanx. Decision was made not to remove the nail bed and only to release the pressure by trephine technique under sterile condition. The patient was scheduled for ED follow up appointment after one week. During follow-up no complications were encountered. The nail bed recovered completely and the nail plate seemed to develop without any deformities. Eight months after the ED visit there are no complaints about pain, shape or loss of function during daily activities. Since there are no agreed upon protocol or algorithm for subungual hematoma and distal phalanx fracture, the author believe that conservative treatment is still an option for treating tuft fracture with subungual hematoma. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

The value of point-of-care ultrasound for detecting nail bed injury in ED

ObjectiveThe aim of this study is to detect the value of point-of-care ultrasound (POCUS) for diagnosing a nail bed injury and fracture of distal phalanx in patients presenting with distal finger trauma to the emergency department (ED). MethodsPatients, 18 to 65 years old, presenting with a blunt trauma of distal finger and diagnosed with subungual hematoma were eligible for the study. Subungual hematoma extending over more than 50%, fracture of distal phalanx, and disruption of periungual tissue or nail integrity were accepted as the indications for nail bed inspection. All the study patients underwent POCUS to detect the existence of a distal phalanx fracture or nail bed injury. X-ray was also obtained from all the patients. ResultsNail bed was visualized in 45 patients. Squeezing and crush injury were the most reported trauma mechanism in study patients (66.7%). The sensitivity and specificity of POCUS in detecting nail bed injury were 93.4% (95% CI, 80%-99%) and 100% (95% CI, 74%-100%), respectively. The sensitivity was 100% (95% CI, 79%-100%), and specificity was 98.4% (95% CI, 91%-100%) for distal phalanx fracture. ConclusionPoint-of-care ultrasound is a promising tool in detecting the nail bed injury and distal phalanx fractures in patients presented with distal finger trauma. Further studies with bigger sample size are needed to reveal the diagnostic ability of POCUS before using it regularly in the ED.

Referral patterns of Israeli pediatricians of common primary care office procedures.

BackgroundPediatric primary care is the cornerstone of health care services for children. Performance of common office procedures is an integral part of primary care. Ideally, the community-based primary care pediatrician provides comprehensive health care services and only refers a small minority of patients for consultation. However, knowledge regarding Israeli pediatricians’ practices of office procedures is scant.ObjectivesTo describe primary care pediatricians’ patterns in the provision of common office procedures and to analyze factors associated with performance or referral.MethodsDesign: Self-completed structured questionnaire consisting of 1) demographic variables; 2) practice characteristics description; 3) List of ten procedures (treatment of subungual hematoma, laceration suturing and adhesive closure, elbow subluxation/reduction , urinary bladder catheterization, supra-pubic aspiration, inguinal hernia reduction, umbilical granuloma and labial fusion treatment, and short lingual frenulum management) followed by questions regarding referral practice for each procedure; and 4) causes and indications for referral when relevant. Participants: Primary care pediatricians attending anational pediatric conferences. Analysis: Descriptive statistics and association assessment.ResultsThe questionnaire was completed by 162 primary care pediatricians, 58.7 % male; mean age 53 ± 9 years, 88.4 % board certified. Of the respondents, 57 % worked in group practices and the remainder solo; salaried employees 68.2 %, independent contractors 31.8 %.Referral rate varied by procedure; least likely to be referred was labial fusion (7.7 %) and most likely was short lingual frenulum (81.3 %). For most procedures, the most frequent non-performance cause was lack of expertise followed by lack of appropriate conditions. The overall number of procedures in which the response selected was out-of-clinic referral was not associated with demographic or employment characteristics. However, association was found for certain specific procedures (e.g. experience with catheterization, gender with suturing and adhesive closure).Conclusions Many common office procedures are referred out of primary care pediatric community settings in Israel. Considerable variability was found among procedures. Lack of experience or lack of appropriate conditions were frequently reported causes for referral and need to be addressed in reducing unnecessary referral with its attendant costs and patient inconvenience. Possible approaches include updates in pediatric residency training, focused in-service training, time allocation and work environment reorganization.

Subungual Hematoma in the Mountains

Subungual Hematoma in the Mountains

Persistent subungual and periungual hematoma versus melanoma: to cut it or to leave it?

Dermatologic TherapyVolume 29, Issue 3 p. 150-151 Therapeutic Hotline: Letters Persistent subungual and periungual hematoma versus melanoma: to cut it or to leave it? Georgi Tchernev, Corresponding Author Georgi Tchernev Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak street 1, Sofia, BulgariaAddress correspondence and reprint requests to: Georgi Tchernev, Associate Professor, Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak street 1, Sofia, Bulgaria, or email: georgi_tchernev@yahoo.de.Search for more papers by this authorAnastasiya Atanasova Chokoeva, Anastasiya Atanasova Chokoeva “Onkoderma”-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, BulgariaSearch for more papers by this authorUwe Wollina, Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanySearch for more papers by this authorTorello Lotti, Torello Lotti University of Rome “G. Marconi”, Rome, ItalySearch for more papers by this author Georgi Tchernev, Corresponding Author Georgi Tchernev Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak street 1, Sofia, BulgariaAddress correspondence and reprint requests to: Georgi Tchernev, Associate Professor, Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, University Hospital Lozenetz, Koziak street 1, Sofia, Bulgaria, or email: georgi_tchernev@yahoo.de.Search for more papers by this authorAnastasiya Atanasova Chokoeva, Anastasiya Atanasova Chokoeva “Onkoderma”-Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, BulgariaSearch for more papers by this authorUwe Wollina, Uwe Wollina Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanySearch for more papers by this authorTorello Lotti, Torello Lotti University of Rome “G. Marconi”, Rome, ItalySearch for more papers by this author First published: 03 September 2015 https://doi.org/10.1111/dth.12293Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume29, Issue3May/June 2016Pages 150-151 This article also appears in:Spotlight: Professor Torello Lotti RelatedInformation

Diagnostic applications of nail clippings.

"Nail clipping is a simple technique for diagnosis of several nail unit dermatoses. This article summarizes the practical approach, utility, and histologic findings of a nail clipping in evaluation of onychomycosis, nail unit psoriasis, onychomatricoma, subungual hematoma, melanonychia, and nail cosmetics, and the forensic applications of this easily obtained specimen. It reviews important considerations in optimizing specimen collection, processing methods, and efficacy of special stains in several clinical contexts. Readers will develop a greater understanding and ease of application of this indispensable procedure in assessing nail unit dermatoses."

Tips for diagnosis and treatment of nail pigmentation with practical algorithm.

The observation of a black-brown pigmentation of the nail is often alarming for the patient and for the clinician, as they are aware that it can be a possible clinical manifestation of melanoma of the nail apparatus. Luckily, however, nail melanoma is a much less frequent cause of brown-black nail color than other melanocytic and nonmelanocytic pigmentations, which include subungual hematoma, exogenous pigmentations, and melanonychia due to benign conditions. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide the correct management of melanonychia both in children and in adults.

Diagnosing and treating nail trauma

Practice NursingVol. 26, No. 1 DermatologyDiagnosing and treating nail traumaJean WatkinsJean WatkinsSearch for more papers by this authorJean WatkinsPublished Online:29 Dec 2014https://doi.org/10.12968/pnur.2015.26.1.27AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Brannon H (2014) Nail anatomy. http://dermatology.about.com/cs/nailanatomy/a/nailanatomy.html (accessed 12 December 2014) Google ScholarCity Chiropody (2014) Ingrown vs involuted toenails. http://citychiropody.co.uk/blog/ingrown-vs-involuted-toe-nails.html (accessed 5 December 2014) Google ScholarDawber R et al. (2003) A Text Atlas of Nail Disorders–Techniques in Investigation and Diagnosis. 3rd edn. Martin Dunitz, London Google ScholarFeied C, Smith M, Handler J, Gillam M (2012) Finger or toenail avulsion. www.ncemi.org/cse/cse1004.htm (accessed 5 December 2014) Google ScholarFell S (2014) Subungual haematoma (bleeding under the nail). www.emedicinehealth.com/subungual_hematoma_bleeding_under_nail/article_em.htm (accessed 5 December 2014) Google ScholarGP Notebook (2008) Nail biting (onychophagia). http://tinyurl.com/k5hzc6o (accessed 5 December 2014) Google ScholarHoy N, Leung A, Metelitsa A et al. (2012) New concepts in median nail dystrophy, onychomycosis, and hand, foot and mouth disease nail pathology. ISRN Dermatology. doi: https://doi.org/10.5402/2012/680163 Crossref, Google ScholarJoint Formulary Committee (2014) British National Formulary 68. September. BMJ Group and Pharmaceutical Press, London Google ScholarKimberly L, Stashhower M (2004) Traumatic transverse leukonychia. www.medscape.com/viewarticle/467074 (accessed 5 December 2014) Google ScholarLeung A, Robson W (1990) Nail biting. Clin Paediatri (Phila)12: 690–2 Crossref, Google ScholarMayo Clinic (2014) Does nail biting cause any long-term nail damage? www.mayoclinic.org/healthy-living/adult…/nail-biting/faq-20058548 (accessed 5 December 2014) Google ScholarNHS Choices (2013) Foot problems and the podiatrist. www.nhs.uk/Livewell/foothealth/Pages/Foot-problems-podiatrist.aspx (accessed 5 December 2014) Google ScholarSentry S (2009) How fast do nails grow? www.wisegeek.com/what-is-leukonychia.htm (accessed 5 December 2014) Google ScholarWang Q, Johnson B (2001) Fingertip injuries. Am Fam Physician 63(10): 1961–6 Google ScholarWeaver B (2014) Onychogryphosis (Ram's Horn nails). www.footvitals.com/toenails/onychogryphosis.html (accessed 5 December 2014) Google ScholarWest L (2001) Onychorrexis–Brittle nails. www.medicineonline.com/topics/O/2/Onychorrhexis/Brittle-Nails.html (accessed 5 December 2014) Google Scholar FiguresReferencesRelatedDetails 2 January 2015Volume 26Issue 1ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Published online 29 December 2014 Published in print 2 January 2015 Information© MA Healthcare LimitedKeywordsNailsfingerstoesnail diseasesPDF download

Severe generalized tetanus: A case report and literature review

Tetanus is a toxin-mediated disease produced by the bacterium Clostridium tetani characterized by generalized rigidity and muscle spasms that may cause respiratory arrest and death. Tetanus typically gains access to the body through apparent or unapparent wounds. Implementation of mandatory vaccination programs has successfully decreased the prevalence of this disease worldwide. We report a case of severe, generalized tetanus in a male patient who presented to the emergency department with dysphagia and back stiffness with no clear history of any trauma, except small subungual hematoma found on physical examination. The patient was admitted to the Intensive Care Unit, received the full supportive therapy for tetanus, and discharged home in good condition.

Management of simple nail bed lacerations and subungual hematomas in the emergency department.

Fingertip crush injuries are common hand injuries in children and often are evaluated initially in an emergency department. Nail bed injuries can be classified into subungual hematomas, simple or stellate lacerations, crush injuries, and avulsions. Emergency department physicians with good knowledge of fingertip anatomy can appropriately manage these injuries so as to prevent long-term fingertip deformities and functional deficits. The management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial with much debate surrounding the necessity of removing the nail plate for repair of a nail bed laceration versus trephination alone of a large subungual hematoma. This article will discuss the management and evaluation of simple nail bed injuries by emergency department physicians to prevent chronic nail and fingertip deformities.

Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department

Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department

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Evacuating a subungual hematoma in the office.

Dermoscopy on subungual melanoma

Subungual melanoma is a rare, but one of the diagnostically most difficult variants of melanoma. Unfortunately, due to its late detection, lack of an early reaction from the patient and diagnosis in advanced stages, subungual melanoma is deemed as a prognostically unfavorable variant of this malignancy. Diagnosis of subungual melanoma is very difficult to establish merely on the basis of clinical examination due to the resemblance of subungual hematoma to melanocytic nevus, fungal or bacterial infections. Dermoscopy seems to be the ideal diagnostic tool in the differential diagnosis of this life-threatening disease. To describe the basic aspects of dermoscopy of subungual melanoma and other conditions involving the nails. Review of medical database PubMed for the literature of the last 10 years on the dermoscopic patterns of subungual melanoma and other subungual diseases. We collate the fundamental rules of performing dermoscopy in subungual melanoma, as well as basic dermoscopic features and diagnostic algorithms of selected subungual lesions requiring differentiation from melanoma. Dermoscopy is a safe, easily repeatable diagnostic method, and the knowledge of basic dermoscopic patterns of developing melanoma in subungual localization, along with the differential diagnosis of other diseases within the nail plate, will help not only dermatologists, but also the professionals of other specialties, such as surgeons, oncologists, orthopedists, and also general practitioners.

Feet injuries in rock climbers.

While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.

Nail Involvement in Leprosy

Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients. The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M leprae infection.

THE MANAGEMENT OF THE ACUTE TRAUMATIC SUBUNGUAL HAEMATOMA: A SYSTEMATIC REVIEW

There is no consensus regarding the optimal mode of managing the acute traumatic subungual haematoma in the hand. In this context the medical literature was searched systematically and the results analysed. The final dataset consisted of four articles. The complication rates of all forms of treatment were low. The outcome in terms of nail cosmesis was generally good, although the method of outcome measurement was variable in nature. There was no difference in cosmetic outcome when comparing nail bed repair with simple decompression. In conclusion the outcome in terms of nail cosmesis does not appear to be affected by the mode of treatment. The acutely painful subungual haematoma should be decompressed, whether this be done by trephining or nail removal. Future research includes the potential for a randomised controlled trial to compare nail bed repair with trephination.

Misdiagnosed, Mistreated And Delay Diagnosed Acral Melanoma: The Atypical Presentations

Background: Acral skin is the most common site of malignant melanoma in non-Caucasian population. Diagnosis in this anatomic site is often delayed because this area is not routinely examined by patients or primary physicians. Objective: To perform an earlier diagnosis underlining the importance of dermoscopy helping clinicians to differentiate this disease from the other lesions and biopsies will result in more timely diagnoses and improved survival. Methods: We present 6 case studies visited in our Department of Dermatology of Naples University between October 2010 and September 2012. Results: These lesions often mimic other entities like warts, calli, bacterial or fungal infections, foreign bodies, vascular lesions, blisters, melanocytic nevi, subungual hematomas, pyogenic granulomas, onychomycosis, keratoacanthomas, diabetic foot ulcers, traumatic lesions that can lead to misdiagnosis and mistreatment. Conclusions: Awareness of atypical presentations of acral melanoma may be important to decrease misdiagnosis rates and improve patient outcome.

Las uñas en la lepra

Leprosy, a disease caused by Mycobacterium leprae, primarily affects the skin and nerves, but the nails are also involved in as many as 3 out of 4 patients .The factors that trigger nail changes in leprosy are numerous and include repeated trauma, neuropathy, vascular impairment, infections, lepra reactions, and the drugs used to manage the disease. The changes most often reported include subungual hematomas, onycholysis, onychauxis, onychogryphosis, pterygium unguis, and onychoheterotopia, most of which can be attributed to nerve damage and trauma. Furthermore, the acro-osteolysis that occurs in the advanced stages of the disease may present with brachyonychia, racquet nails, or even anonychia. Infections of the nail bed leading to paronychia and onychomycosis should also be taken into account in leprosy. Other typical changes include longitudinal striae, pitting, macrolunula, Terry nails, leukonychia, hapalonychia, and Beau lines. In this review, we describe the principal nail changes associated with leprosy. These changes, which are highly varied and diverse in origin, are in fact a reflection of the significant morbidity caused by M leprae infection.

Surgical treatment of acute fingernail injuries

The fingernail has an important role in hand function, facilitating the pinch and increasing the sensitivity of the fingertip. Therefore, immediate and proper strategy in treating fingernail injuries is essential to avoid aesthetic and functional impairment. Nail-bed and fingertip injuries are considered in this review, including subungual hematoma, wounds, simple lacerations of the nail bed and/or matrix, stellate lacerations, avulsion of the nail bed, ungual matrix defect, nail-bed injuries associated with fractures of the distal phalanx, and associated fingertip injuries. All these injuries require careful initial evaluation and adequate treatment, which is often performed under magnification. Delayed and secondary procedures of fingernail sequelae are possible, but final results are often unpredictable.

Nail bed injury detected by ultrasonography

A 46-year-old man presented to the emergency department after being injured with a press machine from his left hand 30 minutes before admission. Subungual hematoma was diagnosed in his index finger, although the nail plate was intact. Emergency physicians could identify nail bed injury with bedside ultrasonography examination. This noninvasive, inexpensive, and repeatable diagnostic modality could preserve patients from a complex, invasive nail removal procedure.