Provider Prepared's Weekly Pearl of Wound Wisdom #32 Smashing!

A 50 year old male presents to the Emergency Department after smashing his left thumb with a sledge hammer. He has increasing pressure like pain associated with increasing subungual hematoma.

Pain associated with a subungual hematoma is caused by pressure building in a contained space between the nail bed and the nail plate.

Trephination is indicated for the relief of pressure and thus pain of a  subungual hematoma; when the injury is less than 24-48 hours old, is not draining spontaneously, and has intact nail folds. Trephination can be accomplished with electrocautery devices or with the boring technique using a needle. Use of a heated paperclip is discouraged, many paperclips are now made of materials that are not capable of retaining sufficient heat for trephination.                                           Fastle, RE et al. Subungual hematoma. UpToDate  December 2016.

Provider Prepared's Laceration Repair Kits come with a selection of needles that allow you to perform the boring technique at home. Check out our smashing options for honest and affordable wound care at home and on the go.

Provider Prepared

Nathan Whittaker, MD

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