How to Care for Your Child with Subungual Hematoma

This leaflet will provide you with information about subungual hematoma (blood under the fingernail or toenail) causes, symptoms, diagnosis, treatment and home care advice.

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What it is subungual hematoma?

A subungual hematoma is blood trapped under a fingernail or toenail after trauma. This is usually caused by a blow to the fingernail or toenail, such as a crush in a door jamb, stubbing one's toe.

What are the symptoms of subungual hematoma?

A child with a subungual hematoma might feel a throbbing pain caused by blood under a fingernail. This often becomes worse as the blood spreads and usually goes away after the blood is drained.

How is subungual hematoma diagnosed?

The doctor will ask few questions about your child's health and examine your child to see if the nail is still intact. Your doctor will decide if further investigations are required

How is subungual hematoma treated?

Subungual hematoma can be drained by a procedure called "Trephination", which consists of placing one or more holes in the nail to permit blood drainage. This procedure is helpful if:

  • The injury occurred within the last 48 hours
  • Subungual hematoma is causing a lot of pain

Home care advice

  • Soak your child's finger or toe in warm, soapy water three times a day for the next two days. Be sure to keep the bandage on between soaks.
  • Some drainage of blood from the small hole is normal.
  • Follow your doctor advice on putting bandages on the injured area
  • If your child has a broken bone or a lot of swelling or pain, place ice wrapped in a towel over the injury to help the swelling and pain. Hold ice in a towel against the finger or toe for 15-20 minutes every 3-4 hours for the next 48 hours.
  • If the finger or toe is very swollen, raise it above the heart level by propping it up on a pillow as much as possible in the first few days.
  • If a splint was placed, follow the doctor's directions for caring for the splint.
  • For pain, you may give acetaminophen OR ibuprofen, if recommended by your doctor.

When should I seek medical advice or?

Seek medical advice if:

  • Your child has continued pain in the area.
  • Swelling or redness does not improve.
  • You notice that blood is again spreading under the nail and causing pain.
  • You see signs of infection in the area, such as redness, warmth, or excessive swelling.
  • Your child has a fever of 100.4°F (38°C) or higher.