The family physician (FP) diagnosed a subungual hematoma and a possible fracture of the distal phalanx (FIGURE 1) in this patient. The FP offered to drain the hematoma, but did not have access to an electrocautery unit. While the patient was scared, she consented to any procedure that would give her pain relief.
The FP opened a paperclip, held it in a hemostat, and heated it with a torch. With a little pressure the hot paperclip pierced the patient’s nail plate and the blood spontaneously drained (FIGURE 2). This relieved the pressure and gave the patient immediate pain relief. The remaining old blood was drained with a little pressure on the proximal nail fold (FIGURE 3). While the FP was concerned about a possible underlying fracture, the patient did not have health insurance and chose to postpone an x-ray. The toe was bandaged and the patient was given directions to keep it elevated and avoid unnecessary standing and walking. Her toe healed well and no radiographs were ever taken.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ. Subungual hematoma. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:842-844.
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