Hyperextension mallet finger.

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Abstract

12. Subungual Hematoma Drainage. Sequeira Campos MB(1), Launico MV(2). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. 2025 Jun 24. Author information: (1)King's College London (2)De La Salle Medical and Health Sciences Institute Subungual hematomas result from bleeding beneath the nail due to nail bed injury (see Image. Subungual Hematoma). Patients typically report pain and nail discoloration. Direct blows or crush injuries to the distal phalanx, such as pinching a finger in a doorway, often cause this damage. Accumulating blood increases pressure on the nail bed, causing significant pain. Associated injuries include distal phalanx fractures, nail avulsion, or fingertip avulsions. Simple trephination, which involves creating a small hole in the nail, typically relieves most hematomas. Larger hematomas or those with suspected underlying nail bed lacerations require removal of the nail plate and direct repair of the nail bed. Prompt assessment and intervention provide pain relief and reduce the risk of long-term complications, including nail dystrophy and infection. Physical Examination The entire nail structure should be examined for disruption of the nail fold, and the whole finger should be assessed for motor function, sensation, and circulation. The extensor mechanism of the distal interphalangeal joint should be evaluated by holding the middle phalanx and testing the strength of extension by applying resistance to the motion. A decrease in strength compared to the contralateral side indicates mallet finger injury. Circulation should be tested by assessing capillary refill distal to the injury. In some patients, such as small children, a digital nerve block may be performed to facilitate examination and reduce discomfort. A thorough neurovascular assessment is essential to rule out associated injuries that may require urgent surgical intervention. Testing Three-view radiographs should be obtained to evaluate for underlying fractures, as distal tuft fractures are commonly associated with them. Point-of-care ultrasound may be used to identify nail bed lacerations and underlying distal tuft fractures that suggest the need for a more involved repair. This imaging modality has emerged as a valuable tool, providing real-time visualization and aiding in decision-making regarding nail plate removal and formal nail bed repair, particularly when clinical suspicion for significant nail bed laceration is high. Copyright © 2026, StatPearls Publishing LLC.