1. Haematoma of a fingernail.
Dr. P.T.Kenny.

2. Introduction
A finger caught in a car door or hit with a hammer, may end up with a haematoma underneath the nail.
Even slight swelling of a finger causes discomfort due to lack of elasticity of the skin.
Due to pressure causing pain, a traumatic haematoma of a finger usually needs to be drained.

5. Treatment options 1) Make a hole in the nail.
2) Dissect the skin fold loose from the nail.
3) Remove the nail (not recommended).
4) Pain killers only, etc.

7. Making a hole in the nail
A ring block of the injured finger is optional.
Straighten one end of a paper clip and then bend it to 90 degrees.
A piece of cotton wool soaked in spirits, or a Webcol swab is placed in a metal kidney dish.
Now set it alight.

8. Procedure continued...
Wrap the ‘handle’ of the paper clip in a swab to protect yourself from being burnt by the hot paper clip.
Then hold the straightened end in the flame until it glows red.
Burn a hole in the nail where the haematoma is, taking care not to press down hard -- you will burn through the nail, into the nail bed!

9. Result
As soon as you burn through the nail, the blood will stream out.
Gently press on the nail to drain out all the blood.
The pressure is thus released.

11. Dressing the finger
The hole in the nail will take some time to grow out.
Dirt or bacteria may enter through this hole and cause infection under the nail.
Apply antiseptic cream and a bandage for a few days.
If all is well at follow up, consider sealing the hole with a drop of super glue.

12. Alternative method:
Take a no.15 surgical blade and gently dissect the nail fold loose from the nail.
Blood will stream out the moment you have cut it loose.
Gentle pressure on the nail will force out all the blood.
Antiseptic cream and a bandage for a few days is all that is needed.