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How a paper clip and a flame can save a fingernail

For 20 years running, we shared New Year’s Eve with college friends and their families.

One such celebration began with a minor but painful injury. Before leaving on a three-hour drive to our host’s house, I heaved wood into our wood furnace. The last chunk – rock maple 2-feet long and 1-foot wide – bounced off a lip inside the loading door and landed on my left index finger – a crush injury.

It wasn’t long before I was driving with my finger raised to slow swelling and to mitigate pain. Short of our destination, I stopped for a cup of ice. Then, no longer driving, I held my finger, in ice, above my head.

On arrival, blood was present under about half the nail – a subungual hematoma. Bleeding and resulting pressure below the nail causes substantial pain. I immediately asked our hosts for a beer, a lighter and a paper clip – in that order. The cure was simple, effective and immediate.

As a kid, I had a similar crush injury, treated by a local doctor. He rotated the point of a scalpel through the nail, draining the blood and relieving the pressure and pain. Another method, described by a lifelong machinist, was using a drill bit, rotated by hand, to poke a hole the nail. Apparently, crush injuries were not rarities, and drill bits are not scarcities in machine shops.

For many decades, the emergency room standard was the paper clip, not 1-inch but 2-inch – the hole from the smaller-diameter wire may clot before drainage is complete.

The clip is partly uncoiled and heated red-hot with match or lighter. Centered over the hematoma, it is quickly pressed into the nail, often resulting in a spurt of blood and almost immediate pain relief. One detail: Whether a scalpel, drill bit or paper clip, a jolt of pain may occur when the tool hits the nail bed. However, it is virtually impossible to go too deep. The finger is withdrawn with the speed of light – one Navy chaplain exploded with expletives that would have made a sailor cringe. We’re all human.

The proximity of oxygen apparatuses in exam and treatment rooms ended decades of using flame and paper clip in the ER. Fire is explosive in the presence of 100 percent oxygen. (Most ER folks have seen an oxygen user or two with a melted nasal cannula and facial burns from lighting a cigarette while oxygen is flowing.) Today, there are battery-powered, penlight-sized drills and a similar tool with a heated filament to make holes in fingernails.

A hematoma should be drained before the blood clots, usually within hours, not days, post injury. Drainage often avoids or delays nail loss by protecting the nail bed. Fingernails grow at a tenth of a millimeter per day, so nail preservation is worthwhile. It can take three to six months for a lost nail to grow back.

Finally, a confession: After I slammed my finger in a car door, an orthopedist’s receptionist gave me a Band-Aid. My finger hurt terribly. Days later, I removed the Band-Aid to find subungual hematoma. I was too late, and I lost the nail.

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.



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