Abstract
CASE HISTORY: A 21-year-old collegiate baseball athlete presented 15 minutes after an acute right index finger ball-strike injury sustained while fielding ground balls pregame. He reported immediate throbbing pain, pressure, swelling, and nailbed discoloration, without numbness or prior injury to the digit. PHYSICAL EXAM: Initial evaluation demonstrated marked subungual hematoma, focal tenderness greatest at the distal interphalangeal joint/distal phalanx, pain-limited DIP flexion, pain with resisted DIP extension, intact sensation, brisk capillary refill, and preserved distal neurovascular status. At hand follow-up 1 week later, the DIP joint was stable, there was no extensor lag, and the athlete was able to throw with some pain. DIFFERENTIAL DIAGNOSES: Subungual hematoma; distal phalanx tuft fracture; nail-bed injury; DIP joint sprain/contusion; terminal extensor tendon injury. TESTS & RESULTS: Initial office radiographs demonstrated normal alignment without obvious acute fracture or dislocation. Therapeutic trephination was performed with electrocautery, yielding bloody drainage and immediate symptomatic improvement. Follow-up finger radiographs obtained 5 days later demonstrated a tiny curvilinear lucency through the tip of the right 2nd distal phalanx, consistent with a nondisplaced tuft fracture. FINAL DIAGNOSIS: Acute right index finger subungual hematoma with nondisplaced distal phalanx tuft fracture. DISCUSSION: Fingertip ball-strike injuries in baseball may initially present as an isolated subungual hematoma, while subtle tuft fractures can be radiographically occult on index imaging. This case underscores the importance of serial assessment, mechanism-specific suspicion, and symptom-guided follow-up imaging in persistent distal phalanx pain after negative initial films. OUTCOME OF THE CASE: Trephination was well tolerated without complication and produced immediate decompression and pain relief. At follow-up, symptoms had improved substantially, the DIP remained stable, and no extensor lag was present. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Hand surgery cleared the athlete for continued baseball activity as tolerated; if he could throw and manage symptoms, full restriction was not required. Follow-up was PRN.
Recommended Citation
Johnson, Stephanie; Gruber, Joshua; Chu, Justin; and Stamatis, Andreas
(2026)
"Acute Subungual Hematoma With Nondisplaced Distal Phalanx Tuft Fracture – Baseball,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
8, Article 24.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss8/24