They suggest that trephining a nail with an underlying fracture should only be carried out when there is sufficient pain to justify it. If trephining is used, the patient should understand the potential risk of developing osteomyelitis, as well as the need to keep the finger clean and dry.

Is nail trephination necessary?

Subungual hematomas should be treated with nail bed trephination, as the progressive pressure from fluid accumulation is painful. This is easily done with an 18-gauge needle and universal precautions.

When do you need nail trephination?

The procedure, called a nail trephination, is useful when performed within the first 48 hours. If your subungual hematoma happened due to a severe injury, you should also see a healthcare provider because there may be a toe or finger fracture.