What should you consider if there is a subungual hematoma that involves more than 50% of the nail bed?

In cases of a subungual hematoma that involves more than 50% of the nail bed, it is critical to assess for possible underlying fractures or injuries to the distal phalanx. When a significant portion of the nail bed is affected, it can indicate not only the presence of a hematoma but also that there may be associated injuries to the bone beneath, which may not be immediately visible.

Ordering X-rays would help determine if there is a fracture present, as radiographic evaluation is essential in guiding appropriate treatment and management. This approach ensures that potential complications, such as improper healing or infection, are minimized.

In contrast, other options may not adequately address the complexity of the situation. Immediate trephination can relieve pressure from the hematoma but may not be warranted if serious underlying injuries are suspected. Simply taking no action overlooks the necessity of evaluating for fractures, and administering antibiotics without clear evidence of infection may lead to unnecessary medication use without addressing the primary concern of potential skeletal injury.