The management of subungual hematomas is still somewhat controversial. The approach to management was initially very aggressive, since subungual hematomas are often seen with fractures of the distal phalanx, damage to the nail, and damage to the nail apparatus.1,2,4–8 The surgical literature generally recommends removal of the nail, inspection of the nail bed, and repair of any nail bed injury if the subungual hematoma involves 25% or more of the nail surface.1,2,4–9 This practice has been questioned recently by newer controlled studies that demonstrated excellent outcomes in patients with large (greater than 25%) subungual hematomas treated by trephination alone, regardless of the presence of fractures.11,12 Larger hematomas involving over 50% of the nail surface may be treated successfully with trephination. Many authors, primarily Hand Surgeons, still advocate the removal of the nail plate to thoroughly inspect the nail bed and effect repair in all patients who present with a subungual hematoma. Although this approach is time-honored, more recent studies have demonstrated that it is not necessary if the patient's nail is still attached to the matrix, even in the presence of a distal phalanx fracture.11,12