J. Chee, MD

I enjoyed reading “Finger injuries: 5 cases to test your skills” (J Fam Pract. 2013;62:300-304), but was a little surprised to see the answer for Case 5. Fenestrating a subungual hematoma with a known or unknown underlying fracture has been controversial, in that doing so effectively converts a closed fracture into an open one.  Though rare, fenestration can lead to infection, raising the potential for liability—especially if any loss of function occurred.

At the very least, informed consent should be part of the conversation in such a case, with a thorough discussion of risks, benefits, and alternative treatments. Personally, I would lean toward a trial of pain control, especially with a known fracture on x-ray.

J. Chee, MD
Pittsburgh, Pa

I enjoyed reading “Finger injuries: 5 cases to test your skills” (J Fam Pract. 2013;62:300-304), but was a little surprised to see the answer for Case 5. Fenestrating a subungual hematoma with a known or unknown underlying fracture has been controversial, in that doing so effectively converts a closed fracture into an open one.  Though rare, fenestration can lead to infection, raising the potential for liability—especially if any loss of function occurred.

At the very least, informed consent should be part of the conversation in such a case, with a thorough discussion of risks, benefits, and alternative treatments. Personally, I would lean toward a trial of pain control, especially with a known fracture on x-ray.

J. Chee, MD
Pittsburgh, Pa

I enjoyed reading “Finger injuries: 5 cases to test your skills” (J Fam Pract. 2013;62:300-304), but was a little surprised to see the answer for Case 5. Fenestrating a subungual hematoma with a known or unknown underlying fracture has been controversial, in that doing so effectively converts a closed fracture into an open one.  Though rare, fenestration can lead to infection, raising the potential for liability—especially if any loss of function occurred.

At the very least, informed consent should be part of the conversation in such a case, with a thorough discussion of risks, benefits, and alternative treatments. Personally, I would lean toward a trial of pain control, especially with a known fracture on x-ray.

J. Chee, MD
Pittsburgh, Pa