No is the straight answer to this question in most cases. A study in 1991 aimed to assess the safety and efficacy of treating simple subungual hematomas (SUH) with nail trephination alone, without resorting to nail removal and suture repair.
Over a 2-year period, 48 eligible patients underwent nail trephination using electrocautery. Radiographs were taken to identify any distal phalangeal fractures, and SUH size was measured. All patients experienced pain relief post-procedure, and follow-up was achieved in 45 of 48 patients over an average period of 10.3 months.
No complications, such as infection, osteomyelitis, or major nail deformities, were reported in any patients treated with nail trephination, regardless of SUH size or the presence of a fracture. The study concludes that, in cases of simple SUH, nail removal with suture repair is unnecessary.
David C. Seaberg, William J. Angelos, Paul M. Paris, Treatment of subungual hematomas with nail trephination: A prospective study, The American Journal of Emergency Medicine, Volume 9, Issue 3,
1991.
https://doi.org/10.1016/0735-6757(91)90077-W.