Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.

EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research

and education and education purposes only. The opinions expressed on this podcast are intended for

information and education purposes only and should not be used to diagnose treat or prevent any medical

condition, nor should they be used as a substitute for medical advice from qualified practicing

physician. In part one of this two-part podcast series with doctors Aaron C.L. and Matt

de Staphano, we explored general principles of hand injuries, tips and tricks

for an efficient physical exam assessment, assessing the compartments, analgesic options,

splinting, and a lot more. In this second part of the podcast, I'd like to run through

some common and some not so common injuries, some that are easy to

diagnose, but we sometimes fall down and managing them appropriately, and then some that

are more difficult to diagnose, and we sometimes miss them altogether.

So the one that's easy to diagnose where there are management pitfalls to avoid are fingertip

injuries.

And when I say fingertip injuries,

I mean skin evulsions, amputations, nail bed injuries, and tough fractures. So let's start with fingertip amputations. We touched on this a little bit in part one, but I want to kind of do a bit

of a deeper dive here. Dr. Diastafno, how do you classify fingertip amputations and why is the classification important

for making management decisions? There's a couple different descriptors, Anton, about

classifying these things, but basically it's zone one, two, three of the fingertip, and it's from the very tip of the finger

to the DIP joint. And quite simply, if it just involves soft tissue, some amount of the

fingertip has been amputated, but you don't see exposed bone, that's zone one. If you get into the

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