1. Hand injuries

2. Priorities 4 Function, Function, Function! 4 Must be able to test sensory, motor and tendon function. Should be able to draw a cross-section of wrist. If tendon, nerve or vascular injury, consult.

3. Know the location of all important deep structures

4. Priorities 4 Adequate coverage of important structures 4 Consider if simple repair of laceratons crossing joint will lead to limiting contracture 4 Must know proper bandaging and splinting

5. Method for sterile field and exsanguination of digit

6. Why a “fight bite”, even seen early needs exploration. Hidden tendon injury and joint violation

7. Anatomy of finger nail

8. “Trap door” will have associated nail bed injury and probable open fracture

9. Remove nail with blunt dissection with iris scissors then pull with clamp

10. Use cleaned whole nail as dressing, base under cuticle to prevent nail matrix to eponychium adhesion. If nail not possible, adaptic or foil from suture package

11. After nail removal 4 Irrigate open wound carefully, remove foreign material, 4 Debride conservatively if at all, very little excess tissue for repair 4 Close nail bed laceration with 6-0 absorbable (eccentric hand guys would use 8-0 and loops, If you try this you will need very fine instruments, such as castro-viejo driver and tying forceps)