Freddy’s Finger: A case study of traumatic amputation and healing by secondary intention instead of termination

Ms Michelle Cruse1

1Southern NSW Local Health District, Pambula District Hospital, Australia

How often do we see and treat a patient in the ED and then wonder what happened to them, or what the final outcome was? So often we just don’t know, patients get swallowed up in the black hole of the wards, or inter-hospital transfer, and are lost to us in the daily rush of a new set of ED presentations. By knowing the various ways an injury can be managed allows us as ED nurses to provide information to our patients or to further explain/interpret treatment options if they are given a choice by Specialist services.

This Case Study presentation follows Freddy, a RH dominant chef who had the poor form to drop his boat on his L middle finger when trying to put it onto the tow ball, thus causing a traumatic fingertip amputation. Management was offered in one of two ways, 1. Termination with flap at the DIPJ, or 2. Heal by secondary intention following surgical washout and distal phalanx trimming. The presentation (with all its glorious pictures!) demonstrates the outcome of choice no 2 – the longer healing time option but the one that ultimately ensured less deformity, and gave a better aesthetic outcome. Freddy returned to the Assessment and Treatment Centre for regular dressings which provided an excellent opportunity to track progress, problem solve dressing and other issues to allow Freddy to continue to work. Freddy has given permission for this Case Study to be presented today.


Michelle has an extensive nursing background including orthopaedics, burns, education and finally settling in emergency. Michelle has been an emergency Nurse Practitioner for the last 9 years, first in Adelaide metropolitan, then remote small hospital in the WA Kimberley region, and now in southern NSW.  Nurses making a positive difference – to their patient and families, and to each other – is central to Michelle’s personal nursing philosophy. Michelle is a long-standing CENA member holding committee positions in including SA Branch President, National Board Member and is a current CENA Fellow.