Finger amputation: Difference between revisions
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==Background== | ==Background== | ||
[[File:Wrist and hand deeper palmar dissection.svg|thumb|Wrist and hand deeper palmar dissection]] | |||
*Due to either blunt or penetrating trauma | *Due to either blunt or penetrating trauma | ||
==Clinical Features== | ==Clinical Features== | ||
*Partial or complete amputation of finger | [[File:PMC4624359 13032 2015 28 Fig11 HTML.png|thumb|Complete amputation at the level of the PIP joint of the right index finger without distal circulation, along with the crush fracture on the proximal phalangeal bone of middle, ring and little fingers.]] | ||
*Partial or complete amputation of finger(s) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX distal finger}} | |||
{{Hand and finger injury DDX}} | {{Hand and finger injury DDX}} | ||
==Evaluation== | ==Evaluation== | ||
[[File:PMC4624359 13032 2015 28 Fig3 HTML.png|thumb|An X-ray image of injured hand with finger amputations.]] | |||
===Workup=== | |||
*Hand/finger x-rays | |||
**X-ray limb and amputated part (if available) | |||
*Consider pre-op labs | |||
===Diagnosis=== | |||
*Clinical diagnosis | *Clinical diagnosis | ||
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*If amputated finger available, irrigate and wrap in moist sterile gauze | *If amputated finger available, irrigate and wrap in moist sterile gauze | ||
**Place in plastic bag and put bag in ice water (do not put finger directly on ice!) | **Place in plastic bag and put bag in ice water (do not put finger directly on ice!) | ||
*[[Tdap|Tetanus Prophylaxis]] if > 5 years since last vaccination | *[[Tdap|Tetanus Prophylaxis]] if > 5 years since last vaccination | ||
*Antibiotics: Ancef 2 grams | *Antibiotics: Ancef 2 grams | ||
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==Disposition== | ==Disposition== | ||
===Admit=== | |||
*Plan for reimplantation or immediate surgery | |||
*Infection | |||
===Discharge=== | |||
*Distal phalanx amputation with controlled bleeding | |||
==External Links== | ==External Links== | ||
Latest revision as of 14:40, 12 December 2020
Background
- Due to either blunt or penetrating trauma
Clinical Features
- Partial or complete amputation of finger(s)
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
Workup
- Hand/finger x-rays
- X-ray limb and amputated part (if available)
- Consider pre-op labs
Diagnosis
- Clinical diagnosis
Management
- Pain control - (Digital block)
- If amputated finger available, irrigate and wrap in moist sterile gauze
- Place in plastic bag and put bag in ice water (do not put finger directly on ice!)
- Tetanus Prophylaxis if > 5 years since last vaccination
- Antibiotics: Ancef 2 grams
- Consult hand surgery regarding possible reimplantation vs revision amputation
- In general, amputation distal to DIP is not amenable to reimplantation
- If bone is exposed, it may be trimmed back with a rongeur to just below the skin level
- In general, amputation distal to DIP is not amenable to reimplantation
- Acceptable warm ischemia times
- 12 hours for digit; 6 hours for muscle bearing extremity[1]
- Acceptable cold ischemia times (i.e. time amputated part is on ice)
- 24 hours for digit; 12 hours for a muscle bearing extremity[1]
Indications for Reimplantation
- Thumb amputation
- Amputation of multiple digits
- Amputation level between MCP and distal forearm
- Amputations in children
Contraindications to Reimplantation
- Severely crushed or mangled parts
- Prolonged ischemia time
- Single digit (except thumb)
- Severe contamination
- Age >60, poor health, atherosclerotic disease
- Avulsion injury
Disposition
Admit
- Plan for reimplantation or immediate surgery
- Infection
Discharge
- Distal phalanx amputation with controlled bleeding