Finger amputation: Difference between revisions

Revision as of 05:41, 20 February 2018

Background

Due to either blunt or penetrating trauma

Clinical Features

Partial or complete amputation of finger

Differential Diagnosis

Hand and finger injuries

Distal finger
Other finger/thumb
- Boutonniere deformity
- Mallet finger
  - Swan neck deformity
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
Hand
- Dupuytren contracture
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

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!)
X-ray limb and part
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
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

External Links

References

↑ ^1.0 ^1.1 Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80

Authors:

[managment-1] 1.0 ^1.1 Lloyd MS. et al. Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80

[1]

@@ Line 1: / Line 1: @@
 ==Background==
+*Due to either blunt or penetrating trauma
 ==Clinical Features==
+*Partial or complete amputation of finger
 ==Differential Diagnosis==
+{{Hand and finger injury DDX}}
 ==Evaluation==
+*Clinical diagnosis
-==Indications for Re-implantation==
+==Management==
-*Thumb
+*Pain control - ([[Digital block]])
-*Multiple digits
+*If amputated finger available, irrigate and wrap in moist sterile gauze
-*Amputation level between palm and distal forearm
+**Place in plastic bag and put bag in ice water (do not put finger directly on ice!)
-*Distal to FDS insertion
+*X-ray limb and part
+*[[Tdap|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
+*Acceptable warm ischemia times
+**12 hours for digit; 6 hours for muscle bearing extremity<ref name="managment">Lloyd MS. et al.  Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80</ref>
+*Acceptable cold ischemia times (i.e. time amputated part is on ice)
+**24 hours for digit; 12 hours for a muscle bearing extremity<ref name="managment"></ref>
+===Indications for Reimplantation===
+*Thumb amputation
+*Amputation of multiple digits
+*Amputation level between MCP and distal forearm
 *Amputations in children
-===Warm Ischemia===
+===Contraindications to Reimplantation===
-*12 hours for digit; 6 hours for muscle bearing extremity<ref name="managment">Lloyd MS. et al.  Preoperative management of the amputated limb. Emerg Med J. Jul 2005;22(7):478-80</ref>
-===Cold Ischemia===
-*24 hours for digit; 12 hours for a muscle bearing extremity<ref name="managment"></ref>
-==Contraindications==
 *Severely crushed or mangled parts
-*Prolonged warm ischemia time
+*Prolonged ischemia time
-*Single digit
+*Single digit (except thumb)
 *Severe contamination
 *Age >60, poor health, atherosclerotic disease
 *Avulsion injury
-*Lower extremity amputations
-==Management==
-*Pain control ([[Digital block]])
-*Irrigate amputated part
-*Place moist, sterile gauze around amputated part
-*Place in water-tight container in ice water
-*X-ray limb and part
-*[[Tdap|Tetanus Prophylaxis]] if > 5 years since last vaccination
-*Consult surgery
-**The management of distal fingertip amputation is controversial and should be individualized
-**Final judgement regarding reimplantation is by surgeon
-**Most amputations distal to the DIP are managed with local wound care and allowed to heal by secondary intention
-**If bone is exposed, it may be trimmed back with a rongeur to just below the skin level
-===[[Antibiotics (Main)|Antibiotics]]===
-{{Open Fracture Antibiotics}}
 ==Disposition==
+*Admit:
+**Plan for reimplantation or immediate surgery
+**Infection
+*Discharge:
+**Distal phalanx amputation with controlled bleeding
 ==External Links==
 ==See Also==
-*[[Fingertip Laceration]]
+*[[Fingertip laceration]]
 *[[Distal phalanx (finger) fracture]]
-*[[High-Pressure Injection Injury]]
+*[[High-pressure injection injury]]
 ==References==
 <references/>
 [[Category:Orthopedics]]
 [[Category:Trauma]]