Finger amputation

Background

Wrist and hand deeper palmar dissection

• Due to either blunt or penetrating trauma

Clinical Features

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

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
  • Finger amputation
  • Fingertip laceration
  • Nail avulsion
  • Nailbed laceration
  • Subungual hematoma
• 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
  • Hand and finger dislocations
  • Hand and finger fractures
  • Hand and finger infections
  • Gout and pseudogout
  • Hand and finger tendon injuries
  • High-pressure injection injury
  • Osteoarthritis
  • Rheumatoid arthritis
  • Ring removal

Evaluation

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

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
• Acceptable warm ischemia times
  • 12 hours for digit; 6 hours for muscle bearing extremity
• Acceptable cold ischemia times (i.e. time amputated part is on ice)
  • 24 hours for digit; 12 hours for a muscle bearing extremity

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

See Also

• Fingertip laceration
• Distal phalanx (finger) fracture
• High-pressure injection injury