Abstract
Optimal treatment for traumatic finger amputation is unknown to date. To use statistical learning methods to estimate evidence-based treatment assignment rules to enhance long-term functional and patient-reported outcomes in patients after traumatic amputation of fingers distal to the metacarpophalangeal joint. This decision analytical model used data from a retrospective cohort study of 338 consenting adult patients who underwent revision amputation or replantation at 19 centers in the United States and Asia from August 1, 2016, to April 12, 2018. Of those, data on 185 patients were included in the primary analysis. Treatment with revision amputation or replantation. Outcome measures were hand strength, dexterity, hand-related quality of life, and pain. A tree-based statistical learning method was used to derive clinical decision rules for treatment of traumatic finger amputation. Among 185 study participants (mean [SD] age, 45 [16] years; 156 [84%] male), the median number of fingers amputated per patient was 1 (range, 1-5); 115 amputations (62%) were distal to the proximal interphalangeal joint, and 110 (60%) affected the nondominant hand. On the basis of the tree-based statistical learning estimates, to maximize hand dexterity or to minimize patient-reported pain, replantation was found to be the best strategy. To maximize hand strength, revision amputation was the best strategy for patients with a single-finger amputation but replantation was preferred for all other injury patterns. To maximize patient-reported quality of life, revision amputation was the best approach for patients with dominant hand injuries, and replantation was the best strategy for patients with nondominant hand injuries. The findings suggest that the approach to treating traumatic finger amputations varies based on the patient's injury characteristics and functional needs.
Highlights
Traumatic finger amputations affect more than 45 000 people a year in the United States.[1,2] Recovery after amputation includes rebuilding manual strength, flexibility, and sensation as well as managing recurrent pain and psychosocial consequences that result from the absence or deformity of fingers.[3,4,5,6] The decision for surgical treatment for traumatic finger amputation is made on a caseby-case basis and typically includes replantation or primary closure of the amputated stump
To maximize patient-reported quality of life, revision amputation was the best approach for patients with dominant hand injuries, and replantation was the best strategy for patients with nondominant hand injuries
The findings suggest that the approach to treating traumatic finger amputations varies based on the patient’s injury characteristics and functional needs
Summary
Traumatic finger amputations affect more than 45 000 people a year in the United States.[1,2] Recovery after amputation includes rebuilding manual strength, flexibility, and sensation as well as managing recurrent pain and psychosocial consequences that result from the absence or deformity of fingers.[3,4,5,6] The decision for surgical treatment for traumatic finger amputation is made on a caseby-case basis and typically includes replantation or primary closure of the amputated stump (revision amputation). There are de facto indications that guide the surgeon’s decision of.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
