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Reoperation after Combined Injury of the Index Finger: Repair versus Immediate Amputation
Suzanne Caroline Wilkens, MD1; Femke Claessen, MD, PhD1; Paul Ogink, MD1; Ali Moradi, MD1; David Ring, MD, PhD2
1Massachusetts General Hospital/Harvard Medical School, Boston, MA, 2Dell Medical School, Austin, TX
Introduction: To identify factors associated with unplanned reoperation of severely injured index fingers and to address the number of amputations after initial repair.
Materials & Methods: In this retrospective study we included all patients over 18 years of age who had repair or immediate amputation for combined index finger injury at two level I trauma centers and one community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation.
Results: Among 114 patients with combined injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and eight after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for fingers other than the index finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair.
Conclusion: Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined injury of the index finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple fingers. Effective shared decision making is particularly important in this setting given that one in five repaired index fingers were eventually amputated.
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