Comparative Outcomes Following Digital Amputation And Ray Resection: A Single-Center Retrospective Review
William T Li, BS; Adam B Strohl, MD; Michael P. Gaspar, MD; A. Lee Osterman, MD; Patrick M. Kane, MD
Thomas Jefferson University, Philadelphia, PA
INTRODUCTION: Digit and ray amputations are often necessary to restore functionality in patients who have suffered traumatic injury to the hand. It is expected that the significant functional impact of these procedures would parallel patients' ability to return to work (RTW) postoperatively. The purpose of this study was to compare outcomes following 3 different levels of finger amputations: Distal to the DIP joint, proximal to the DIP, and ray resection with regards to postoperative grip strength and return to work (RTW) ability. Our study compares postoperative hand functionality between people who have undergone ray resections to that of proximal and distal resections.
MATERIALS & METHODS: We conducted a retrospective chart review of 186 patients treated with digit or ray amputations by one of 3 fellowship-trained orthopedic hand surgeons from 2009 to 2015. Grip strength and RTW ability were compared among the proximal, distal, and ray amputation groups. Grip strength was measured via the JAMAR Dynamometer with grip setting on III for men and II for women, and compared to the grip strength of that of the unaffected contralateral (CL) hand. RTW status of the patients was obtained from their clinical files.
RESULTS: At 2-year follow-up, grip strength in the distal and proximal amputation groups were both about 75% of unaffected hand and significantly lower in the ray resection group (45% unaffected) P < 0.05. Patients who had distal amputations had a RTW rate of 90% whereas the proximal amputation and the ray amputation groups both had a significantly lower RTW rate of about 62% P < 0.05.
CONCLUSIONS: The distal amputation group had the best outcomes for RTW ability and grip strength, while proximal and ray resection groups are less likely to return to full duty work. The ray resection group had the worst outcomes for both RTW and grip strength. That being said, ray resections have better cosmetic and dexterity outcomes than proximal amputations do. Therefore, these procedures involve a trade-off between hand functions and surgeons must counsel patients accordingly.
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