Outcomes And Prosthetic Use In Patients With Significant Partial Hand And Multi-Digit Amputations

Purpose: Partial hand amputation (PHA) describes upper extremity amputations (UEA) to the thumb, digits, and/or metacarpals, which may occur secondary to trauma, vasculopathies, or infections. Despite being the most common upper limb amputation, there is a paucity of literature describing the outcomes of individuals with PHAs in the United States. This group is especially unique regarding prosthetic use and functional outcomes in comparison to those with more proximal UEAs. This study's aim is to characterize PHAs within a large, rural catchment area in the United States, and to determine if there are factors that predict prosthetic use. Methods: After IRB approval, a retrospective chart review was performed to identify finger, thumb, and metacarpal level amputations at an adult Level I Trauma Center with a broad catchment area covering 5 states. Out of 411 charts, we narrowed the cohort down to 60 patients with significant amputations at/proximal to the thumb IP joint, multi-digit amputations proximal to the DIP joint, or any number of trans-metacarpal amputations. The following data points were collected: demographics, injury etiology, surgical outcomes, hand therapy engagement, prosthetic referral/utilization, and patient-reported outcome measures. Results: Over half (53.5%) of PHAs were secondary to trauma. The dominant hand was involved in 35% of all PHAs (unilateral dominant, n=17; bilateral injury, n=4). The proximal phalanx was the most common final level of amputation (33.3%), and the majority of the PHAs (73.3%) occurred in multiple digits. Male patients comprised 70% of the cohort, and the mean age at index hospitalization was 48.6 years (SD: +/- 15.08). The mean number of primary surgeries was 1.37 (SD +/- 8.84), with 78.3% receiving revision amputation at the index hospitalization. The most common early and late complications were skin necrosis (30%, n=18) and finger stiffness (25%, n=15), respectively. Overall, 53.3% (n=32) of post-operative complications necessitated surgical take-back, resulting in a total of 31 additional surgeries. More than half (63.3%) of the cohort was referred to hand therapy, with 92.1% (n=35) of those referred ultimately participating. The therapy participants had a final mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 50.3 (SD: 21.3). Of the 35 patients who attended therapy, 19 (54.3%) were referred to a prosthetist, but only 13 (37.1%) received a device. DASH scores were similar between patients  referred to a prosthetist and those who were  not referred  (mean=51.5 vs 49.3, p=0.79). None of the following variables were significant predictors of prosthetic use: amputation level (p=.639), traumatic etiology of injury (p=.310), amputation of multiple digits (p=.481), or insurance type (p=0.973). Conclusions: PHAs frequently occur secondary to traumatic injuries in male patients and often involve multiple digits. Despite the severity of injuries within the cohort, only 58.3% of the patients attended hand therapy, which highlights an opportunity for future clinical interventions to improve participation. Finally, prosthetic referral and use is rare, with no clear predictors identified, including injury etiology, insurance status, or level of disability. Future clinical aims and research should focus on maximizing therapy utilization and streamlining prosthetic referral to improve patient outcomes. *Source: https://ps-rc.org/meeting/Program/2026/CS34.cgi*