A retrospective review of 50 patients treated for single or multiple digit amputations was performed at a single center. Physical examination and a comprehensive questionnaire were administered by the physicians and an occupational therapist. The 50 patients (42 male, 8 female) presented with 84 amputated digits. All but one amputation was a result of traumatic injury. 74% were work-related accidents. Each patient was measured for range of motion, grip strength, key and chuck pinch and sensation, defined by static and moving two-point discrimination. The patients also rated their pain on a subjective 0-10 scale. Functional outcome was measured with the Jebsen hand test, which was compared with published norms. A functional independence questionnaire was administered, measuring self-care abilities, location and mobility, communication, and social cognition on a 1-7 scale. The data were analyzed statistically to determine the effect on the parameters of level of amputation, number of amputated digits, work or non-work related injuries, and time elapsed since the amputation. The results confirmed that distal amputation levels performed better and had fewer symptoms than proximal levels with higher grip and pinch strength. Sensation was significantly better in distal amputations as well. Subjective pain was not affected by the level of amputation. It was affected by having more than one digit amputated and by having a work-related etiology. Jebsen scores and functional independence measures were significantly affected only by multiple digit amputations, not by level, cause, or timing. Overall, less than half of the patients with manual jobs returned to their pre-injury occupation. The mean time to return to work for work-related accidents was 7.5 months, versus 1.7 months for non work-related accidents.
The authors have confirmed previous studies showing that digital length has the most significant impact on physical and functional well-being after amputation. The impact of psychosocial factors on subjective pain perception was also borne out, as both multiple digital amputations, regardless of level, and work-related etiology negatively impacted patients’ pain. Amputations in this patient population proved no different than other industrial injuries in producing a longer period of disability in work-related than non-work related causes. Work-related injuries also impacted total range of motion after injury. Importantly, despite collecting data on the involvement of specific fingers in the amputations, no analysis of the impact of different loci of injury on the measured parameters was provided. More than level or number of amputations, involvement of the thumb versus small finger or border versus central digits would be expected to have a significant impact on function, return to work, strength, and Jebsen scores. This omission detracts from the significance and usefulness of the study. It does, however, support the notion that maintaining digital length has perhaps the most significant impact on patient performance and satisfaction after amputation injuries.