A Nationwide Review of the Treatment Patterns of Traumatic Thumb Amputations

Abstract

Traumatic thumb amputations are a common problem with significant associated cost to patients, hospitals, and society.The purpose of this study was to review practice patterns for traumatic thumb amputations using the National Trauma Data Bank. By using a large nationwide database, we hoped to better understand the epidemiology and predictors of attempts and successful replantation.The design was a retrospective review of the National Trauma Data Bank between the years 2007 and 2010, investigating patients with traumatic thumb amputations. Analyses of these patients based on replantation attempt, mechanism of injury, and demographics were performed. Comparisons were made between hospitals based on teaching status and on patient volume for replant attempt and success rates.There were 3341 traumatic thumb amputations with 550 (16.5%) attempts at replantation and an overall success rate of 84.9%. Nonteaching hospitals treated 1238 (37.1%) patients, and attempted 123 (9.9%) replantations with a success rate of 80.5%. Teaching hospitals treated 2103 (63.0%) patients, and attempted 427 (20.3%) replantations with a success rate of 86.2%. Being in a teaching hospital increased the odds of attempted replantation by a factor of 3.1 (P < 0.001) when compared to a nonteaching hospital. Treatment at a high-volume center increased the rate of attempted replantation by a factor of 3.4 (P < 0.001), as compared to low-volume hospitals.Practice patterns show that teaching and high-volume hospitals attempt to replant a higher percentage of amputated thumbs. Success rates are similar across practice settings.

Results of upper limb digital and hand replant and revascularisation at a UK Hand Centre

“…We recognise that our reported survival rates for digital replantation still seem to be significantly lower than the published figures, 71-93 % [1,3,12,13]. Although clean cut guillotine type mechanisms are regarded as the most favourable for replantation [9], this was a relatively rare occurrence in our study cohort with only five digits being injured in this way.…”

Epidemiology of digital amputation and replantation in Taiwan: A population-based study

“…To obtain the failure rate of digital replantation from this population-based study, we followed Shale et al's study 8 and assumed that patients who underwent replantation and amputation during single hospitalization were replantation failures.…”

Hand Trauma Care in the United States

“…Shale et al 17 described 3341 patients with thumb amputations treated at 474 hospitals. Nonteaching hospitals treated 37% (1238/3341) of patients and attempted replantations for 10% (123/1238) of those patients with an 81% success rate.…”

“…Further nationally representative studies of hand trauma care in the U.S. are required. Third, except in a few studies, 17 severity of hand injuries were not reported, which made comparisons of the findings difficult. Despite these limitations, this study provides a comprehensive view of challenges facing the hand trauma care in the U.S.…”