Results of Ray Resection and Amputation for Ring Avulsion Injuries at the Proximal Interphalangeal Joint

Abstract

We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24-63) months in the ray resection group and 32 (range, 24-40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.

Single Ray Amputation for Tumors of the Hand

“…Although the role of single ray amputation for treatment of traumatic hand injuries and hand infection is well established [7,14,17,19,20], its functional and oncologic outcomes for management of hand tumors are not as well defined. Several variations in the procedure, when used for tumors, may affect the eventual outcome of surgery.…”

“…Some authors report reasonable functional scores, grip and pinch strength, and high rates of return to work when performing single ray amputations as primary or secondary reconstructive procedures after hand trauma [7,14,17,19,20]. Many others focused on local recurrence and survival rates from treatments of aggressive benign and primary malignant hand tumors, and metastases to the hand [1-3, 5, 6, 8, 10-12, 15, 16, 18, 21].…”

Amputations, replantation and thumb reconstruction

“…5,6 Careful dissection of digital neurovascular structures is important to avoid hypersensitivity and neuroma formation in the palm of the hand. It is rarely performed as a primary amputation unless for soft tissue tumour excision.…”

Alternative à la replantation dans les amputations type doigt d’alliance stade IV : amputation basimétacarpienne d’emblée

“…La perte de force (30 %) rejoint les chiffres de la littérature [15][16][17]. Nuzumlali et al [18] rapportent également cette perte de force plus importante qu'en cas d'amputation simple au niveau de P1 et ne conseillent pas la régularisation en base de métacarpien chez les travailleurs manuels. Néanmoins, cette perte de force n'empêche pas la reprise du travail en moyenne à trois mois sans changement de poste chez des patients dans notre série rentrant le plus souvent dans cette catégorie.…”

“…Huit patients au total, et quatre à la révision, étaient toujours suivis sur ce plan et cet item dominait souvent le tableau à distance de l'intervention. Nuzumlali et al[18] retrouvent également l'impact psychologique de cette chirurgie alors que tous les patients se disent satisfaits sur le plan esthétique. Une prise en charge précoce et efficace doit accompagner l'acte chirurgical afin que les conséquences psychologiques d'une telle intervention ne compromettent pas le résultat final et la reprise précoce d'activités.…”