Edited by Christina Liu and CJ Nessralla - 7/1/2021
Descriptors
Amputations distal to MCP joint
Exam Pearls
Note degree of amputation: partial vs complete
Note level of amputation relative to DIP/PIP/MCP and relative to flexor tendon zones of injury (1-distal to FDS insertion, 2-FDS insertion to A1 pulley)
Neurovascular status: vascular (O2 probe on amputated fingertip if only partial amputation to determine if perfused) more important than nerve (sensation)
Tendon function: isolate individual finger and joint when testing for flexion/extension
Examine amputated portion of distal finger(s): contamination level, storage situation (ideally - irrigated, wrapped in wet gauze, in sealed plastic bag, placed in ice in 2nd plastic bag)
Workup
Radiographs: AP and lateral of the hand or digit concerned including amputated part
Other imaging: None
Labs: None needed. Standard preop labs if going to OR emergently
Other: NA
Management
Staff first with fellow prior to doing any procedure in case decision made to go to OR
Need for acute intervention: Yes, I&D + exploration under digital block if possible, otherwise just I&D and take to OR.
Weight-bearing and range of motion: NWB, no finger ROM (volar resting splint may also block wrist ROM). ROM elbow and shoulder
Type of immobilization: volar resting splint including fingertip
Admission or discharge status: Discharge
Anticoagulation: None
Antibiotics: Keflex if no concerns for MRSA, Bactrim if concerned for MRSA, Clinda if penicillin allergy Keflex: 250mg Q6 x 7 days vs 500mg Q12 x 7 days Bactrim: 1 DS tablet Q12hr x 7 days Clindamycin : 150-300mg Q6hr x 7 days
Surgical Indications
Absolute: Rarely absolute indication - often per institution. Recommend staffing early with fellow. Emergent OR: revascularization or replantation of distal fragment (institution dependent, some places do not replant given lack of microsurgical capabilities)
Indications for replantation: Thumb amputations Multiple fingers Proximal to MCP Pediatric
Relative: distal finger amputations do not always require replantation or revascularization
Not an indication: open tuft fracture