Traumatic Versus Nontraumatic Hand Digit Amputations: Neuroma Risk, Prevention Success, and Predictive Factors.

PURPOSE: Digital amputations can occur following trauma for a variety of reasons. The objective of the study was to evaluate the difference in neuroma rates between elective and emergent digital amputations and the factors contributing to persistent pain following amputation.

METHODS

A retrospective review of 907 patients treated with digital amputation from 2015 to 2023 met inclusion criteria. Demographic data, comorbidities, body mass index, workers' compensation cases, surgical data, digit (zone) injuries, and indications for surgery were noted. A total of 1,171 amputations were included.

RESULTS

At a median duration of follow-up of 2.6 months (interquartile range, 1.8-6.7), individuals who received elective procedures (n = 401) exhibited a neuroma rate of 4%, whereas those who underwent emergent surgeries (n = 506) had a neuroma rate of 3.2%. Patients were predominantly male (74%) with an average age of 52 years. Comorbidities were more frequent in patients who underwent elective surgeries. One hundred eleven patients had severe stump pain affecting their day-to-day lives, of which 32 (female, 28%) were diagnosed with a neuroma (mean follow-up: 18 months). In neuroma cases, 18 were treated with revision amputations, and 11 had nonsurgical treatments for their neuropathic symptoms. Other factors associated with pain following amputation included: proximal amputations (zones 4 and 5), middle finger amputations, alcohol abuse, tumors, rheumatoid arthritis, blast injury, crush injury, and multiple amputations in revision surgery.

CONCLUSIONS

In this single institutional retrospective study, elective and emergent surgeries had comparable symptomatic neuroma rates. Factors predictive of pain following amputation included more proximal amputations, pre-existing alcohol use, inflammatory arthritis or vasculitis, and blast mechanism. These factors may be selected for patients best suited for prophylactic targeted muscle reinnervation or regenerative peripheral nerve interface surgeries at the time of amputation.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.