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Symptomatic Neuroma Following Initial Amputation for Traumatic Digital Amputation.

Margot A Vlot1, Suzanne C Wilkens1, Neal C Chen1

  • 1Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

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Summary

Symptomatic neuroma affects 6.6% of patients after traumatic digital amputation. Index finger injuries and avulsion mechanisms increase the risk, often requiring surgery.

Keywords:
Digital amputationincidenceneuromarevision amputationtraumatic amputation

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Hand Surgery

Background:

  • Traumatic digital amputation can lead to complications.
  • Symptomatic neuromas are a potential sequela, impacting patient outcomes.
  • Identifying risk factors is crucial for prevention and management.

Purpose of the Study:

  • To test the hypothesis that no factors are independently associated with symptomatic neuroma development after traumatic digital amputation.
  • To identify specific risk factors for symptomatic neuroma.
  • To inform clinical practice regarding post-amputation care.

Main Methods:

  • Retrospective review of 1,083 patients undergoing revision amputation for traumatic digital amputation.
  • Exclusion of patients undergoing replantation or revascularization.
  • Multivariable logistic regression analysis to identify independent risk factors for symptomatic neuroma development.

Main Results:

  • 6.6% of patients (71/1,083) developed symptomatic neuroma.
  • Index finger injury and avulsion injury mechanisms were significantly associated with increased risk.
  • 66% of affected patients underwent surgery for neuroma, with a mean delay of 11 months.

Conclusions:

  • Approximately 1 in 15 patients develop symptomatic neuroma post-traumatic digital amputation.
  • Early identification of risk factors like index finger and avulsion injuries is important.
  • Delayed surgical intervention highlights the need for timely diagnosis and management.