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Updated: Jan 29, 2026

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Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries.

H R Smith¹, C Conyard², J Loveridge²

¹* College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.

The Journal of Hand Surgery Asian-Pacific Volume

|February 15, 2019

Summary

Tooth knuckle injuries can lead to amputation or multiple surgeries. Osteomyelitis is a key predictor for amputation, while delayed treatment and diabetes increase the need for repeat debridements, aiding risk prediction.

Keywords:

Amputation Clenched fist injury Health care costs Tooth knuckle injury

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Area of Science:

Orthopedic Surgery
Trauma Care
Infectious Disease

Background:

Tooth knuckle injuries pose significant treatment challenges, including high costs and potential amputation.
Existing literature lacks comprehensive understanding of factors predicting amputation and multiple debridements for these injuries.

Purpose of the Study:

To identify predictors for amputation and the need for multiple surgical debridements in patients with tooth knuckle injuries.
To develop predictive models for patient risk stratification.

Main Methods:

A historic cohort study involving 321 patients treated for tooth knuckle injuries.
Collection of 21 demographic, clinical, and laboratory variables.
Multivariate logistic regression analysis to assess predictor-outcome relationships.

Main Results:

1.6% of patients required amputation, and 25% needed multiple debridements.
Osteomyelitis was a strong predictor of amputation (Odds Ratio = 35).
Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) significantly increased the risk of requiring multiple debridements.

Conclusions:

Predictive models accurately identified patients at high risk for amputation and multiple debridements.
Reducing osteomyelitis and addressing delayed presentations are crucial for minimizing amputation and reoperation rates.