The Mangled Digit Severity Score: Determining Salvageability of Severe Digital Injuries

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Trauma Surgery

Background:

• Mangled digital injuries present complex challenges in assessment and treatment decisions.
• Predicting functional salvage versus amputation requires a reliable prognostic tool.

Purpose of the Study:

• To develop and validate a novel scoring system, the Mangled Digit Severity Score (MDSS).
• To aid surgeons in determining the optimal management strategy for mangled digits.

Main Methods:

• A modified Delphi method involving 67 hand surgeons to identify and weight critical prognostic factors.
• Development of a weighted scoring system based on expert consensus.
• Retrospective validation of the MDSS using a cohort of 54 mangled digits.

Main Results:

• Consensus was reached on 14 factors, including injury mechanism and fracture patterns.
• The MDSS showed an area under the curve of 0.87, indicating good predictive accuracy.
• At a threshold of 35, the MDSS achieved 60% sensitivity and 88% specificity for predicting amputation.

Conclusions:

• The Mangled Digit Severity Score (MDSS) is a validated tool developed through expert consensus.
• The MDSS provides a structured framework and prognostic guideline for managing mangled digits, assisting in amputation or salvage decisions.