Systematic Review of Outcomes Following Single Central Ray Amputation of the Hand

Background: Ray amputation is an uncommon but occasionally necessary procedure in select clinical scenarios. The ray can be resected at different skeletal levels. This systematic review aimed to evaluate the outcomes following single central ray amputation, with particular attention to functional recovery, return to work and complications and compare them by bony resection level. Methods: A systematic review of the literature was undertaken, identifying 25 studies reporting on 238 patients who had undergone single central ray amputation. Extracted data included range of motion (ROM), grip strength, return to work, patient-reported outcome measures (PROMs) and post-operative complications. Results: Of those reported, 90% of patients achieved a 'full' ROM following surgery. The mean time off work was 95 days, with 71% returning to their previous occupation. Average grip strength was 69% of the contralateral hand. No technique emerged as superior for the outcomes measured. Functional tests and PROMs were infrequently reported. Complications such as scissoring, malrotation and painful neuroma were described. Conclusions: The overall quality of evidence was low, with considerable heterogeneity between studies, thereby limiting direct comparisons. The most important determinant of outcome appeared to be the degree of concomitant trauma sustained by the remaining structures of the hand. Level of Evidence: Level IV (Therapeutic).