Hand Amputations at the Radiocarpal Level With Proximal Neuromuscular Avulsion

PurposeTo report a series of 6 radiocarpal avulsion amputations in 5 patients.MethodWe replanted 6 radiocarpal amputations in 5 patients with proximal musculotendinous and nerve avulsion between 2005 and 2013 and reviewed them retrospectively. All 5 patients were men, age range from 21 to 32 years. Functional results were evaluated through total active motion (TAM) of the fingers, 2-point discrimination, monofilament test, grip strength, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Follow-up was 4 to 10 years.ResultsAll replanted parts survived without systemic complications. No infections or major wound complications occurred despite the preservation of presumably avascular tendons. The functional results of the right side in patient 1 who suffered bilateral amputations, were very modest, with only 360° of TAM (about 30% of the TAM of a normal hand) and weak grip after 5 secondary surgical procedures including 2 free functional gracilis transfers. This was the only hand in which the tendons were not reinserted primarily. The other hands achieved TAM between 590 and 820°, which corresponds roughly to 50% to 70% of the normal TAM of a healthy hand, and mean of 10-kg grip force.ConclusionsRadiocarpal amputation with proximal musculotendinous avulsion is an infrequent pattern of injury in which replantation with tendon reinsertion can yield functional results comparable with those reported for sharp wrist-level amputations.Type of study/level of evidenceTherapeutic IV.