Thumb amputations from team roping.
BACKGROUND
Thumb injuries during team roping have elements of both avulsion and crush, resulting in a poor prognosis for replantation success.


OBJECTIVE
To review 19 cases of thumb amputation from team roping at our institution since 1983.


METHODS
Retrospective cohort study.


METHODS
Cases were included in the study only if a microvascular repair of artery and vein was needed for the thumb to survive. Vein grafts were used to span the damaged vessel segment. Of the 19 thumb amputation cases, 15 attempts were made to replant the thumb. In the remaining four cases, patients had bone shortening and primary closure. The force of injury was calculated based on mechanism.


RESULTS
Of the 15 attempts at replantation, only 5 (33%) were successful, despite meticulous technique. One patient subsequently had an emergency toe-to-thumb transfer after an unsuccessful replant, and the remaining nine underwent amputation. Nine of the 10 patients with failed replants had poor flow intraoperatively. In the group of patients younger than 15, the success was 3 of 5 (60%) and in the group 15 years or older the success was 2 of 10 attempts (20%.) Follow-up was available in 13 of the 15 cases of replanted thumbs.


CONCLUSIONS
All patients were subjectively satisfied with their results, and all patients with successful replants and seven patients with no thumb returned to rodeo. Biomechanical analysis showed a huge amount of force and pressure, several times larger than that of ring avulsion injury, results when a steer pulls on the thumb.
Moneim
Moheb S
MS
Department of Orthopaedics and Rehabilitation, School of Medicine, University of New Mexico, Albuquerque, New Mexico 87131, USA.
Firoozbakhsh
Keikhosrow
K
Gross
Dominic
D
Young
Steven D
SD
Omer
George
G
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000673:Amputation, Traumatic / Q000209:etiology* / Q000601:surgery*; D001265:Athletic Injuries / Q000209:etiology* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012039:Regional Blood Flow; D012092:Replantation; D012189:Retrospective Studies; D013933:Thumb / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D014034:Toes / Q000637:transplantation; D016896:Treatment Outcome