title: Functional outcomes of replantation following radiocarpal amputation.
abstract: OBJECTIVE
  To assess the long-term functional and clinical outcomes of patients who have undergone replantation after radiocarpal amputation.
  
  
  METHODS
  We performed a retrospective review of radiocarpal joint amputations at a level 1 trauma center over a 13-year period. Medical records of patients treated with replantation were queried for injury data, operative reports, complications, and clinical progress. Patients who met inclusion criteria were contacted for long-term follow-up. We measured total active motion of each digit, strength (grip and pinch), and 2-point discrimination. Functional outcomes were assessed with Disabilities of Arm, Shoulder, and Hand score, Mayo Wrist Score, Patient-Rated Wrist Evaluation, and Michigan Hand Questionnaire. Descriptive statistics were calculated, including frequencies for categorical variables and means and ranges for continuous variables.
  
  
  RESULTS
  Six patients met the inclusion criteria. The mean age was 36 years (range, 26-50 y). Five patients were available at a mean follow-up of 3.9 years (range, 1.0-6.9 y). Compared with the contralateral uninjured extremity, total active motion of the hand was 38% (range, 26% to 59%) and grip strength was 9% (range, 0% to 18%). Neither tip nor key pinch was present. Mean 2-point discrimination was 10.6 mm (range, 8-12 mm). All mean outcome scores indicated moderate disability, including Disabilities of Arm, Shoulder, and Hand (76; range, 45-82), Mayo Wrist Score (23; range, 5-50), Patient-Rated Wrist Evaluation (86; range, 56-98), and Michigan Hand Questionnaire (27; range, 15-55). Two patients were able to return to work and 3 were permanently disabled. All patients were satisfied with the hand function.
  
  
  CONCLUSIONS
  Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
authors.forename: Amar Arun
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Blount
authors.affiliation: Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Owens
authors.affiliation: Department of Orthopaedics, Hand, and Microvascular Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL. Electronic address: maskari@med.miami.edu.
authors.forename: Morad
authors.initials: M
authors.lastname: Askari
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D004185:Disability Evaluation; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D052581:Pinch Strength / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014110:Touch / Q000502:physiology*; D014954:Wrist Injuries / Q000601:surgery*
keywords: Replant; amputation; outcomes; radiocarpal; wrist