title: Reoperation After Combined Injury of the Index Finger: Repair Versus Immediate Amputation.
abstract: OBJECTIVE
  To identify factors associated with unplanned reoperation of severely injured index fingers and to address the number of amputations after initial repair.
  
  
  METHODS
  In this retrospective study, we included all patients older than 18 years of age who had repair or immediate amputation for combined index finger injury at 2 level I trauma centers and 1 community hospital tied to a level I trauma center between January 2004 and February 2014. Twelve patients were excluded because of inadequate follow-up. Bivariate and multivariable analyses sought factors associated with unplanned reoperation after repair and immediate amputation.
  
  
  RESULTS
  Among 114 patients with combined injury, 75 were treated with repair and 39 with immediate amputation. A total of 41 patients had an unplanned reoperation, 33 after repair (44%) and 8 after immediate amputation (21%). In multivariable analysis, patients who had a reoperation for fingers other than the index finger were at risk for unplanned reoperation after repair. Women were more likely to have an unplanned reoperation than men, and patients who had a ray amputation were at risk for unplanned reoperation after immediate amputation. Six patients (18%) had amputation after initial repair.
  
  
  CONCLUSIONS
  Surgeons may counsel patients that they are twice as likely to have an unplanned reoperation after a repair for combined injury of the index finger compared with an immediate amputation. Unplanned reoperations were more common among patients with injuries involving multiple fingers. Effective shared decision making is particularly important in this setting given that 1 in 5 repaired index fingers were eventually amputated.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Wilkens
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
authors.forename: Femke M A P
authors.initials: FM
authors.lastname: Claessen
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Ogink
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
authors.forename: Ali
authors.initials: A
authors.lastname: Moradi
authors.affiliation: Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA. Electronic address: dring@mgh.harvard.edu.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Amputation; combined injury; index finger; reoperation; repair