Traumatic amputation and re-plantation of thumb

Case contributed by Dr Tom Elswood

Presentation

Alleged assault to right hand with partial thumb amputation.

Patient Data

Age: 36
Gender: Male
Modality: X-ray

Oblique film (original):

There is complete transverse amputation of the right thumb at the level of the
proximal phalanx. The distal amputated segment is noted on the film. No other bony injury seen.  

AP and lateral right thumb films (2 week later):

The previously amputated right thumb segment has been re-planted, with K-wire and circular wire fixation. A second K-wire enters the base of the thumb metacarpal and terminates in the base of the index metacarpal.

Case Discussion

A 36 year-old gentleman presented to the ED after allegedly being assaulted by someone with a machete. 

The wound was cleaned by ED staff, and the patient was immediately transferred to plastic surgery for re-plantation. 

Upon review in clinic two weeks later, the thumb was viable, partially sensate and flexing.

This is a good example of a prudent radiographer including the distal amputated segment in the initial film - the plastic surgery team would want to know about any bony damage to the amputated segment. 

This is also a good example of the kind of potential dangers faced in the Greater Glasgow area.

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Case Information

rID: 52492
Case created: 10th Apr 2017
Last edited: 16th Apr 2017
Inclusion in quiz mode: Excluded

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