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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Digit Amputations

Overview of injury

Mechanism of Injury:  Guillotine, Crush, Avulsion

Associated injuries:    Fractures, Soft-Tissue Defects, Neuromuscular Trauma

Indications

Absolute Indications​

  • thumb

  • multiple digits

  • single digit in child

​

Relative Indications

  • Single digit distal to FDS

    • Replant in this instance based on strong patient desire​

    • Often coverage/formalisation is a better solution with faster recovery times

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Contra-Indications

  • Severely crushed or mangled parts​

    • Red line on skin over NV bundle​

      • Indicates significant injury to vessel​

      • Poor prognosis for replantation

  • Multiple level amputations

  • Associated injuries or pre-existing injuries

    • These may preclude prolonged surgical times​

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Please refer patient to a ULQ fellowship trained hand surgeon for management 
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