Replantation in upper limb remains the gold standard for amputation injury of upper limb for highest potential for functional restoration. Prosthesis service offers an alternative option but may be less commonly used due to potential lack of familiarity.
We would like to investigate our local experience of artificial limb service provision for digital and manus loss.
Retrospective case study of all patients who have engaged with New Zealand Artificial Limb Service (NZALS) in Waikato and nationwide, using national NZALS database.
A standardised proforma was used for data collection. Patients who were identified as current patients of Waikato NZALS were invited to participate in a structured phone interview based on a validated questionnaire. Hand therapy records of manual dexterity of individual patients were collected and analysed as part of the study.
There are over 100 upper limb patients on the NZALS database. Waikato NZALS database has 15 patients managed by the department with 6 active patients.
Four patients were invited to participate in our interview to provide insights into mid-palmar amputation, single, double and triple digital tips amputation functional profiles, with or without prosthesis.
Patient 1 (myoelectric prosthesis for mid-palmar amputation): Michigan Hand Questionnaire (MHQ) for overall hand function is 18 (without prosthesis) and 76 (with prosthesis) showing myoelectric prosthesis improves functional status (chi-squared p=0.0001).
Patient 2,3 and 4 (MCPDriver for single mid-digital amputation and double PIPDrivers for double and triple digital amputation): MHQ scores for single mid-digit and multiple digit tips without prosthesis are similar (t-test p=0.4).
Functional score improves in single mid-digit with prosthesis (chi-squared p=0.02). There is no statistical improvement detected in multiple tips amputation with application of prosthesis (chi-squared p=0.98).
Our study suggests prosthesis can improve the functional status of patients with at least mid-digital tip amputation and more proximal injury.