Hand Surgeons' Understanding of Partial Hand Prostheses: Results of a National Survey Study.

PURPOSE: Partial hand amputations are devastating injuries that often negatively affect individuals and communities. Partial hand prostheses can mitigate the burdens of living with an amputation, especially when reconstruction alone cannot restore form or function. However, hand surgeons may be unfamiliar with these newer devices because the prosthetic field is rapidly progressing. METHODS: An electronic survey was distributed to hand surgeon members of the American Association for Hand Surgery with the intent of assessing surgeons' familiarity with partial hand prosthetic devices and their clinical applications. Survey items used Likert 5-point scales, rank order, multiple-choice, and yes/no question formats. Responses were compared by training background (orthopedic or plastic surgery) and by years of experience (≤10 years in practice or >10 years in practice). RESULTS: Overall, hand surgeons are unfamiliar with modern partial hand prosthetic devices. Most of the cohort denied working within a multidisciplinary hand team (76.2%) or consulting with a prosthetist prior to revisional surgeries (71.4%). Restoring gross motor function and reducing pain were important outcomes to the cohort (4.42 and 4.17, respectively). Plastic trained hand surgeons were more likely to list toe-to-hand transfers as treatment options for multilevel digital amputations (P = .03) and transmetacarpal amputations (P = .02). Senior hand surgeons were more likely to suggest no treatment for partial thumb amputations (P = .02). CONCLUSIONS: Expanding surgeon knowledge and encouraging collaboration within a multidisciplinary team may enhance amputee care.

Making the Best of a Bad Situation: Case Report of a Nonreplantable Four-finger Amputation with Flap Coverage and Partial Hand Prosthesis Utilization.

Partial hand amputations (PHAs) are often associated with detriments to self-expression, independence, and employment. Modern partial hand prostheses, coupled with reconstructive surgery, may greatly mitigate the physical, psychological, social, and financial impairments caused by PHAs. The MCPDriver is a body-powered prosthesis and is an example of one of these modern, easy-to-use prostheses. This case report describes a 30-year-old man who experienced a traumatic, nonreplantable four finger degloving amputation of digits 2-5 at the level of the proximal phalanges. Initial reconstruction included preserving the length of the amputated phalanges and using a pedicled groin flap for soft tissue coverage with the goal to ultimately facilitate the use of a partial hand prosthesis. Once the PHA was stable, the multidisciplinary hand team held several discussions to review how to revise the flap for an MCPDriver. Staged debulking surgeries and syndactyly releases facilitated a successful fitting with the prosthesis. The patient resumed employment and bimanual tasks shortly after being fit with the prosthesis. The patient also reported significant improvements in his mental health and in the quality of his social interactions. This case illustrates how reconstructive surgeries coupled with partial hand prosthesis utilization can restore form and function following amputation. Familiarity with the modern classes of upper extremity prostheses and collaborating within a multidisciplinary hand team will likely enhance reconstructive outcomes following traumatic PHAs.

A Multi-User Transradial Functional-Test Socket for Validation of New Myoelectric Prosthetic Control Strategies.

The validation of myoelectric prosthetic control strategies for individuals experiencing upper-limb loss is hindered by the time and cost affiliated with traditional custom-fabricated sockets. Consequently, researchers often rely upon virtual reality or robotic arms to validate novel control strategies, which limits end-user involvement. Prosthetists fabricate diagnostic check sockets to assess and refine socket fit, but these clinical techniques are not readily available to researchers and are not intended to assess functionality for control strategies. Here we present a multi-user, low-cost, transradial, functional-test socket for short-term research use that can be custom-fit and donned rapidly, used in conjunction with various electromyography configurations, and adapted for use with various residual limbs and terminal devices. In this study, participants with upper-limb amputation completed functional tasks in physical and virtual environments both with and without the socket, and they reported on their perceived comfort level over time. The functional-test socket was fabricated prior to participants' arrival, iteratively fitted by the researchers within 10 mins, and donned in under 1 min (excluding electrode placement, which will vary for different use cases). It accommodated multiple individuals and terminal devices and had a total cost of materials under $10 USD. Across all participants, the socket did not significantly impede functional task performance or reduce the electromyography signal-to-noise ratio. The socket was rated as comfortable enough for at least 2 h of use, though it was expectedly perceived as less comfortable than a clinically-prescribed daily-use socket. The development of this multi-user, transradial, functional-test socket constitutes an important step toward increased end-user participation in advanced myoelectric prosthetic research. The socket design has been open-sourced and is available for other researchers.

Targeted Muscle Reinnervation in Children: A Case Report and Brief Overview of the Literature.

Absence of the proximal upper limb, whether congenital or acquired, has a profound impact on quality of life. Targeted muscle reinnervation (TMR) was originally developed to improve functional control over myoelectric prostheses; however, it has also been shown to decrease phantom limb pain and neuroma pain as well as prevent neuroma formation. In children, whose rates of prosthetic use are considerably lower than adults, the effects of amputation on limb function can be devastating. To date, there is very little literature regarding the use of TMR in children. In this case report, we review the current literature and present the case of a 9-year-old boy with a transhumeral amputation secondary to a traumatic injury who underwent acute TMR at the time of wound closure. At 22 months follow-up, the patient is doing well with minimal pain, no evidence of neuroma formation, and signs of muscle reinnervation.

Restoring Form and Function to the Partial Hand Amputee: Prosthetic Options from the Fingertip to the Palm.

Partial hand amputations are the most common upper extremity amputations and affect individuals across a spectrum of socioeconomic and geographic backgrounds. Prosthetic devices can provide straightforward solutions to the devastating aesthetic, functional, psychological, and social deficits caused by these injuries. However, because of the recent development of multiple partial hand prosthetic devices, many hand providers remain unaware of their applicability in practice. This article highlights the various classes of partial hand prostheses currently available, including passive functional, body-powered, and externally powered options. Familiarity with these partial hand prostheses will better enable providers to care for partial hand amputees.