BACKGROUND: Revision amputation is a common treatment in the emergency department (ED) for traumatic finger injuries, yet there is limited data on outcomes for procedures completed in the emergency room versus the operating room. This study aims to assess outcome differences between ED revision amputation and delayed OR management.

METHODS: 103 consecutive patients with traumatic finger(s) amputations were identified from a single tertiary care center. Patients were evaluated by the on-call hand team and staffed with a fellowship-trained hand attending. ED revision amputations were performed with the goal of definitive care. Data was collected for injury/patient demographics, follow-up, and further revision procedures. Odds ratios were calculated to assess for predictive factors for ED management failure.

RESULTS: 55 patients were treated with ED revision amputation, 18 of whom (32.7 %) required further surgical management. Presence of multiple digit amputations was associated with increased initial treatment in the operating room. The most common indication for surgery was revision amputation and soft tissue coverage (88.9 %), followed by additional bony fixation for underlying fractures (44.4 %). Number of fingers amputated, fracture presence, and significant soft tissue injury were not associated with failure. Of the 48 patients with planned delayed management in the OR, 11 were treated with nonoperative wound care.

CONCLUSIONS: Definitive ED revision amputation was associated with a high rate of failure, need for revision surgery, and loss to follow up. Injuries with complex wound coverage or bony fixation may be better suited to OR management. Some patients may ultimately be appropriate for management without revision amputation and may be overtreated with this procedure in the ED.