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

Working with partial hand prostheses: An investigation into experiences of clinicians

BACKGROUND

Individuals living with partial hand absence often face challenges in performing everyday tasks and fully participating in society. Prosthetic devices offer a range of benefits, including improved functionality or cosmesis. However, partial hand devices can be rejected by users. In addition, there is a lack of evidence that establishes methods or factors influencing the clinical prescription of prosthetics specifically designed for this population.

OBJECTIVES

The objectives of the investigation were to gain understanding of who is prescribing partial hand prosthetics and the factors which influence device selection.

STUDY DESIGN

A 36-item anonymous online survey was designed on Qualtrics and distributed to clinicians. The survey contained multiple-choice, Likert-type, closed, and open-ended questions.

METHODS

Quantitative and qualitative analyses were performed on Qualtrics and Microsoft Excel.

RESULTS

Thirty-seven clinicians from various occupations participated. The majority agreed that outcome measures are useful for assessing partial hand prosthetics but suggested room for improvement. Although clinicians use various outcome measurement tools, there is a lack of tools specifically tailored to this population. Factors such as existing function, occupation, and hobbies were identified as important when selecting prosthetic devices for users. Funding influenced the range of partial hand devices available for prescription.

CONCLUSIONS

The prescription process involves multiple stakeholders. Various factors, including funding and user satisfaction, must be considered in the decision-making process. There is a lack of specific outcome measures recommended for evaluating prosthetics in this population. However, providing loaner units before final prescription yields positive outcomes.

Hybrid Soft-Rigid Active Prosthetics Laboratory Exercise for Hands-On Biomechanical and Biomedical Engineering Education

This paper introduces a hands-on laboratory exercise focused on assembling and testing a hybrid soft-rigid active finger prosthetic for biomechanical and biomedical engineering (BME) education. This hands-on laboratory activity focuses on the design of a myoelectric finger prosthesis, integrating mechanical, electrical, sensor (i.e., inertial measurement units (IMUs), electromyography (EMG)), pneumatics, and embedded software concepts. We expose students to a hybrid soft-rigid robotic system, offering a flexible, modifiable lab activity that can be tailored to instructors' needs and curriculum requirements. All necessary files are made available in an open-access format for implementation. Off-the-shelf components are all purchasable through global vendors (e.g., DigiKey Electronics, McMaster-Carr, Amazon), costing approximately USD 100 per kit, largely with reusable elements. We piloted this lab with 40 undergraduate engineering students in a neural and rehabilitation engineering upper year elective course, receiving excellent positive feedback. Rooted in real-world applications, the lab is an engaging pedagogical platform, as students are eager to learn about systems with tangible impacts. Extensions to the lab, such as follow-up clinical (e.g., prosthetist) and/or technical (e.g., user-device interface design) discussion, are a natural means to deepen and promote interdisciplinary hands-on learning experiences. In conclusion, the lab session provides an engaging journey through the lifecycle of the prosthetic finger research and design process, spanning conceptualization and creation to the final assembly and testing phases.

3D Printing and The Evolution Of Partial Hand Prostheses: My Journey from Theory To Practice

The world of prosthetics has been undergoing significant changes, with the evolution of materials, design techniques, and manufacturing methodologies converging to redefine the landscape. Central to this narrative is the imperative for a holistic approach, harmonizing the trinity of materials, design, and methodologies to yield optimal outcomes. This balance is especially pivotal for the overlooked yet significant segment of those with partial hand and finger differences. Historically, this demographic has been underserved, with rehabilitation and prosthetic innovations often falling short. The sheer prevalence of partial hand differences underscores the urgency of tailored solutions. Traditional fabrication methods like wet lamination have posed challenges, particularly in aligning and efficiency. The advent of additive manufacturing has been transformative. The case of designing and printing a partial finger socket for Point Designs, LLC's Point Partial finger highlights this paradigm shift. Where conventional techniques demanded hours, digital design and 3D printing have condensed the process to mere minutes, without compromising on quality. This is not merely a win in terms of time efficiency; the implications for the end users are profound, ensuring a more customized and efficient solution. The journey underscores the potential of blending technology and traditional prosthetic knowledge, pointing towards a future where prosthetics align more seamlessly with users' needs.

Upper Extremity Prosthetics: Current Options and Future Innovations

Major upper extremity amputations can have a considerable impact on patients' lives, altering their ability to independently perform activities of daily living and leading to changes in occupations and hobbies. Although upper extremity prosthetics have existed for millennia, recent advances have improved prosthetic motor control and sensory feedback, leading to increased overall satisfaction. The goal of this article was to describe the current options that exist for upper extremity prosthetics and explore the recent advances and future directions in prosthetic technology and surgical techniques.

A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle

BACKGROUND

Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy.

METHODS

Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions.

RESULTS

A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively).

CONCLUSIONS

Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

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.

Current and emerging prostheses for partial hand amputation: A narrative review

Partial hand amputation can have a tremendous range of impact and functional loss on a person's life. One solution to improve function and address some of the problems that partial hand amputees face is to fit them with a prosthesis. Partial hand prosthetic devices range in a wide spectrum in both function and aesthetics. At this time, there is no one, perfect prosthetic device that can replace what is lost. Many individuals with partial hand amputation require more than one prosthetic device. In this review article, we explored and compared several prosthetic options that have been investigated and marketed by researchers and companies. Some of these options include passive, body-powered, activity-specific, and externally-powered prostheses. Lastly, we described our experiences with partial hand prostheses at Walter Reed National Military Medical Center.

[Update on prosthesis for partial hand and finger amputations]

Partial hand and finger amputations are relatively rare but devastating due to the consequences they provoque. In addition, they are more likely than lower limb amputations in car accidents, work accidents and by certain weapons of war. Men are going to have a much higher risk of traumatic amputation than women, with a rate 6.6 times higher. Fitting can be a complex process and a challenge for professionals. For this reason, it is important to know all the options available on the market that can meet the needs of patients, from cosmetic to myoelectric prostheses. Fitting requires the coordinated activity of a multiassistant clinical work team, the center of the team being the person who has suffered the amputation, who must have all the information possible to be able to actively participate in decision-making.

User experiences of digital prostheses in daily functioning in people with an amputation of thumb or finger

STUDY DESIGN": Qualitative research design using interpretative phenomenological analysis (IPA) to interpret users' experiences with digital prostheses.

BACKGROUND

Digital prostheses are rarely used, and little is known about the experiences of traumatic finger amputees with digital prostheses. When advising patients regarding digital prostheses, it is crucial for professionals to understand users experiences of wearing a digital prosthesis and the meaning attached to wearing a digital prosthesis.

PURPOSE OF STUDY

The aim of this study was to explore and understand users experiences of wearing a digital prostheses in daily functioning.

METHODS

Individual semi-structured interviews were conducted, recorded, and transcribed. The written interview texts were analysed following Interpretative phenomenological analysis guidelines.

RESULTS

Four participants were interviewed. They experienced the prostheses as valuable additions to their daily functioning. Three different themes relating to wearing and using digital prostheses emerged from in-depth analysis of the data: How the prosthesis supporting them regaining a 'grip' on life, reduced overload on unaffected side and restored body image.

CONCLUSIONS

This study provides a deeper understanding of the experiences of people with digital amputations who use prostheses. Most importantly, that a prosthesis is of crucial importance for participants to be able to act independently and autonomously as well as to participate in family, work and social environments. This insight will help practitioners when considering, with clients the most appropriate digital prosthesis to meet their goals.

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.