Laboratory Studies
Assess the patient's hemoglobin/hematocrit at baseline, and follow up with serial determinations if significant blood loss is suspected. Assess coagulopathy by determining the prothrombin time/international normalized ratio (INR) and platelet count if the patient's history suggests a bleeding disorder or liver disease.
Type and cross-match 2-4 units of packed red blood cells if the patient's history suggests significant blood loss.
Obtain an electrocardiogram in patients older than 45 years and in those with a history of cardiac ischemia or arrhythmia.
Pulse oximetry can be used to document arterial flow to a part that is incompletely amputated when clinical findings of arterial flow with Doppler ultrasonography suggest an absence of arterial perfusion. [13, 14]
Imaging Studies
Radiographs of the injured part should be performed as follows:
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Obtain posteroanterior, lateral, and oblique radiographs of the amputated part and stump.
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Carefully assess for radiopaque foreign bodies.
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Comminution of the fracture implies a crush injury mechanism and is associated with soft-tissue trauma.
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If the joint is destroyed at the level of amputation, perform arthrodesis (fusion); this results in loss of joint function.
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If a crush injury is severe, a mosaic of fragments may preclude attempts at replantation.
See the images below.
Obtain a chest radiograph if it is indicated by the patient's age or underlying lung or heart disease or if blunt or penetrating chest injury is suspected.
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Complete amputation of 2 digits.
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Radiologic appearance of a hand with 2-digit amputation.
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After 2-digit replantation.
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Complete thumb amputation.
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Radiologic appearance of a complete thumb amputation.
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Complete thumb amputation.
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After thumb replantation.
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Surgical amputation of a left big toe.
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Toe-to-thumb transfer.
