Finger/Thumb Amputations

Finger and thumb amputations range from fingertip injuries to complete loss of a digit. Management depends on the level, mechanism and patient. Thumb length is preserved wherever possible, and replantation is considered for the thumb, multiple digits and amputations in children.

Finger/Thumb Amputations, radiograph of a hand after finger amputations, world war i era
Radiograph of a hand after finger amputations, World War I era. Image by , Wikimedia Commons, CC BY-SA 3.0.

Thumb Amputations

Thumb provides 40% of hand function

  • Amputation at/distal to IPJ = good function
  • Through P1 = reduced function
    • Loss of opposition and significantly reduced pinch and grip strength
  • At/proximal to MCPJ = no function

Treatment options for proximal amputations:

  • Pollicization — another functioning finger is transplanted to give thumb function
  • Toe transplantation
  • Metacarpal lengthening
    • An option when most of MC remains (so when performing the amputation, it’s important to retain as much length as possible)
    • This technique allows for a longer, more functional stump without donor site morbidity

Finger Amputations

Distal Finger:

  • Preserve tendon insertions if distal to DIPJ
    • If amputation being performed at DIPJ then cut tendons and allow to retract
    • Don’t suture flexor tendons to extensor tendons for coverage to avoid quadriga effect which leads to a flexion lag and reduced grip strength – use skin flap instead
  • Ablate entire nailbed if >2/3 gone
    • Prevents nail horn formation
  • Lumbrical plus deformity
    • Extension at phalanges when MCPJ flexed due to intact lumbrical attachment on the extensor apparatus but loss of distal FDP attachment

Proximal Finger:

  • Proximal to FDS = poor flexion
  • Central digits — gap interferes with grip
    • Can be more of a hindrance due to issues holding objects
    • Ray amputation may be more beneficial

Ray amputation:

  • Entire removal of the digit and most, if not all, of the metacarpal
  • Transverse metacarpal ligament is repaired to bring the remaining metacarpals together
  • Narrows the hand and can reduce grip strength, but this is balanced against the gain in a more functional grip, especially in central finger amputation where a small stump may mean objects fall through the hand when gripped
  • Consider when only small stump would be left
  • Amputating index finger shifts pincer grip to middle finger

Author Contributions

Page written by Dr James Drummond

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.