Replantation in Emergency Medicine Workup

Updated: Sep 12, 2017
  • Author: Mark I Langdorf, MD, FAAEM, FACEP, MHPE, RDMS; Chief Editor: Harris Gellman, MD  more...
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Workup

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. [9, 10]

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Imaging Studies

Radiographs of the injured part should be performed as follows:

  • Obtain posteroanterior, lateral, and oblique radiographs of the amputated part and stump.
  • Carefully assess for radiopaque foreign bodies.
  • Comminution of the fracture implies a crush injury mechanism and is associated with soft-tissue trauma.
  • If the joint is destroyed at the level of amputation, perform arthrodesis (fusion); this results in loss of joint function.
  • If a crush injury is severe, a mosaic of fragments may preclude attempts at replantation.

See the images below.

Radiologic appearance of a hand with 2-digit amput Radiologic appearance of a hand with 2-digit amputation.
Radiologic appearance of a complete thumb amputati Radiologic appearance of a complete thumb amputation.

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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