Clinical Orthopaedics and Related Research®

, Volume 468, Issue 5, pp 1390–1395 | Cite as

Single Ray Amputation for Tumors of the Hand

  • Mark Edward PuhaindranEmail author
  • John H. Healey
  • Edward A. Athanasian
Clinical Research


Single ray amputation after hand trauma or infection can result in good aesthetic and functional outcomes. The role of this procedure in the management of aggressive benign or malignant hand tumors has been described only in case reports and small case series. We retrospectively reviewed the records of all 25 patients who underwent single ray amputations at our center during a 10-year period; there were seven index, five middle, six ring, and seven small ray amputations performed. The minimum followup was 2 months (mean, 36 months; range, 2–120 months), with four patients having a followup of 1 year or less. No patients had local recurrences, although two patients had positive resection margins. One underwent repeat resection followed by radiotherapy. The other was treated with radiotherapy alone, as local tumor control would have required a hand amputation. Functional assessment based on the Musculoskeletal Tumor Society staging system showed an average of 27.5 (range, 21–30). Patients who underwent perioperative radiotherapy experienced a decrease in functional ability. Grip strength was an average of 66% (range, 38%–100%) of the contralateral side. Our study suggests single ray amputation for hand tumors has a low local recurrence rate and high functional scores. However, function can be compromised by radiotherapy and a decrease in grip strength by a mean of 34% is to be expected.

Level of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.


Grip Strength Giant Cell Tumor Carpometacarpal Joint Musculoskeletal Tumor Society MSTS Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Anakwenze OA, Parker WL, Wold LE, Amrami KK, Amadio PC. Ewing’s sarcoma of the hand. J Hand Surg Eur Vol. 2009;34:35–39.CrossRefPubMedGoogle Scholar
  2. 2.
    Athanasian EA, Wold LE, Amadio PC. Giant cell tumors of the bones of the hand. J Hand Surg Am. 1997;22:91–98.CrossRefPubMedGoogle Scholar
  3. 3.
    Coleman RA. Fibro-osseous pseudotumour of the digit: amputation for a benign but aggressive lesion. J Hand Surg Br. 2005;30:504–506.CrossRefPubMedGoogle Scholar
  4. 4.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.PubMedGoogle Scholar
  5. 5.
    Gross E, Rao BN, Pappo AS, Michalkiewicz E, Hudson MM, Kaste SC, Greenwald CA, Pratt CB. Soft tissue sarcoma of the hand in children: clinical outcome and management. J Pediatr Surg. 1997;32:698–702.CrossRefPubMedGoogle Scholar
  6. 6.
    Hamm JC, DeFranzo AJ, Argenta LC, White W. Keratoacanthoma necessitating metacarpal amputation. J Hand Surg Am. 1990;15:980–986.CrossRefPubMedGoogle Scholar
  7. 7.
    Hanel DP, Lederman ES. Index transposition after resection of the long finger ray. J Hand Surg Am. 1993;18:271–277.CrossRefPubMedGoogle Scholar
  8. 8.
    Healey JH, Turnbull AD, Miedema B, Lane JM. Acrometastases: a study of twenty-nine patients with osseous involvement of the hands and feet. J Bone Joint Surg Am. 1986;68:743–746.PubMedGoogle Scholar
  9. 9.
    Heslin MJ, Woodruff J, Brennan MF. Prognostic significance of a positive microscopic margin in high-risk extremity soft tissue sarcoma: implications for management. J Clin Oncol. 1996;14:473–478.PubMedGoogle Scholar
  10. 10.
    Jayakumar S, Jatavalabulla S, Miller IM. Peripheral primitive neuroectodermal tumour of the hand in an adult. J Hand Surg Eur Vol. 2007;32:460–461.CrossRefPubMedGoogle Scholar
  11. 11.
    Johnstone PA, Wexler LH, Venzon DJ, Jacobson J, Yang JC, Horowitz ME, DeLaney TF. Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation. Int J Radiat Oncol Biol Phys. 1994;29:735–745.CrossRefPubMedGoogle Scholar
  12. 12.
    Kobus RJ, Leinberry C, Kirkpatrick WH. Metastatic renal carcinoma in the hand: treatment with preoperative irradiation and ray resection. Orthop Rev. 1992;21:983–984, 990–995.PubMedGoogle Scholar
  13. 13.
    Küntscher MV, Erdmann D, Homann HH, Steinau HU, Levin SL, Germann G. The concept of fillet flaps: classification, indications, and analysis of their clinical value. Plast Reconstr Surg. 2001;108:885–896.CrossRefPubMedGoogle Scholar
  14. 14.
    Melikyan EY, Beg MS, Woodbridge S, Burke FD. The functional results of ray amputation. Hand Surg. 2003;8:47–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Mowlavi A, Quinn BM, Zook EG, Milner S. Ray amputation as a treatment for recurrent myxohyaline tumor of the distal extremity. Plast Reconstr Surg. 2003;111:1573–1574.CrossRefPubMedGoogle Scholar
  16. 16.
    Muramatsu K, Ihara K, Doi K, Hashimoto T, Seto S, Taguchi T. Primary reconstruction with digital ray transposition after resection of malignant tumor. Arch Orthop Trauma Surg. 2008;128:1017–1021.CrossRefPubMedGoogle Scholar
  17. 17.
    Nuzumlali E, Orhun E, Oztürk K, Cepel S, Polatkan S. Results of ray resection and amputation for ring avulsion injuries at the proximal interphalangeal joint. J Hand Surg Br. 2003;28:578–581.CrossRefPubMedGoogle Scholar
  18. 18.
    Patil S, de Silva MV, Crossan J, Reid R. Chondrosarcoma of small bones of the hand. J Hand Surg Br. 2003;28:602–608.CrossRefPubMedGoogle Scholar
  19. 19.
    Peimer CA, Wheeler DR, Barrett A, Goldschmidt PG. Hand function following single ray amputation. J Hand Surg Am. 1999;24:1245–1248.CrossRefPubMedGoogle Scholar
  20. 20.
    Slocum DB. Amputations of the fingers and the hand. Clin Orthop. 1959;15:35–59.PubMedGoogle Scholar
  21. 21.
    Talbert ML, Zagars GK, Sherman NE, Romsdahl MM. Conservative surgery and radiation therapy for soft tissue sarcoma of the wrist, hand, ankle, and foot. Cancer. 1990;66:2482–2491.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Mark Edward Puhaindran
    • 1
    Email author
  • John H. Healey
    • 1
  • Edward A. Athanasian
    • 1
  1. 1.Orthopaedic Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations