Grants Funded

Abstract
Despite the widespread performance of replantation surgery in the United States, a substantial number of finger injuries still result in amputations. These injuries affect all segments of the population, including children, young active workers, and older patients involved in labor-intensive hobbies. Finger amputations leave the patient with impairment that causes substantial functional and emotional disability. A system for determining impairment designed by the American Medical Association (AMA) is widely used; however, it is uncertain whether this rating system reflects the true physical condition of the injured. Patient-reported outcomes (PRO) questionnaires provide a unique approach in assessing disability and quality of life as reported by the patient, but have not been evaluated in the finger amputation population. We plan to use strength and sensory tests, PRO questionnaires, and the Jebson-Taylor test that simulates activities of daily living to more accurately measure disability after finger amputations. We will analyze patients in four groups: single finger amputations, thumb amputations, multiple finger amputations, and multiple finger and thumb amputations. The goals of this project are to 1) evaluate the ability of PROs to assess impairment after revision amputation, and 2) compare PROs and AMA ratings of disability with true functional disability as reflected by performance in the Jebson-Taylor test. The data gathered through these techniques will improve our understanding of the degree of disability that results from various amputation injuries, and the accuracy of PROs in rating this disability. The impact of this project is in applying evidence-based medicine concepts to improve assessment of impairment and disability for patients with finger amputations.

Biography
Aviram M. Giladi, MD, MS is a board-certified and fellowship trained upper extremity surgeon at The Curtis National Hand Center and holds appointments of Assistant Professor in the Departments of Plastic Surgery at Georgetown University and Johns Hopkins University. He completed his medical degree at Vanderbilt University and residency in plastic and reconstructive surgery at The University of Michigan. During residency, he completed a Master’s in Health and Health Care Research. Dr. Giladi completed hand and upper extremity fellowship in the Department of Orthopaedics at Beth Israel Deaconess Medical Center. Dr. Giladi has a broad hand surgery clinical practice with a substantial volume of acute trauma care including revascularization and replantation. He also serves as Research Director for The Curtis National Hand Center and Scientific Director of Orthopedics for MedStar Union Memorial Hospital. His published research includes work on post-traumatic impairment and disability, delivery of upper extremity trauma care, and how trauma systems and networks affect care implementation and policy. As Research Director, he coordinates basic science, animal, biomechanics, and clinical outcomes studies through the Hand Center, and has a strong history of collaborative efforts across specialties and institutions. He is involved with many professional societies including active membership in the American Society of Plastic Surgeons and the American Society for Surgery of the Hand.