Disclosures: Deborah Pacik, MD, MPH, MAc: No financial relationships or conflicts of interest

Case Description: History was provided by a staff member from the group home. Several weeks prior to the office visit, the patient was donning his AFO while sitting and placed his index finger posteriorly in the open angle of the articulating joint and then stood up for increased leverage. As he abruptly stood and increased his plantarflexion angle at the ankle, the combination of the gap closure due to change in position plus the weight of his body when standing resulted in accidental guillotine amputation of his distal phalangeal joint. Immediately after the injury his wound was bandaged and he was started on antibiotics in the emergency department.

Setting: Outpatient Prosthetics & Orthotics Clinic

Patient: 37 year old male with intellectual disability and bilateral pes planus with ankle instability requiring articulating ankle-foot orthoses (AFO). Assessment/

Results: On exam, the wound was healing with secondary intention and granulation tissue. The patient was sent for evaluation by a hand surgeon. X-rays revealed a second finger distal phalangeal transverse amputation. Evaluation of the orthosis revealed blood at the articulating joint and missing plantarflexion stop. Although the patient was upset because he had done something wrong, he did not understand what he had done to cause himself injury.

Discussion: The patient with intellectual disability did not understand how to properly don and doff his orthoses leading to significant injury. Additionally, orthosis components were missing that, had they been present, may have decreased the severity of the injury.

Conclusion: This unusual case highlights the importance of ensuring that patients and/or their caregivers understand how to don and doff orthoses as well as the importance of a plantarflexion bumper. If a patient is unable to understand or demonstrate the proper technique, a caregiver plan should be implemented.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/accidental-finger-amputation-by-ankle-foot-orthosis-a-case-report/