Finger prostheses in amputation claims: an update

Since our last article discussing digit prosthetics, such devices have become much more established in the market. Inevitably this has added to the cost of digit amputation claims whilst also impacting volumes, with our complex injury teams seeing an increase in case numbers.

As this type of prosthetic surges in popularity, our Amputations Special Interest Group analyses the latest technology on the market and its potential effect on the cost of claims.

Example of available prosthetics

Source: Naked Prosthetics. Note: All these devices are marketed as being usable in conjunction with each other.

PIP Driver

This is a body-powered mechanical finger, designed for individuals who have an amputation at the middle of the distal phalanx. It claims to restore length, provide dexterity, replace a missing DIP joint and offer protection to sensitive residua. This prosthesis is pushed onto the remaining part of the finger and is held on in a similar way to a ring.

PIP Drivers can also be made static where the objective is to help with weight distribution in the hand and length restoration.

MCP Driver

Also a body powered mechanical finger, the MCP Driver is designed for those with amputations through the proximal phalanx. It claims to restore the middle and distal phalanges and, as it is body driven, it allows patients to regain fine dexterity and pinch and restore grip stability.

Thumb Driver

This is arguably one of the most important prosthetics as the loss of a thumb can impair hand function by 40%, which equates to an 8% impairment of the whole body. It is intended for use by those with a thumb absence between the MCP (metacarpophalangeal) joint and the IP (interphalangeal) joint.

Grip Lock Finger

This is intended for use following an amputation at, or proximal to, the MCP joint and is designed for digits two to five. It is claimed to restore length, encourage bilateral hand use and be a valuable aid in activities of daily living.

Costings

The following costings (provided in January 2024) are used by way of illustration of an industrial accident claim dealt with by Keoghs, where the claimant sustained a comminuted fracture of the distal phalanx of the index finger to his non-dominant hand and a small laceration of left middle finger, damaging the nail bed. 

Recommendation 1: Naked Prosthetics PIP Driver including extended warranty

Recommendation 2: 2 x silicone digits - one winter colour, one summer colour

Total potential cost of initial 3-year period: £14,500*

*Prices are an example only and are subject to change
Look out for the upcoming prosthetic pricing guide from the Amputations SIG which will be released shortly.

The latest ‘Third Generation’ technology

This year Naked Prosthetics announced a product update with the release of Third Generation technology for their digit prosthetics. The devices we have already discussed are being marketed as having a number of improvements: improved durability, increased personalisation options, improved ease of service and replacement of consumable parts. A two-year warranty will now come as standard, and this can be extended to a maximum of three years at an additional cost. The extent of any improved functionality is unclear at this stage.

It is understood that all new orders of products will be the Third Generation devices and all repairs to existing products will be fitted with Third Generation parts.

We understand that costings for this new generation of devices have increased by approximately 20% which will inevitably impact the cost of claims going forward.

NHS provision  

In the past, finger and toe amputees were typically not referred to prosthetic centres due to the lack of functional devices available. It is possible this may change with more prosthetic options appearing on the market. However, we suspect these would not be funded by the NHS so it still remains unlikely that claimants would be referred to NHS prosthetic centres. This may explain the increased number of claims we are seeing.

Warranty and life span

Given these types of products have now been on the market for over three years, statistics may soon be available from current clinical providers to determine how frequently the devices are actually being replaced along with abandonment rates. A warranty is commonly provided for every three or four years. However, this is not an indication of the product’s lifespan, and the prosthetics we’ve listed have no end expiry date.

The lifespan of a product references the duration it is expected to function optimally before it requires replacement due to normal wear and tear. The individual lifespan will however be dependent on the amount of usage and activities carried out during day to day living activities, labour-intensive work, sporting activities etc.

The warranty period offered for the individual products regularly dictates the replacement cycles claimed which, for a young claimant, quickly results in quantum inflating. It is important to discuss views on replacement cycles with instructed experts and where appropriate, consider potential insurance arrangements as an alternative to simply relying on the manufacturer’s own warranty information.

The future

As the devices are still in their infancy in the UK, it remains to be seen whether a claimant will actually replace a device at such regular intervals and whether the warranty period is realistic, especially where the device is not regularly used.

It will be interesting also to see if the market becomes diluted with a wider range of companies offering alternatives in the coming years. Such competition has the potential to drive down prices and we will continue to monitor any further developments in this field.

Practice points

• It is important to consider the extent of the amputation and how much of the residual digit remains. In the right cases we should be challenging the requirement for expensive prosthetics at the outset.
• Obtaining an early steer from a hand surgeon or prosthetic expert following consideration of the operation notes can be important when rehabilitation is being considered. Once a claimant has trialled a device and claims to have gained improved function, either domestically or at work, it can be difficult to successfully oppose a claim for prosthetics. It is important for experts instructed by the defendant to comment on the current and future requirements for prosthetic devices.
• It also needs to be borne in mind that the prosthetics on the market do not provide sensory feedback to the individual and by their very nature they create a barrier between the outside world and sensate skin. Therefore, they do not provide a like-for-like replacement to the lost digit and may not be desired by everyone. Their introduction to a claim could be lawyer-led, seeking to bolster the claim value. Careful questioning by experts instructed is desirable to aid in understanding the motivation behind the device being requested.
• Conversely, as much as prosthetics are an expensive product, it can be argued that, where appropriate, their purchase facilitates a return to the employment market and ability to self-care, thereby driving down the cost of future loss of earnings and care claims. A case-by-case assessment is required.

We will be keeping an eye on further innovations and their impact on claims costs. If you’d like more information in the meantime, make sure to contact our Amputations SIG.

Contact Joanne Whitwell or Natalie Dawes for more information