Digital avulsions and amputations are not uncommon in outdoor activities. Rope entanglement is often the cause, though specific descriptions of the mechanism of injury have not been reported. We report a common scenario where entanglement during a fall resulted in an amputation injury. Although any roping activity may cause a loop formation leading to digital entrapment and subsequent amputation injury, activities involving soft and loose ropes may increase the chances of injury. Rope slack is to be avoided to minimize the likelihood of entanglement. This case report describes a digital amputation during an indoor climbing incident and also describes a possible mechanism for such injuries.

Case report

An 18-year-old otherwise healthy, right-hand dominant, experienced rock climber was climbing at an indoor climbing wall. After leading a 12-m long climbing route, he attempted to use his left hand to clip the rope into the anchor carabiner at the end of the route, 2 m above the last protection. During this maneuver, he lost balance and fell approximately 5 m before he was caught by the dynamic climbing rope. During falls, experienced climbers are taught to grab the rope approximately 50 cm away from their harness to stabilize their body during the deceleration phase. While attempting this maneuver, the climber's right index and middle fingers became entangled in a loop of the rope. The full force of the fall was thus transferred to his middle and index fingers before being distributed by the harness. This caused a near-complete amputation of the index finger at the distal interphalangeal joint level. Only the flexor digitorum profundus tendon was in continuity, whereas all vessels, nerves, and soft tissue were completely avulsed. A minor soft tissue injury occurred at the middle finger. Because of the mechanism of injury with severely compromised soft tissue as well as delays during transfer resulting in a presentation 12 hours after the injury, a replantation was not attempted and a completion amputation was performed at the distal interphalangeal level. The distal articular surface of the middle phalanx was removed and the soft tissue envelope was closed over the defect. The postoperative course was uneventful.