Injury patterns and workplace safety characteristics of traumatic upper limb amputations in industrial press workers

Objectives: Industrial press machines are an important source of occupational upper-limb trauma, with injuries ranging from isolated digital amputations to extensive hand and proximal limb loss. The mechanism of injury may substantially influence the anatomical pattern and severity of amputation, while workplace safety measures such as machine guarding and personal protective equipment (PPE) may play an important role in injury prevention. The aim of this study was to compare the anatomical injury patterns and severity associated with guillotine and crush-cut mechanisms in industrial press machine-related upper-limb amputations and to evaluate workplace safety characteristics among affected workers. Methods: This prospective observational study included 185 patients aged 18–45 years presenting with press machine-related traumatic upper limb amputations between October 2023 and October 2024. Data regarding injury mechanism, duration of employment, machine guarding, PPE use, side of injury, and anatomical level of amputation were collected. Severe amputation was defined as hand-level or below-elbow amputation. Results: The mean age was 29.4 ± 6.3 years, and 97.3% of patients were male. The right upper limb was involved in 75.7% of cases. Guillotine injuries accounted for 86.5% of injuries, whereas crush-cut injuries comprised 13.5%. Distal four-digit amputation was the most frequent injury pattern (64.3%). Severe amputations occurred in 9 patients (4.9%). Exploratory regression analysis suggested an association between crush-cut injury and severe amputation (odds ratio 5.90; 95% confidence interval 1.43–24.2). However, because only nine severe amputation events occurred, this finding should be regarded as hypothesis-generating and interpreted cautiously. Conclusion: Crush-cut injuries were more often linked to severe proximal limb loss than guillotine injuries. However, because this observation was based on a limited number of severe events, it should be considered exploratory and requires confirmation in larger multicenter studies.