BACKGROUND Clinical decision-making between replantation and digit shortening after traumatic partial digital amputation is guided by surgical feasibility and expected functional outcomes. It is also impacted by patient preferences, strongly influenced by cultural values relating to appearance, and stigma. Failure to recognise these factors may cause decisional conflict and dissatisfaction despite technically successful surgery. AIM To synthesise evidence on functional and patient-reported outcomes, and cultural preferences between replantation and digit shortening, and to propose a culturally safe shared decision-making framework for hand trauma care. METHODS A narrative review of comparative studies between replantation and digit amputation, evaluating outcomes – pain, sensation, range of motion, strength and decisional drivers such as occupation, appearance, perceived function, stigma, and body integrity. Comparative cultural studies between North American and Japanese populations were prioritised. RESULTS Replantation achieves sensation and strength comparable to digit shortening, with advantages including reduced pain and improved patient-reported outcomes in selected injury patterns1. Digit amputation provides acceptable function and sensation, particularly for distal fingertip injuries, and may be favoured when rapid recovery is prioritised. Cross-cultural studies suggest a higher societal and surgeon preference for replantation in Japan than the United States, due to greater emphasis on cosmetic appearance, bodily “wholeness,” and anticipated stigma2. CONCLUSION A culturally safe shared decision-making approach in hand trauma should integrate injury location, functional prognosis, recovery time, and elicitation of patient values. Recognising cultural influences aligns operative strategy with patient goals and improve long-term satisfaction. REFERENCES 1.Chung KC et al. JAMA Surg. 2019;154(7):637. 2.Nishizuka T et al. J Hand Surg Am. 2015;40(8):1646–1656.