Determinates of functional disability after complex upper extremity trauma.
This is a retrospective chart review of 71 patients who were operated on for presumed upper extremity arterial trauma between June 1992 and June 1998. Penetrating trauma occurred in 50 (70%) patients, and blunt trauma in 21 (30%). There were 2 innominate, 6 subclavian, 13 axillary, 26 brachial, 5 radial, 6 ulnar, and 6 multiple arterial injuries. There were 7 negative explorations (4 venous injuries, 2 false-positive angiograms, and 1 branch artery injury). In addition to the vascular injury, 44 patients (69%) had another injury in the extremity, including 8 (12.5%) orthopedic injuries, 12 (19%) nerve injuries, and 24 (37.5%) combination nerve and orthopedic injuries. There were three arterial thromboses, one arterial disruption, and four amputations, resulting in a patency rate and limb salvage rate of 94%. Persistent disability was more common in those patients with blunt injury (p = 0.02) and in those patients with associated neurologic and orthopedic injuries (p < 0.05). Full functional recovery was seen in 21 (33%) patients, while some form of disability was noted in the remaining 67%. The magnitude of the concomitant neurologic injury was the major determinate of functional outcome in this patient population.
Brown
K R
KR
Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee, USA.
Jean-Claude
J
J
Seabrook
G R
GR
Towne
J B
JB
Cambria
R A
RA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000098:blood supply / Q000294:innervation; D001134:Arm Injuries / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001808:Blood Vessels / Q000293:injuries; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures