title: Upper limb morbidity as a direct consequence of intravenous drug abuse.
abstract: OBJECTIVE
  To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU).
  
  
  METHODS
  A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified.
  
  
  RESULTS
  Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome. Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes. These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up.
  
  
  CONCLUSIONS
  The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.
authors.affiliation: Department of Hand Surgery, St. Vincent's Hospital Melbourne, Australia. aaronbuckland@hotmail.com
authors.forename: Aaron
authors.initials: A
authors.lastname: Buckland
authors.forename: Richard
authors.initials: R
authors.lastname: Barton
authors.forename: David
authors.initials: D
authors.lastname: McCombe
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D001158:Arteries / Q000293:injuries; D001315:Australia / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology*; D013290:Streptococcal Infections / Q000453:epidemiology / Q000209:etiology*; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply / Q000293:injuries* / Q000473:pathology; D055815:Young Adult