title: Upper extremity injuries in motorcyclists: Implications for mortality and need for rehabilitation services.
abstract: BACKGROUND
  Motorcycle crashes (MCCs) constitute a disproportionately high number of road accidents that result in mortality and injury, compared with other motor vehicle collisions. Distribution and characteristics of upper extremity injuries sustained by motorcyclists and their implications are not well established. We sought to determine the epidemiology of upper extremity injuries in motorcyclists and the independent effects of the injuries on mortality and need for rehabilitative services.
  
  
  METHODS
  All motorcyclist admissions at our Level I trauma center from 2006 through 2010 were retrospectively reviewed. We identified and categorized all upper extremity injuries. Demographic data, in-hospital mortality, disposition to a rehabilitation facility, and other potential confounding covariates were recorded. Propensity score-adjusted logistic regression models quantified the effects of upper limb injuries on mortality and transfer to rehabilitation facilities.
  
  
  RESULTS
  Thirty-five percent (759 of 2,151 patients) involved in MCCs sustained upper extremity injury. Shoulder girdle injuries were most common (n = 433), followed by forearm fractures (n = 272). Mortality rate was 4% (87 of 2,151 patients) for all MCC admissions. Propensity score-adjusted logistic regression models showed that injuries distal to the humerus had an independent odds ratio for mortality of 0.41 (95% confidence interval, 0.21-0.8). Odds of requiring rehabilitation after discharge were 1.82 times (95% confidence interval, 1.47-2.26) higher when any upper extremity injury was sustained.
  
  
  CONCLUSIONS
  Upper extremity injuries are common in MCCs. Distal injuries are associated with lower mortality rates possibly because of a "crumple zone effect" of distal upper extremities sparing the head and neck region from direct impact in head-first injuries. MCC patients with upper extremity injuries are more likely to require rehabilitation services.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Paryavi
authors.forename: Mohit N
authors.initials: MN
authors.lastname: Gilotra
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Johnson
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Pensy
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Eglseder
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Abzug
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000328:Adult; D005260:Female; D006230:Hand Injuries / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009049:Motorcycles; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers