Determinates of functional disability after complex upper extremity trauma

This is a retrospective chart review of 71 patients who were operated on fo r 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 ra dial, 6 ulnar, and 6 multiple arterial injuries. There were 7 negative expl orations (4 venous injuries, 2 false-positive angiograms, and 1 branch arte ry injury). In addition to the vascular injury, 44 patients (69%) had anoth er 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 a mputations, resulting in a patency rate and limb salvage rate of 94%. Persi stent disability was more common in those patients with blunt injury (p = 0 .02) and in those patients with associated neurologic and orthopedic injuri es (p < 0.05). Full functional recovery was seen in 21 (33%) patients, whil e some form of disability was noted in the remaining 67%. The magnitude of the concomitant neurologic injury was the major determinate of functional o utcome in this patient population.