LONG-TERM OUTCOMES AFTER UPPER-LIMB ARTERIAL INJURIES

OBJECTIVE: To assess long-term outcomes in multisystem trauma victims who have arterial injuries to upper limbs. DESIGN: A retrospective cas e series. SETTING: Tertiary care regional trauma centre in a universit y hospital. PATIENTS: All consecutive severely injured patients (Injur y Severity Score greater than 15) with an upper limb arterial injury t reated between January 1986 and January 1995. Demographic data and the nature and management of the arterial and associated injuries were de termined from the trauma registry and the hospital records. OUTCOME ME ASURES: Death rate, discharge disposition, residual disabilities and f unctional outcomes as measured by the Glasgow Outcome Scale. RESULTS: Twenty-five (0.6%) of 4538 trauma patients assessed during the study p eriod suffered upper extremity arterial injuries. Nineteen of them wer e victims of blunt trauma. The death rate was 24%. There were 10 prima ry and no secondary amputations. An autogenous vein interposition graf t was placed in 10 patients. Concomitant fractures dr nerve injuries i n the upper limb were present in 80% and 86% of the patients, respecti vely. Long-term follow-up data (mean 2 years) were obtained in 16 of t he 19 who survived to hospital discharge. The residual disability rate was high. It included upper limb joint contractures, pain and persist ent neural deficits (69%). Associated injuries in other body areas als o contributed to overall disability. Only 21% of the patients recovere d completely or had only minor disabilities. CONCLUSIONS: Associated i njuries, rather than the vascular injury, cause long-term disability i n the multisystem trauma victim who has upper extremity involvement. P ersistent neural deficits, joint contractures and pain are the princip al reasons for long-term impairment of function.