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 case series.

Setting

Tertiary care regional trauma centre in a university hospital.

Patients

All consecutive severely injured patients (Injury Severity Score greater than 15) with an upper limb arterial injury treated between January 1986 and January 1995. Demographic data and the nature and management of the arterial and associated injuries were determined from the trauma registry and the hospital records.

Outcome measures

Death rate, discharge disposition, residual disabilities and functional outcomes as measured by the Glasgow Outcome Scale.

Results

Twenty-five (0.6%) of 4538 trauma patients assessed during the study period suffered upper extremity arterial injuries. Nineteen of them were victims of blunt trauma. The death rate was 24%. There were 10 primary and no secondary amputations. An autogenous vein interposition graft was placed in 10 patients. Concomitant fractures or nerve injuries in the upper limb were present in 80% and 86% of the patients, respectively. Long-term follow-up data (mean 2 years) were obtained in 16 of the 19 who survived to hospital discharge. The residual disability rate was high. It included upper limb joint contractures, pain and persistent neural deficits (69%). Associated injuries in other body areas also contributed to overall disability. Only 21% of the patients recovered completely or had only minor disabilities.

Conclusions

Associated injuries, rather than the vascular injury, cause long-term disability in the multi-system trauma victim who has upper extremity involvement. Persistent neural deficits, joint contractures and pain are the principal reasons for long-term impairment of function.