Upper extremity amputations after motor vehicle rollovers

BACKGROUND: The upper extremity is vulnerable to injury during a rollover motor vehicle crash (MVC). There is some concern that positioning one's arm on a vehicle door/window eliminates the benefit of maintaining containment within a protective structure. Mangled extremities with associated vascular injuries have an amputation rate exceeding 40%. The primary goal was to describe the care process and outcome of patients requiring an emergent upper extremity amputation after a rollover MVC. METHODS: All patients requiring an upper extremity amputation after a rollover MVC (2000-2008) were included. Patient demographics, injuries, and outcomes were analyzed. RESULTS: Seventeen patients required an upper extremity amputation after a rollover MVC (mean injury severity score = 23; hemodynamic instability at presentation = 29%). Injuries occurred on the side ipsilateral to the occupant vehicle position in 88% of cases. Most (76%) amputations occurred between May 1 and August 1 of their respective years, with 11 (65%) in the past 24 months. All amputations except one (replantation attempt) were completed within 24 hours. Concurrent operative procedures were performed in six (35%) patients, including three diagnostic peritoneal lavages, two laparotomies (splenectomies), one craniotomy, and one thoracotomy (atrial rupture). Mortality (12%) was a direct result of traumatic brain injuries. Temporary intravascular shunts were used before amputation in four (24%) patients. The majority (65%) of amputations were above the elbow joint. CONCLUSIONS: Blunt mangled upper extremities requiring completion amputations are most often caused by MVC rollovers. The risk of this injury is strongly associated with summer days and seems to be increasing in frequency.