Abstract
Background:
Side-by-side all-terrain vehicle (ATV) crashes produce high-energy upper-extremity trauma requiring complex reconstruction. Despite the increasing prevalence of these injuries, characterization of injury patterns, management, and outcomes remains limited.
Methods:
A multicenter retrospective review was performed across 9 level I trauma centers from 2019 to 2023. Adult patients with upper-extremity injuries from side-by-side ATV crashes who were evaluated by the hand surgery service were identified through a trauma registry and manual chart review. Demographics, injury characteristics, operative interventions, and outcomes were collected. A minimum of 6 weeks of follow-up was required for inclusion in the outcome analysis.
Results:
Among 207 patients (mean age, 32 ± 17 y; 70.5% male), the hand was the most frequently injured region (76.8%), followed by the wrist (30.4%) and forearm (26.6%). Open fractures occurred in 66.7% of patients, including 28% with Gustilo type IIIB or IIIC injuries. Patients underwent a mean of 1.5 operations during the index hospitalization; reconstruction included rotation flaps (10%), free flaps (4%), and dermal substitute placement (27%). Early amputation occurred in 18.4%. At a mean follow-up of 31 weeks (n = 158, 76.3%), patients underwent a mean of 2.6 ± 2.3 total operations; infection occurred in 19.6%; 15.2% required operative debridement; and late amputation occurred in 9.5%, yielding an overall amputation rate of 25.6%.
Conclusions:
Side-by-side ATV crashes cause severe, often contaminated, multitissue upper-extremity injuries with high rates of infection and amputation despite aggressive surgical management.