Upper limb morbidity as a direct consequence of intravenous drug abuse

To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU).

A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified.

Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome. Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes. These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up.

The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.