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Arterial trauma of the upper extremity in children
Y G Wolf1, T Reyna, K P Schropp
1Department of Surgery, Ohio State University, Columbus.
Insights
Pediatric upper extremity arterial trauma, often from broken glass, requires prompt repair. Long-term limb function in children primarily depends on nerve injury, not vascular issues.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Upper extremity arterial trauma in children is uncommon.
- Penetrating injuries, particularly from broken glass, are the leading cause.
- Associated nerve and tendon injuries are frequent.
Purpose of the Study:
- To review outcomes of pediatric upper extremity arterial trauma.
- To identify factors influencing long-term functional recovery.
- To inform preventative strategies.
Main Methods:
- Retrospective review of 30 children with upper extremity arterial trauma.
- Analysis of injury mechanisms, surgical interventions, and postoperative outcomes.
- Assessment of vascular, nerve, and tendon injury and repair.
Main Results:
- 87% of trauma was penetrating, 53% caused by broken glass.
- Arterial repair was successful in most cases; vascular insufficiency was rare.
- Neurologic deficit occurred in 33%, significantly impacting limb function.
Conclusions:
- Long-term functional outcomes in pediatric arterial trauma are primarily dictated by neurologic injury.
- Prompt surgical repair of arteries, nerves, and tendons is crucial.
- Preventing glass-related injuries in children's play areas is essential.
Abstract:
Thirty children with upper extremity arterial trauma were retrospectively reviewed. Trauma was penetrating in 87% of cases and in 53% injury was caused by broken plate glass. The injured artery was repaired in all but four cases. Nerves were injured in 53% and tendons in 23%. All severed nerves and tendons were repaired primarily. Postoperatively three children with proximal injuries had no palpable pulse in the affected extremity. One patient died of underlying disease and another required amputation during initial surgery due to extensive soft-tissue injury. Followup revealed no dysfunction directly related to vascular insufficiency. Neurologic deficit was found in 33% of the children followed, but only in one was the limb totally nonfunctional. We conclude that the long-term outcome is largely dependent upon neurologic injury. Glass doors and large glass windows should be avoided in the vicinity of children's play areas.