Secondary Procedures after Severe Upper Extremity Injury

Upper extremity trauma is one of the most common types of injuries, accounting for 20 to 40 percent of injured patients presenting to the emergency department. In severe upper extremity injury, the likelihood of secondary procedures to improve function and resolve outstanding clinical problems is high. Secondary procedures are performed later than initial primary surgery, usually after wound healing and with a discernible time gap of days, weeks or occasionally longer. They should be considered as separate procedures from the primary surgery, with due diligence given to planning for it. When approaching secondary procedures, the key principles are anchored in early preparation, patient engagement, optimal timing and sequencing, reviewing and considering alternatives, and finally knowing when to stop. Although secondary procedures after upper extremity injuries can be a complex undertaking, the careful application of these principles and considerations will optimise outcomes.