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Operative Exploration Versus Selective Nonsurgical Management in Hemodynamically Stable Patients With Penetrating
Angelica T McDaniel1, Oblaise A Mercury2, Mitchell Koss1
1University of California, San Francisco School of Medicine, San Francisco, CA.
Purpose:
Penetrating upper-extremity trauma (PUET) presents complex challenges due to the risk of injury to neighboring structures. With many patients requiring surgery, data on the efficacy of selective nonsurgical management (SNSM) questions its role as first-line treatment. Investigation is especially needed within Federally Qualified Health Centers (FQHCs) to enhance care for individuals who often encounter barriers to care. This study descriptively characterizes practice patterns and outcomes associated with operative and nonsurgical management of PUET within an FQHC serving a predominantly underinsured, urban population.
Methods:
A retrospective study identified patients within an FQHC who were evaluated for PUET between 2019 and 2024. Data collected includes mechanism, location, and severity of the injury, timing of operative interventions (if any), and postdischarge outcomes. Descriptive analyses identified factors associated with the likelihood of operative intervention.
Results:
Ninety-nine patients met inclusion criteria; 16 (16.2%) underwent operative intervention and 83 (83.8%) were managed with SNSM. The cohort had a median age of 39 years and predominantly comprised men. Gunshot wounds were the most common mechanism, and the hand was the most frequently injured site. Operative patients had significantly higher rates of fracture and tendon disruption compared to SNSM patients. Infections were more frequent in operative patients. Follow-up completion differed substantially between groups, with operative patients attending hand clinic at higher rates than SNSM patients.
Conclusions:
This descriptive study characterizes how PUET is managed within an FQHC, contributing to the limited literature examining upper-extremity surgery care in resource-limited, safety-net settings. For hand surgeons practicing in these environments, these findings support a selective rather than routine operative approach for hemodynamically stable patients, using physical examination and plain radiographs as primary decision tools.
Clinical Relevance:
SNSM can be considered a safe and appropriate approach for hemodynamically stable PUET patients without fracture or tendon injury, reducing surgical burden and supporting efficient care in FQHCs.
