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Vehicle Factors and Outcomes Associated with Hand-out-window Motor Vehicle Collisions
Adam J. Bakker, MD; Jessica Moseley, BA, BS; Jeffrey Friedrich, MD; University of Washington
University of Washington, Seattle, WA, USA


Patients can suffer devastating injuries when an upper extremity travels out of a window during a motor vehicle collision. These injuries are typically very severe and can even result in loss of the affected limb. Little has been published about this particular motor vehicle collision phenomenon. The purpose of this retrospective study is to determine the clinical fate of these extremities, and analyze for common factors during the collisions.


A retrospective chart review of twenty patients between the years of 2003 to 2010 evaluating the patient’s age, arm involvement, number and types of surgeries as well as the Mangled Extremity Severity Score (MESS) was conducted. Additionally, patients were contacted to survey them about accident and vehicle factors and to complete the Quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) survey. The data were then analyzed for common factors.


The average age of the twenty patients involved was 28.8 years (range 14 to 63). There were eleven men, (mean age 27.2 years), and nine women (mean age 30.8). The average MESS score was 5.4 (range 4 – 10). Two patients required amputation of some form. Fifteen patients were wearing a seat belt at time of collision, 4 were not, and the restraint status of one patient was unknown. The closest extremity to the window was involved in eighteen of twenty (90%) of the patients. Vehicle rollover was the most common mechanism of injury with sixteen (80%) patients involved, while four (20%) patients were involved in head-on or side impact type collisions. Truck/SUV wrecks were slightly more common than car/sedan. Only 5 patients stated that the side window was open at the time of collision. The average quickDASH score was 24 (range 5-91).


The hand out window phenomenon during motor vehicle crashes results in very serious injury to the affected extremity. The average MESS was high in these patients, although amputations were rare. The majority of patients were involved in rollover accidents and most were wearing a seat belt. The arm closest to the window was nearly always involved. The majority of the patients sustained open fractures of the forearm and hand, and flaps were frequently required.

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