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Factors and Outcomes of Traumatic Pediatric Distal Upper Extremity Injuries
Catherine Tang, BS, Srivathsan Ramesh, MD, Jacob Siahaan, BS MS, Krysta M Sutyak, DO, Ethan W Sij, MD, Natalie A Drucker, MD; Hannah A Dineen, MD
UT Health Science Center, McGovern Medical School, Houston, TX
Background
Traumatic vascular injuries of the distal upper extremity (UE) in pediatric patients present a unique set of advantages and disadvantages, including faster healing time, fewer comorbidities, smaller anatomy, and more technical skill required for success. Given the complex nature of injury, this study aims to describe injury patterns, presentation, and associated outcomes in children.
Methods
A single-center retrospective study of distal upper extremity vascular injuries below the elbow was conducted in patients (<18 years old) from 2011 to 2024. Patient demographics, injury mechanisms, repair type, vascular status, preoperative and postoperative sensory and motor exams, and postoperative complications were collected. Multivariate analysis, logistic regression and Fisher exact tests were used.
Results
Twenty-four patients (19 males, 5 females) with a mean age of 12 were included. Twelve patients (50%) sustained concomitant nerve, tendon, and/or bony injuries in addition to vascular injury. Mechanism of injury was penetrating in 14 patients (58%) and blunt in 10 (42%). Vascular injuries involved the radial artery (n=9), ulnar artery (n=7), brachial artery (n=5), and digital arteries (n=5), with some patients sustaining multiple injuries. Fourteen patients (58%) underwent primary repair, 7 (29%) underwent repair with a graft, and 9 (38%) underwent ligation. Fasciotomy was performed in 6 patients (25%) at the time of initial surgery, and 6 patients (25%) required reoperation. No statistically significant association was found between mechanism of injury and reoperation rate (p > 0.05). Secondary amputation was performed in 3 patients (13%). Of the 20 patients who presented with initial motor deficits, 12 (60%) improved: nine achieved full recovery and three experienced partial recovery. Six patients experienced no improvement. Two patients had complete persistent motor loss after injury. Sensory outcomes improved in 10 patients, with five demonstrating a 1-level improvement and five showing ?3-level improvement on the Mackinnon-Dellon sensory scale (S0-S4).
Conclusion
This study provides an overview of the types of vascular injuries in pediatric patients as well as outcomes and expected recovery. This can be useful in counseling patients and families at initial evaluation and in the perioperative recovery period. Penetrating injuries were more common than blunt sources of injuries. There was no statistical difference between mechanism of injury and reoperation rate. It is helpful to demonstrate that a sizable group of patients had notable improvements in their motor and sensory exams from their initial presentation; however, our analysis did not show any statistical significance in rates of improvement between various subgroups.
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