From the Division of Plastic Surgery.
Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania.
Plast Reconstr Surg. 2023 Oct 1;152(4):820-830. doi: 10.1097/PRS.0000000000010453. Epub 2023 Mar 22.
Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy.
Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions.
A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively).
Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
全地形车（ATV）和最近普及的并排式多功能越野车（UTV）导致的手部致残性损伤发生率正在上升。提高外科医生对手部（UE）损伤类型、严重程度以及 ATV 和 UTV 事故后结果的熟悉程度，可能会改善患者的护理和宣传。
对 ATV 和 UTV 引起的 UE 损伤类型、严重程度、住院和重症监护病房（ICU）入院时间以及手术次数进行回顾性比较。采用 Fisher 精确检验、多变量方差分析、方差分析和事后分析以及多元线性回归分析进行分析。
共纳入 154 例患者（ATV，87 例；UTV，67 例）。患者年龄 4~89 岁。UTV 组手部和手指损伤明显更多，开放性骨折也更多（P = 0.005、P < 0.001 和 P < 0.001）。与 ATV 骑手相比，UTV 骑手手部致残性损伤的发生率增加了近 3 倍，截肢率增加了近 9 倍（P < 0.001 和 P < 0.001）。平均而言，UTV 组在医院多住院 2.5 天，在 ICU 多住院 0.91 天，多进行 1.3 次手术（P = 0.001、P = 0.007 和 P < 0.001）。车辆类型是唯一与住院天数、ICU 天数和 UE 手术次数显著相关的变量（P = 0.002、P = 0.008 和 P < 0.001）。
手部外科医生处于独特的地位，可以成为提高公众对越野车辆风险意识和促进骑手安全的先驱。与制造商和急救护理提供者合作，并指导教学活动，可能会改善患者的结局。
临床问题/证据水平：风险，II 级。
