Machete injuries to the upper extremity

• Published in: Archives of orthopaedic and trauma surgery 2017-12, Vol.137 (12), p.1615-1621
• Main Authors: Donnally, Chester J., Hannay, William, Rapp, Derek A., Lekic, Nikola, Dodds, Seth D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arteries - injuries; Assaults; Female; Humans; Infection - etiology; Injuries; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopaedic Surgery; Orthopedics; Patients; Peripheral Nerve Injuries - etiology; Retrospective Studies; Risk Factors; Tendon Injuries - etiology; Tobacco; Trauma; Trauma Centers; Upper Extremity - blood supply; Upper Extremity - injuries; Upper Extremity - innervation; Violence; Wounds, Stab - complications; Young Adult
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-017-2783-y

Purpose We intend to describe and analyze the spectrum of upper extremity injuries that arises from both accidental and intentional machete injuries with a focus on associated complications and comorbidities. This review is the first from a United States institution, and the only from a designated level 1 trauma center. Methods A retrospective review of machete related upper extremity injuries admitted to a level 1 trauma center from 2008 to 2016. The following data was collected on admitted patients: demographics, mechanism of injury, surgical management, and complications. We assessed the data with Pearson Chi square analysis. Results This cohort consisted of 48 patients (mean = 42 ± 13 years old); the majority were men (96%) involved in an assault (81%). These patients had a high rate of documented psychiatric history, substance and tobacco abuse, and being underinsured. Patient follow-up was extremely variable: 75% of patients presented for follow-up care (mean = 149 ± 344 days; range 8–1846 days). 44% had complications (i.e., infection, tendon rupture, nerve palsy). We identified no associations when examining follow-up rates or complication rates regarding patient comorbidities, insurance status, mechanism of injury, or the need for a nerve, artery, or tendon repair. Patients with current tobacco use did have an increased risk for infection. The majority (52%) of injuries occurred on the ulnar side of the forearm and to the non-dominant extremity (66%). Patients assaulted by machetes are significantly more likely to have a history of psychiatric illness, substance abuse, tobacco use, and are more likely to be underinsured compared to those with accidental machete injuries. Conclusions While machete injuries may be uncommon in most areas of the United States, physicians should give special attention to the patient comorbidities as many of these patients have complex medical and social issues which could complicate attempts of appropriate treatment. Level of evidence IV; Prognostic Study.