Upper-extremity Injuries from Side-by-side All-terrain Vehicle Accidents: Experience and Outcomes in over 200 Patients.

Authors

Benjamin Watzig, Leeann Qubain, Clayton Hui, Michael McKee, Joshua Mirrer

Published in

Plastic and reconstructive surgery. Global open. Volume 14. Issue 10. Pages e8156. Epub Oct 06, 2026.

Abstract

Side-by-side all-terrain vehicle (ATV) crashes produce high-energy upper-extremity trauma requiring complex reconstruction. Despite the increasing prevalence of these injuries, characterization of injury patterns, management, and outcomes remains limited.
A multicenter retrospective review was performed across 9 level I trauma centers from 2019 to 2023. Adult patients with upper-extremity injuries from side-by-side ATV crashes who were evaluated by the hand surgery service were identified through a trauma registry and manual chart review. Demographics, injury characteristics, operative interventions, and outcomes were collected. A minimum of 6 weeks of follow-up was required for inclusion in the outcome analysis.
Among 207 patients (mean age, 32 ± 17 y; 70.5% male), the hand was the most frequently injured region (76.8%), followed by the wrist (30.4%) and forearm (26.6%). Open fractures occurred in 66.7% of patients, including 28% with Gustilo type IIIB or IIIC injuries. Patients underwent a mean of 1.5 operations during the index hospitalization; reconstruction included rotation flaps (10%), free flaps (4%), and dermal substitute placement (27%). Early amputation occurred in 18.4%. At a mean follow-up of 31 weeks (n = 158, 76.3%), patients underwent a mean of 2.6 ± 2.3 total operations; infection occurred in 19.6%; 15.2% required operative debridement; and late amputation occurred in 9.5%, yielding an overall amputation rate of 25.6%.
Side-by-side ATV crashes cause severe, often contaminated, multitissue upper-extremity injuries with high rates of infection and amputation despite aggressive surgical management.

PMID:
42841083
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

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