Narrow Results

Aim: To quantify and qualify the types of upper limb injuries admitted to hospital as a direct result of illicit intravenous drug use (IVDU).

Method: A retrospective case series identified all inpatient admissions for upper limb injuries as a direct result of IVDU over a two-year period. The type of injury, procedures, complications, co-morbidities, relevant investigations and other notable events during admission and follow-up were identified.

Results: Thirty-six people were admitted with upper limb injuries. Infective presentations (abscess, cellulitis, osteomyelitis, and septic arthritis) were most common. Other injuries were due to accidental intra-arterial injection, soft-tissue necrosis and compartment syndrome.

Microbiological analysis from abscesses showed a high frequency of multiple organisms, and most commonly identified Streptococci, Staphylococcus aureus, and anaerobes.

These patients had high rates of hepatitis C, malnutrition, psychiatric and behavioural co-morbidities; 77% were lost to follow-up.

Conclusion: The most common injuries from IVDU are infections, and ischaemia. High rates of concurrent medical and psychosocial co-morbidities add further challenges to effective patient care.

Background: Traumatic digital amputations require early replantation, and proper surgical technique is a critical factor for a successful digital replantation. Non-surgical factors can also effect the digital survival rate. Previous studies have used univariate analysis and logistic regression which could not identify the various complex associations of patient-related and digit-related factors. This study aimed to identify the determinants of digital survival after replantation, using multi-level analysis.

Methods: A retrospective analysis of 209 patients with 272 finger revascularizations and replantations performed from the metacarpophalangeal joint to the end of the finger. Demographic data, place of injury, mechanism of injury, level of amputation, and success rate were examined.

Results: The overall survival rate of digital replantation during the study period January 2004–December 2017 was 64%. Surgeon’s experience 3–5 years (OR 13.04), type of injury as guillotine (OR 6.79) and number of venous anastomoses for two veins (OR 6.83) were the most important pre-operative and intra-operative factors affecting the survival rate as clarified by a multi-level hierarchical model.

Conclusions: Although successful replantation involved many factors, the most important factors that directly affected the survival of the amputated digit were surgeon’s experience, venous anastomosis and type of injury.