241 posters, 10 topics, 7 sessions, 899 authors, 296 institutions
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The AAPS 103rd Annual Meeting 2025
May 24-27, 2025 | Austin, Texas
D133
Operative Exploration Vs. Selective Non-operative Management In Hemodynamically Stable Patients With Penetrating Upper Extremity Trauma: A Study In A Federally Qualified Health Center (FQHC)
Poster Presenter
Authors
Angelica McDaniel, Oblaise Mercury, Mitchell Koss, Carter Bernal, Zachary Brumm, Daniel Rouhani, Scott Hansen
Affiliations
University of California, San Francisco, California Northstate University College of Medicine, University of California, San Francisco School of Medicine, University of California, San Francisco Department of Plastic Surgery
Part of Topic
Hand/Extremity
Operative Exploration vs Selective Non-Operative Management in Hemodynamically Stable Patients with Penetrating Upper Extremity Trauma: A Study in a Federally Qualified Health Center
Background:
•Penetrating upper extremity trauma (PUET) poses unique challenges due to the risk of neighboring neurovascular and bone injury
•Hemodynamically stable patients are often managed conservatively with selective non-operative management (SNOM)
•SNOM effectiveness in upper extremity injuries remains unclear, especially in Federally Qualified Health Centers (FQHCs)
•This study aims to evaluate whether SNOM provides outcomes comparable to surgery for PUET in FQHC settings
Methods:
•Retrospective chart review of 101 patients was conducted for PUET within Zuckerberg San Francisco General Hospital between 2019-2024
•Data collected includes the mechanism of injury, types of SNOM, nature and timing of operative intervention (if any), and outcomes after discharge from the hospital
•Comparative analyses identified factors associated with the likelihood of operative intervention and compared the distributions of these variables between those who underwent surgery and those who did not
Discussion:
•Gunshot wounds were the most common injury mechanism, with most injuries located on the hand
•All patients underwent extremity examination, with surgical patients more frequently receiving CT or X-ray imaging
•Surgical patients were more likely to have adverse outcomes post-discharge, including unexpected ED visits and nerve deficits
•Those who received surgery were significantly more likely to attend follow-up care, such as occupational therapy or follow-up with the hospital’s hand service
Future Directions:
•Larger, multi-site studies across FQHCs are needed to confirm the generalizability of these findings
•Future research should also assess long-term functional outcomes, patient-reported measures, and the cost-effectiveness of SNOM compared to surgical intervention
•Identifying barriers to follow-up care and rehab could inform strategies to improve recovery and service utilization in underserved settings