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J Trauma Acute Care Surg. 2013 Feb;74(2):687-91. doi: 10.1097/TA.0b013e31827e1857.

Vehicle factors and outcomes associated with hand-out-window motor vehicle collisions.

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  • 1Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA.



Patients can experience devastating injuries when an upper extremity travels out of a window during a motor vehicle collision. These injuries are typically very severe and may even result in loss of the affected limb. The purposes of this retrospective study were to determine the clinical fate of these extremities and analyze for common factors during the collisions.


A retrospective chart review of 20 patients between 2003 and 2010, evaluating the patient's age, arm involvement, number and types of surgeries, as well as the Mangled Extremity Severity Score (MESS) was conducted. In addition, patients were contacted to survey them about accident and vehicle factors and to complete the Quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) survey. The data were then analyzed for common factors.


The mean age of the 20 patients involved was 28.8 years. There were 11 men and 9 women. The mean MESS was 5.4. Two patients required amputation of some form. Fifteen patients were wearing a seatbelt at time of collision, four were not, and the restraint status of one patient is unknown. The closest extremity to the window was involved in 18 (90%) of 20 patients. Vehicle rollover was the most common mechanism of injury with 16 patients (80%) involved, while 4 patients (20%) were involved in head-on or side-impact type collisions. The average quickDASH score was 24 (range, 5-91).


The hand-out-of-the-window phenomenon during motor vehicle crashes results in very serious injury to the affected extremity. Most patients were involved in rollover accidents, and most were wearing a seatbelt. The arm closest to the window was nearly always involved. The mean MESS is high in these patients but did not necessarily correlate with amputation.


Therapeutic, level IV.

[PubMed - indexed for MEDLINE]
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