Upper Extremity Injury Patterns Unique to Utility Terrain Off-Road Vehicles.

OBJECTIVES: Utility terrain vehicles (UTVs), equipped with roll cages and safety harnesses, are increasingly popular recreational vehicles. Unlike all-terrain vehicles (ATVs) which lack these features and have well-documented injury patterns, UTV injury patterns are not represented well in literature. This study aims to characterize these distinct injury patterns and their impact. METHODS: A retrospective chart review from a Level 1 trauma center was conducted, including all UTV- and ATV-related injuries between 2018 and 2022. Statistical analyses utilized Chi-square, t-tests, and Mann-Whitney U tests to compare patient demographics, injury characteristics, and outcomes between the two groups. RESULTS: A total of 226 patients (ATV = 103, UTV = 123) were identified from 2018 to 2022. While the ATV group had a higher incidence of polytrauma (76.7% vs. 16.3%), the UTV group showed significantly higher rates of severe, isolated upper extremity injuries. UTV injuries resulted in higher rates of mangled extremities (48.8% vs. 2.9%), open fractures (69.1% vs. 11.7%) with higher Gustilo grades, vascular injuries (41% vs. 1.9%), and peripheral nerve injuries (45.1% vs. 1.9%). Distal upper extremity fractures (forearm and hand) were more common in UTVs. UTV injuries also led to higher replantation attempts (16.4% vs. 0%), amputations (25.2% vs. 1.9%), and significantly higher median hospital charges ($115,900 vs. $66,300). CONCLUSION: UTVs are associated with high-energy crush injuries primarily affecting a single upper extremity during rollovers. These devastating injuries lead to higher rates of mangled extremities, dysvascular limbs, amputations, and increased costs. LEVEL OF EVIDENCE: Level IV Retrospective Cohort Study.