Senior Physician Speaker Series
Curated and hosted by Sam Yared, MD
Topic: Consensus & Controversy in Upper Extremity Trauma
Guest Speaker: Dexter Weeks, MD
At the April meeting of the Senior Physicians Committee, Dr. Sam Yared, chair, introduced UofL Health Clinical Instructor in the Division of Plastic and Reconstructive Surgery, Dexter Weeks, MD, for a presentation on upper extremity trauma.
Upper extremity trauma represents one of the most common and complex challenges encountered in modern clinical practice, accounting for more than one-third of emergency department visits in the United States. Yet despite its frequency, the management of these injuries remains an evolving intersection of established principles, emerging evidence and ongoing debate. Dr. Weeks offered a nuanced look at both the consensus and controversies shaping care in this field, highlighting not only technical considerations, but also the deeper clinical judgment required to optimize patient outcomes.
At the core of upper extremity trauma is anatomical complexity. As Dr. Weeks emphasized, the hand and arm are composed of multilayered structures— bone, tendon, nerve and vascular networks— that function in remarkable coordination. This intricate design allows for the dexterity and precision that define human interaction with the environment, but it also introduces significant challenges when injury occurs. Trauma can range from relatively straightforward lacerations to devastating crush, burn, or ballistic injuries, each demanding a tailored and often multidisciplinary approach.
The beauty, Dr. Weeks noted, lies in this complexity – but it is the same complexity that drives controversy in management decisions. Unlike more standardized areas of medicine, upper extremity trauma often lacks clear, universally accepted treatment algorithms. Instead, clinicians must weigh competing priorities: restoration of function, preservation of tissue, minimization of complications and long-term quality of life.
One area that illustrates this tension is the management of isolated vascular injuries, particularly radial and ulnar artery lacerations. These
34 LOUISVILLE MEDICINE injuries are not uncommon, representing a significant proportion of upper extremity vascular trauma. However, the decision to repair versus ligate remains debated. While traditional teaching has favored repair to preserve dual blood supply, emerging evidence suggests that in select cases— particularly when one artery remains intact— ligation may be sufficient without compromising perfusion.
This divergence in practice underscores a broader theme in trauma care: the importance of context. Factors such as the mechanism of injury, extent of soft tissue damage, patient comorbidities and available resources all influence decision-making. In resource-limited settings or time-sensitive scenarios, the“ ideal” intervention may not be feasible, requiring surgeons to adapt while still aiming for acceptable functional outcomes.
Equally important is the recognition that not all injuries demand immediate surgical intervention. Advances in imaging, wound care and rehabilitation have expanded the role of non-operative management in certain cases. However, this shift also requires careful patient selection and close follow-up, as missed or delayed complications, particularly involving nerves or tendons, can significantly impact recovery.
Dr. Weeks also highlighted the growing role of education and collaboration in addressing these challenges. Regular interdisciplinary meetings, such as the senior physician group gathering where this discussion took place, provide valuable opportunities for knowledge exchange. These forums allow clinicians to share experiences, review emerging evidence and refine their approaches in a rapidly evolving field. Increasingly, they also incorporate discussions on medical technology and artificial intelligence, reflecting the expanding toolkit available to modern practitioners.
Beyond technical considerations, the philosophy guiding upper extremity trauma care remains rooted in function. The ultimate goal, as Dr. Weeks described, is to“ restore and maximize the function of