Agricultural injuries to the upper limbs represent up to 70 per cent of all hospitalizations due to farm accidents, occurring mostly in males. Injuries are often debilitating and result in loss of limb or extensive correctional surgeries. The cause of most accidents have been studied in detail and include lack of attention, complacency, hurriedness, carelessness, removal of safety shields, and not using machinery in the manner it was meant. The size of the injury depends on the speed and force of the machinery involved, the amount of contact and struggle, and the type of release from the machine. Machines most frequently involved in upper limb farm accidents include tractors, augers, hay balers, combine harvesters and corn pickers. Often, limbs are pulled into a piece of rotary equipment on the machine resulting in complex injuries of soft tissues (nerves, blood vessels, tendons, muscles) and bone, if not complete amputations.
Because most of the injuries are in rural settings and frequently involve amputation, proper management of amputations should be followed at the first medical clinic prior to transfer to a trauma center. For instance, an amputated finger should be rinsed in clean water or warm saline mixture, wrapped loosely in gauze and placed in a plastic bag submerged in ice. The stump should be wrapped with gauze with compression and elevation to minimize bleeding. Because of the high amount of contamination from farm equipment, antibiotics should immediately be administered along with a tetanus booster.
Once the patient is in the operating room, the gauze is removed and surgeons have the difficult task of determining the next step: to attempt to replant the appendage, reconstruct or amputate. This is based on the extent of the injury, available vasculature and nerve damage as well as the basic surgical principles of preventing infection, restoring greatest amount of function and best healing times. Surgeons are best prepared to make this decision if they have knowledge of the type of farming equipment involved in association to the injury present as well as the risk of infection from this piece of equipment.
Because of the great amount of complexity associated with agricultural upper extremity injuries the optimum treatment is not straightforward. However, with the proper initial trauma treatment, transfer to a surgery center in a timely manner, and treatment by a surgeon familiar with the farm equipment involved outcomes can be more promising with a faster return to work at a greater level of function.