(Kiosk 6) Traumatic Left Arm Amputation After Subway Surfing (a Case Report)

Case Diagnosis: Traumatic left arm amputation

Case Description or Program Description: 14 y/o male brought into ED 08/29 after being run over by a subway train while subway surfing, resulting in traumatic left arm amputation at elbow and right tibial fracture. Additional injuries were crush avulsion with left humerus intact, along with an attached portion of left olecranon.
Patient was treated with washout and debridement to bone of left elbow under general anesthesia. Arm was amputated below the elbow with humerus intact with brachial artery litigated. Nerve block was performed and left proximal arm was wrapped with iodine gauze and ACE bandage. Patient underwent left upper thigh skin grafting on 9/8. Patient was admitted to rehabilitation for post-surgical management and prosthesis planning. Patient reported intermittent painful phantom limb sensation.

Setting: Bellevue Hospital

Assessment/Results: Amputation patients necessitate intervention beyond pain management. Prosthetics are more likely to lead to recovery with fewer complications. Prosthetics will promote increased independence with ADLs. Collaboration with chaplaincy will improve management by developing values-based treatments on patients’ individual goals. Rehabilitation should include psychological intervention to prevent development of common conditions associated with traumatic amputation such as depression, anxiety, and phantom limb disorder.

Discussion (relevance): MTA reports that subway surfing nearly doubled in the last three years. While most traumatic amputations in civilians occur from occupational hazards, subway surfing is a novel cause of traumatic amputations leading to the deaths of multiple teens. Although attempts have been made to limit accessibility of videos on social media, the trend persists and will continue to cause death and traumatic injuries.

Conclusions: Increased rates of dangerous subway surfing will cause increased prevalence of traumatic amputations. When traumatic amputation does occur, concurrent pain medication and physical rehabilitation with individualized values-based care and psychological intervention will improve quality of life.