Trauma

Sept. 30, 2025

In this article, Brandon J. Yuan, M.D., an orthopedic surgeon at Mayo Clinic in Minnesota, responds to questions about farm injury management, with a focus on mangled extremities. Dr. Yuan's clinical work focuses on geriatric trauma as well as periprosthetic fractures and injuries to the upper and lower extremities, acetabulum and pelvis.

1. Are farm injuries with mangled extremities common in southern Minnesota, western Wisconsin and northern Iowa?

There are enough of these injuries that trauma professionals need to be prepared for them. At Mayo Clinic in Minnesota, we see about 15 to 20 such injuries per year. I consider this injury highly seasonal.

2. When patients experience a mangled extremity on a farm, what type of equipment are they typically using?

Often, they are using harvesting machines and trailers, heavy power equipment, or machines with power takeoff.

3. How would you describe the mechanism of these injuries? Are they usually high-energy or low-energy trauma?

Here are common scenarios we see in our patients:

• An individual gets a pant leg or finger caught in an agricultural machine with a spinning mechanism, such as a grain auger, which then pulls the arm or leg into the machine.
• An individual attempts to make repairs on equipment while it is still running or is unaware that powered equipment is still running while working near it. The spinning mechanism in this machine mangles an extremity, which becomes crushed, torn, cut, bent or broken in it.

These are high-energy injuries.

4. What are the demographics of patients presenting with this injury?

Farm injuries damaging extremities are more common in adult men simply because of the volume of men in the industry. Men also tend to perform chores using the type of equipment that can harm the extremities. These patients' ages vary widely. Overall, younger adults tend to sustain these injuries, but we also see injuries in 60- and 70-year-olds.

Farm injuries also occur in children who help with farm chores, including equipment operation, or who ride on equipment recreationally and fall off.

5. Where do patients with farm-related mangled extremities usually present for trauma care? When a patient with this type of injury enters presents at a trauma center, what are healthcare professionals likely to see?

It's a mix: Some patients go to a local rural facility first. At other times, EMS immediately transfers patients to Mayo Clinic.

If a patient who had a farm incident presents at your facility, an example of what you might see is a mangled extremity with the clothes still present, a leg turned or twisted, or open wounds with contamination, such as hay or manure. These injuries usually are gruesome.

6. What puts patients at risk of farm-related extremity injuries?

Usually, when extremities become mangled in farm incidents, substances aren't involved, nor are there notable distractions. Rather, these injuries occur in what my patients would call freak accidents. For example, farmers may lose sight of power takeoff equipment while in use and get their pants caught in it.

Often patients tell me about these injuries:

• "I've done this 100 times before and just made one wrong move."
• "I thought I'd just quickly grab that one thing out of there. And that one time, this happened."

7. What steps do you recommend that healthcare professionals take to help patients with these injuries?

I'd recommend these steps if a patient with a mangled extremity enters your facility:

• Trauma ABCs. Go through the Advanced Trauma Life Support procedures, attending to the patient's airway, breathing and circulation (ABC). With these injuries, specifically check to see if the injured limb has perfusion or if EMS applied a tourniquet to stop exsanguination.
• Administer antibiotics. Most patients with mangled extremities have open injuries that become contaminated, leading to high infection risk. For further information, I'd direct trauma professionals to their center's guideline for open fracture management, which also includes types of antibiotics to administer.
• Control pain. While one trauma professional completes the previous steps, another should manage the patient's pain. Typically, extremity injuries from a farm incident have high pain scores. Physicians often order patient intubation to administer narcotic pain relievers and for blood pressure management.
• Address psychological response. Patients with injured extremities can be hysterical about saving an injured arm or leg. To calm patients and allow for necessary or even lifesaving treatment, administer a sedative.
• Wash wounds and set bones. Thoroughly debride and wash the injury site, setting and splinting the arm or leg as needed.
• Arrange for transfer. Usually with these injuries, we don't conduct video consultations with smaller trauma centers. We suggest stabilizing the patient and transferring to a higher level of care.

8. Is there anything you'd advise not to do in these circumstances?

You should not spend considerable time getting additional information from the patient and loved ones or doing imaging afterward if you know you will be transferring the patient.

9. Are these injured extremities often saved?

We try our best to save patients' injured arms or legs. We want to perform limb salvage, which we can accomplish through reconstruction with muscle flaps and skin grafts. Generally, we can fix these injuries with treatment such as vascular surgery or external stabilizers.

However, there are situations in which the injury is dire: The patient's life is in danger without an amputation due to severe vascular injury or serious infection. Sometimes the limb is essentially already detached from the patient's body. Severed fingers or a thumb can be reattached, but unfortunately, it's typically not feasible to reattach an entire arm or leg.

10. How and what do you communicate with patients who have extremity injuries that may not be salvageable?

The prospect of an amputation is complex. Prior to amputation, the surgeon discusses options with the patient, including limb salvage and amputation. We sometimes have a healthcare professional from the Mayo Clinic Physical Medicine and Rehabilitation amputee subspecialty group and, if possible, a patient who has undergone an amputation speak to the injured patient.

At times, patients are unconscious, but we also try to communicate with them personally whenever possible so they will never wake up with an arm or a leg gone.

11. Do patients who undergo amputation due to farm incidents usually resume their careers?

Most farmers find a way to continue their careers with prosthetics. Yet this depends on the level of amputation and the patient's specific farm-related career.

12. How can healthcare professionals follow patients seen at their facilities after transfer?

If you work at a Mayo Clinic Health System (MCHS) site and are already part of the patient's care team, you may look at the medical chart to see how things went and treatment rendered. If your trauma center is not part of MCHS, you may look up the patient's record if you were a member of the patient's care team and your facility has Epic. Alternatively, I'd encourage you to talk with the patient's family. You also may reach out to the receiving hospital and ask the telephone operator to connect you to follow up on the patient or connect with the Midwest Admission and Transfer Center and request help with following the patient's progress.

For more information

Trauma Education: Advanced Trauma Life Support. American College of Surgeons.