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Childhood finger injuries and safeguards
Abstract
To understand the epidemiology, sites, and mechanism of finger injuries in children and to consider safety measures.
Accident and emergency department of a children's hospital in Glasgow.
A prospective study was carried out with a specifically designed questionnaire. Altogether 283 children presenting with isolated finger injuries were identified over six months. Available safety measures to avoid or reduce damage from such injuries were considered.
Finger injuries were common (38%) in those under 5 years. Most of these occurred at home (59%), commonly (48%) because of jamming between two closeable opposing surfaces, and mostly (79%) in doors at home and school. The doors were commonly (85%) closed by someone and often (60%) by a child. Sixteen (6%) were treated for amputation.
Finger injuries are common, especially at the preschool age, and are mostly caused by jammed fingers in doors, at home. Safeguards should be considered according to location, like home or institutions, and expense.
... Therefore, mechanism-oriented prevention strategies are needed. Doraiswamy et al. (1999) found in their studies that the hinge side of the door, which was identified as the cause of 57% of injuries, is particularly dangerous [12]. For this reason, safety regulations are required for doors in the homes of preschool-aged children. ...
... Therefore, mechanism-oriented prevention strategies are needed. Doraiswamy et al. (1999) found in their studies that the hinge side of the door, which was identified as the cause of 57% of injuries, is particularly dangerous [12]. For this reason, safety regulations are required for doors in the homes of preschool-aged children. ...
... As technology advances, the development of innovative techniques such as sensors and slow-closing mechanisms that can be placed on car doors will also reduce fingertip injuries caused by car doors in the future. Parents need to be aware of and trained in fingertip injuries [7,12]. ...
The primary aim of this study was to assess the epidemiological evaluation of acute pediatric hand injuries frequently encountered in emergency department units. Its secondary aim was to identify the risk factors associated with such injuries. Out of the 1547 acute hand and forearm injury cases admitted to emergency trauma department between March 2017 and March 2018, the 129 injuries pertaining to children were included in the study. Mechanism, time, etiology, injured structures, anatomical regions, cut structures, and occupational accident status were determined in addition to demographic information. The injuries were evaluated according to circadian rhythm in order to ascertain the hours of intensification. The Modified Hand Injury Severity Score (MHISS) was used to assess injury severity. The mean age of 129 patients was 10.1 years. The most injuries were observed in the groups of patients over 12 years of age (57, 44%), and 0-6 years of age (42, 32%), respectively. Nineteen students participating in vocational internships were injured (14%). Twenty-six cases (20%) in the 12-year-old group involved punching glass, and 34 (26%) cases in the 0-6 age groups involved fingertip crush injuries. Temporal injury intensity was seen to have increased between 12.00 and 19.00 hours. The mean MHISS was 41 (8-120). Injury prevention measures need to be increased, particularly for fingertip injuries. A specific injury severity assessment system is also required for pediatric hand injuries, which are often simpler and easier to treat than adult hand injuries. Additionally, training and increasing awareness are believed to be important steps in preventing pediatric hand injuries.
... Quel que soit l'âge, l'accident était domestique dans 60 à 75 % des cas [2,6,9,10]. Peu d'auteurs se sont intéressés à déterminer les pièces de l'habitat sièges de l'incident, le côté de la porte impliqué ou l'acteur intra-ou extrafamilial en cause dans la fermeture de la porte [10,11]. L'ensemble toilettes-salle de bain représentait 20 % des lieux de l'accident dans l'étude de Doraismy [11] et la salle à manger était le lieu principal (32 % des cas). ...
... Peu d'auteurs se sont intéressés à déterminer les pièces de l'habitat sièges de l'incident, le côté de la porte impliqué ou l'acteur intra-ou extrafamilial en cause dans la fermeture de la porte [10,11]. L'ensemble toilettes-salle de bain représentait 20 % des lieux de l'accident dans l'étude de Doraismy [11] et la salle à manger était le lieu principal (32 % des cas). Dans notre étude, la chambre de l'enfant était le lieu de prédilection (33 % des enfants) (Tableau 1). ...
... Outre l'absence quasi systématique de système de prévention (94 % des habitations), un habitat en maison (70 %) et une fratrie nombreuse sont des éléments favorisants, un autre enfant étant responsable de la fermeture de la porte dans 44 % des situations. Le côté de la porte impliqué est surtout la charnière avant l'âge de 10 ans, la personne responsable de la fermeture de la porte n'ayant pas la visibilité du petit enfant situé derrière [11]. Main droite ou main gauche sont lésées sans différence significative chez l'enfant latéralisé ou non. ...
AimEpidemiological analysis in a universitary paediatric emergency unit of children admitted after accidental injuries resulting from fingers crushed in a door.
... 2,3 Most studies that have examined door-related injuries are from countries outside of the United States and are usually limited to retrospective analysis of cases from single-hospital emergency departments (EDs). [4][5][6][7][8][9][10][11][12][13][14] Previous studies have generally included door-related injuries as part of a larger study focused on injuries to a specific body region (usually hand or finger injuries), 6,7,9,11,12,[15][16][17][18] the pinching mechanism of injury, 13,14,19,20 or the clinical management of injuries (primarily phalanx fractures). 2,3,21 Glass door-related injuries have been discussed as part of architectural glass-related injury articles but not as a separate topic. ...
... 11 Other studies have reported that in more than one third of cases, another child, an adult, or the wind closed the door on the patient's fingers. 11,15,18,32 Therefore, we cannot rely solely on parental supervision or behavior change among children to prevent these injuries. ...
... In agreement with previous studies examining injuries to the forearm, hand, and fingers, 6,11,13,15 this study found that most door-related injuries occurred at home. Child care center standards from the National Resource Center for Health and Safety in Child Care and the General Service Administration's Child Care Center Design Guide both state the need for the use of door hinge protection to prevent pinching, 34,35 but this need extends beyond child care centers. ...
This is the first study to provide national estimates of pediatric door-related injuries in the United States. Data from the National Electronic Injury Surveillance System were analyzed for patients ≤17 years who were treated in US emergency departments for a door-related injury from 1999 through 2008. An estimated 1 392 451 US children ≤17 years received emergency treatment for door-related injuries, which averages approximately 1 injury every 4 minutes in the United States. Both the frequency and rate of injury increased significantly. Boys accounted for 55.4% of injuries, and 41.6% of children were ≤4 years. The most common mechanism of injury was a “pinch in the door” (54.8%) or an “impact to the door” (42.0%). Patients admitted to the hospital were most frequently treated for amputations (32.0%) or lacerations (25.2%). The frequency of injuries associated with glass doors increased significantly with increasing age, in contrast to injuries from other types of doors.
... International guidelines set a value of 100 N for maximum window closing force, but this value, which is intended to prevent child strangulation, is not based upon published scientific results, and no boundary value for the protection of fingers, especially those of children, exists. Not surprisingly, finger injuries in children are frequently caused by jam events (Bhende et al., 1993;Brandmair et al., 1980;Claudet et al., 2007;Doraiswamy and Baig, 2000;Doraiswamy, 1999;Giddins and Hill, 1998;Macgregor and Hiscox, 1999;Salazard et al., 2004), which can happen if children hold their fingers between mechanically moving parts such as the window glass and seal entry of a motor vehicle side door window (Fig. 1). The US National Highway Traffic Safety Administration (2009) estimated an incidence of 2000 injuries in 2007 due to closing vehicle windows. ...
... The US National Highway Traffic Safety Administration (2009) estimated an incidence of 2000 injuries in 2007 due to closing vehicle windows. Doraiswamy (1999) and Doraiswamy and Baig (2000) found that most such jam injuries occurred in young children (38% to children under 5 years, 32% aged 5-10 years). ...
... Our data indicate that the little finger and the distal phalanges of all fingers are most at risk with regard to jam injuries. This study focused on the 3-10 year age group because most jam injuries happen in young children (Doraiswamy and Baig, 2000;Doraiswamy, 1999). Children under three are not in danger when child restraint systems are correctly used because of the height of the seal entry above the seat. ...
We obtained data on the lengths, girths, and diameters of the fingers of children from 3 to 10 years of age. A total of 160 children (78 girls, 82 boys) were examined in a cross-sectional investigation. The length of each finger of the right hand of every child was measured, as were the girths of the proximal, middle, and distal phalanges, and of the proximal and distal interphalangeal joint. The average length of the thumb was 49 (35-65) mm. The index and ring fingers both averaged 69 (index, 50-88; ring, 42-96) mm in length, while the middle and little fingers averaged 72 (57-100) and 56 (40-74) mm, respectively. Average diameter, calculated from the girth measurement, was 16 (11-22) mm for the thumb, 15 mm for both the index (9-22) and middle (10-21) fingers, 14 (10-20) and 13 (8-19) mm for the ring and little fingers, respectively. The average length of each finger increased by 37% from 3 to 10 years of age, average girth by 24%, and diameter increased by 20%. We observed no differences in length, girth, and diameter between the sexes. The dimensions of children's fingers are relevant to injuries from automatic, power-operated window lifters of motor vehicles because risk of injury to a finger jammed between an ascending window and the seal entry depends upon the diameter of the finger. Additionally, short fingers of young children can be jammed over almost their entire length in the oblique design of a car window seal entry.
... Door-pinch injuries were observed in 403 patients, which primarily resulted in fractures of the phalanges of ngers. Al-Anazi [38] and Doraiswamy [39] concluded that door-related nger crush injury is the leading cause of nger injury in children. These injuries frequently occur at home, where the affected ngers are often crushed against the hinged side of the door, and are more likely to occur in younger children. ...
... 30%) had an interval between injury and hospital visit of > 72 h, and the main reasons for this delay were transfers to our hospital due to unsatisfactory treatment results in other hospitals (606, 79.22%), unsatisfactory results of outpatient conservative treatment (62, 8.10%), cases of high-energy trauma (car accident injuries and falls from height) that were transferred to our hospital after prior hemodynamic resuscitation(39,5.10%), the lack of parental care for the patient after injury (23, 3.01%), parent refusal of hospitalization for surgical treatment at rst visit (19, 2.48%), and neonatal patients who visited our hospital due to other chief complaints and were diagnosed with fractures during physical examination by a physician (16, 2.09%).In our study, the highest number of fractures occurred in western Shenzhen with 4631 cases (44.16 %), followed by eastern Shenzhen, southern Shenzhen, northern Shenzhen, and Shenzhen City, with 2713We retrospectively analyzed the time of hospital admission among the 9,544 children treated at our Longgang, Baoan, and Nanshan Districts, respectively. Among the 3,734 patients who were transferred to our hospital after their initial visit in local hospitals, 1,253 (33.56%), 933 (24.99%), 471 (12.61%), and 227 (6.08%) patients had their initial visits at Shenzhen Baoan, Shenzhen Longgang, Shenzhen Nanshan, and Shenzhen Futian District Hospitals, respectively. ...
Purpose: To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures.
Methods: This study retrospectively analyzed the epidemiological characteristics of fractures in children aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020.
Results: A total of 10486 pediatric patients were included in the study, of whom 6,961 (66.38%) were boys, and 3,525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5,584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3,843 sites, 27.49%), distal ulna (1,740 sites, 12.44%), and distal radius (1,587 sites, 11.35%). The top three causes of injury were falls (7,106 cases, 82.10%), car accidents (650 cases, 65.72%), and pinch injuries (465 cases, 5.37%). Fractures predominantly occurred between July and November (4,664 cases, 48.87%) and on Saturdays and Sundays (3,172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4,339 cases, 45.46%).
Conclusion: We should strengthen preschool children health and safety education and increase protective measures. It is necessary to allocate medical resources in a targeted manner, to establish a closed-loop regional pediatric trauma treatment system centered on trauma centers that links together regional trauma centers, and to establish substantively operating comprehensive pediatric trauma treatment teams that follow a multidisciplinary treatment model.
... Door-related finger injuries are common [1][2][3][4][5][6]. Essentially, doors are dangerous for the fingers of young children [7]. ...
... Essentially, doors are dangerous for the fingers of young children [7]. The resulting injuries are often crush injuries, nail avulsions, fractures, lacerations, and amputations leading to pain, reduction of function, shortening of the phalanx, and distress for both the child and parent [1][2][3][8][9][10][11][12][13]. The door is a classic old design and we believe that it can be improved to reduce its guillotine-like injury potential while maintaining its security and weather protection properties. ...
... Another study describes similar findings about the vulnerability of small children's fingers. 18 Some prevention measures for the home have been suggested: placing rubber stoppers on the door or taking other measures to prevent the door from fully closing in the home. 18 However, these measures have not been evaluated for their effectiveness in preventing finger amputations. ...
... 18 Some prevention measures for the home have been suggested: placing rubber stoppers on the door or taking other measures to prevent the door from fully closing in the home. 18 However, these measures have not been evaluated for their effectiveness in preventing finger amputations. Some amputations occur in locations other than the home, such as in a motor vehicle when a child is boarding or alighting. ...
Background: Limb loss and limb deficiency are potentially disabling conditions affecting the health and well being of persons worldwide. There are multiple pathways to the loss of a limb. Acquired limb deficiencies as a result of disease or physical trauma, are less ordinary. Similar to other types of trauma, determination of the patterns of these injuries is necessary for establishment of preventive strategies. Thus, the patterns of these injuries has not yet been well defined in our set up. So the epidemiological evidence is needed to define and understand the patterns of these injuries which results in amputation in children.
... Prior studies show that most hand injuries in children occur at home (59-62%), despite the presence of adult supervision. 1,13,[15][16][17] As expected, injuries from doors were the predominant the cause of hand injuries (Fig. 7). The large number of door-related injuries may correspond to the relatively large amount of time spent indoors by children in recent years. ...
... The importance of proper safety education to both children and their carers cannot be overemphasized, given the preventable nature of most childhood fingertip injuries. Door stoppers placed near the lock or at the base of the door and plastic hinge protectors 16) are simple techniques that may prevent door crush injuries in children. In addition, earlier studies have found that the cost of prevention of fingertip injuries by installing safety equipment was much less than the cost of treating the injuries themselves. ...
Fingertip injuries are common in children, with varying degrees of severity. However, there is limited epidemiological information in the literature. An understanding of the characteristics of these injuries can be used as a basis to prevent such injuries. Epidemiological data was gathered through a retrospective review of all fingertip injuries affecting children, that presented to our department. There were 202 children with 234 injured fingertips in a period of 36 months. Most children were boys and most children injured their left hand. The mode age affected was 2 years. Accidental crush injuries in doors was the most common cause of fingertip injuries in children. An unexpectedly high number of children have fingertip injuries, with many requiring surgical treatment. Safety awareness and prevention of door crush injuries could reduce a large number of fingertip injuries in young children.
... Finger injuries are quite common in childhood and one study reported an incidence of 38% in those below 5 years. [2] 'Finger stuck in a hole' is a common casualty presentation and various different techniques have been used for its removal. A number of household items such as soap solution, shampoos, Vaseline, butter, cooking oil, and baby oil have all been used as lubricants to manipulate and gently remove the finger stuck in a hole. ...
... [1] Methods have been described to remove hair from a totally avulsed scalp. [2,3] However, on a partially avulsed scalp, the same cannot be done as the injured part that needs to be shaved cannot be separated from the cranium. We present a simple ...
A 3-year-old child was referred with a history of the index finger being stuck in a plate hole. 'Idli' or simply steamed rice cake, made by steaming a batter consisting of fermented black lentils (de-husked) and rice is a south Indian delicacy that is prepared in moulds where the batter is put in and steamed. The steam enters through small holes in the mould and cooks the batter. With the advent of pressure cookers, the ubiquitous idli can be prepared in steel moulds that are placed inside a pressure cooker. Our toddler had managed to ingeniously slide his finger into the central hole in the steel mould while playing with it and turning it round and round over her finger [Figure 1]a. Eventually the distal finger became edematous and it was then that the parents realized that the idly mould had become a inseparable part of their toddler's finger. All attempts at home to pull out the 'stuck finger' failed and the child was taken to a local hospital where the standard modes of removal were attempted. The child was then brought to our center. The unusual shape of the mould made us realise that cutting the plate away was the only way to remove the finger. The child was fairly co-operative and hence it was decided to try removing the 'stuck finger' under local anesthesia. Additional analgesic support and sedation was given in the form of oral syrup paracetamol and syrup triclofos. One percent solution of Lidocaine was injected as a ring block to anesthetize the index finger. An attempt was made to cut the plate with a regular wire cutter which failed. A heavy duty steel plate cutter was then procured and the steel mould was then cut into two parts across the circumference and the finger removed [Figure 1]b. Besides a small laceration on the finger that was left for secondary healing, no other injuries were noted. Language: en
... Most injuries arise at home and are due to "jamming/crushing", usually by doors, either by their parents or siblings. [5] Fingertip injuries can affect the bones at the ends of the ngers (distal phalanges), the ngernails or the soft pads of the ngers. Crush injuries are the most common causes of injury to the tip of the nger, but cuts and dislocations can also occur. ...
Background - A stable, mobile and sensate fingertip is important to the overall function of the hand. In addition, the face and hand are the most looked at parts of our body. When faced with a fingertip injury, clinicians will need to manage both functional and aesthetic considerations in their treatment plan. Materials & Methods – A prospective study of 50 patients were analysed and the results tabulated. Results – Most of the patients were male with the involvement of the dominant hand and in the second decade of life. With treatment most of them regained normal function and aesthesis. Conclusion – Early and appropriate intervention of fingertip injuries can help the patient to return to work early with little or no morbidity.
... teenagers (16 -20). The most frequent injuries in children were attributable to door jamming (54%), which is consistent with the results in Doraiswamy's study [9]. Teenagers were injured frequently at work, which is likely attributable to local economic issues. ...
... Door-clipping were observed in 403 patients, which primarily resulted in fractures of the phalanges of fingers. Al-Anazi [38] and Doraiswamy [39] concluded that door-related finger crush injury is the leading cause of finger injury in children. These injuries frequently occur at home, where the affected fingers are often crushed against the hinged side of the door, and are more likely to occur in younger children. ...
Purpose
To explore and analyze the causes and related influencing factors of pediatric fractures, and provide theoretical basis for reducing the incidence and adverse effects of pediatric fractures.
Methods
This study retrospectively analyzed the epidemiological characteristics of fractures in pediatric aged ≤18 years old who were admitted to the our hospital between July 2015 and February 2020.
Results
A total of 10,486 pediatric patients were included in the study, of whom 6961 (66.38%) were boys, and 3525 (33.62%) were girls. For the fracture incidence, age group of the 3-6 years reached the peak. 5584 (60.76%) children were operated upon within 12 h after admission. The top three types of fractures were the distal humerus (3843 sites, 27.49%), distal ulna (1740 sites, 12.44%), and distal radius (1587 sites, 11.35%). The top three causes of injury were falls (7106 cases, 82.10%), car accidents (650 cases, 65.72%), and clipping (465 cases, 5.37%). Fractures predominantly occurred between July and November (4664 cases, 48.87%) and on Saturdays and Sundays (3172 cases, 33.24%). The highest number of hospital visits occurred between 20:00 and 00:00 (4339 cases, 45.46%).
Conclusion
For pediatric fractures, we should take appropriate and effective preventive measures to reduce the incidence of children’s fractures according to the distribution characteristics of age, gender, cause of injury, and fracture site.
... It is possible that in our subpopulation of ultra-Orthodox children, simple technical solutions aimed at the prevention of door slamming, may be effective in lowering injury rates. Simple interventions are available for this purpose [35]. Education authority initiatives combined with community leadership are needed to implement such interventions, and these may prove effective in homes as well as in educational institutions. ...
Background
Wrist and hand injuries are common and constitute a major economic burden. General injury prevention programs have failed to demonstrate a decrease in injury rates. We hypothesized that there are differences in injury patterns in culturally diverse subpopulations of a metropolitan area treated within the same medical system, which may partly explain the difficulties associated with injury prevention.
Methods
We conducted a survey of patients admitted to emergency departments of two hospitals in Jerusalem for wrist and hand injuries during a 3 month period. Patients were asked to complete a questionnaire regarding demographic data, injury type and mechanism. Injury type and mechanism were then compared for age, gender, level of education and degree of religiosity.
Results
The questionnaire was completed by 799 patients (response rate 62%; 75% male; average age 27). Thirty-one percent reported they were injured at work, 33% at home and 36% during leisure activities. Data analysis showed that several subpopulations were found to be at risk as compared to their corresponding groups and relative proportion in the overall population of the city. These included contusions after falls in non-ultra-Orthodox Jewish women aged 65 years and over, crush injuries in ultra-Orthodox Jews under the age of 10 (53% vs. 14% for non ultra-Orthodox Jews, respectively) and Muslim teens. Muslims were injured more, especially at work, in comparison to their relative proportion in the population as a whole.
Conclusion
Different subpopulations at risk and different injury patterns of wrist and hand injuries were found in this culturally heterogeneous population. Awareness of these differences may be the first step when designing specific injury prevention programs in a culturally diverse population. A combined effort of community leaders and government agencies is needed to deal with the specific populations at risk, although legislation may be needed to limit some of the risks such as teens and specific work related hazards and exposures.
... Complex laceration or other injury involving multiple digits that can be more easily and adequately anesthetized with a nerve block at the wrist. 1,3,4,5 Aims and objectives ...
BACKGROUND
To know the efficacy of a safe and simple digital block for anaesthesia in A&E for suturing in finger lacerations and other minor
finger surgeries that need not require hospital stay and surgery can be done at the earliest.
MATERIALS AND METHODS
After getting ethical committee approval, and written consent from the patients this study was carried out with the help of the
Plastic surgery department and Casualty (A&E) of ACS Medical College and hospital from May 2015 to May 2018. Patients aged
16 to 80 years with finger lacerations were enrolled. After standard wound preparation and lignocaine test dose, all wounds,
lacerations were randomized to anaesthesia with digital infiltration of 1% lignocaine. Pain of needle insertion, anaesthetic
infiltration, and suturing were recorded on a validated 100-mm Visual Analog Scale (VAS) from 0 (none) to 10(worst); also
recorded were percentage of patients requiring rescue anaesthesia; time until anaesthesia; percentage of wounds with infection
or numbness at day 7. A sample of 100 patients were selected who were able to detect a 15-mm difference in pain scores.
RESULTS
100 patients aged 16 to 76 years of age were given digital block in the minor OT in casualty which had all back up for GA and
any emergency. Mean age (SD) was 38.1 (16.8) years, 29% were female. Only one patient in the digital anaesthesia group
required rescue anaesthesia. Not only single injection digital block is equally effective in delivering anaesthesia but also in a
single injection making it less invasive, easier to perform and teach, and avoids the risk of damaging the finger nerves. All the
patients were discharged from hospital from as early as 6 hours to maximum 3 days and followed thoroughly.
CONCLUSION
Intrathecal single digital block of fingertip injuries to all wounds results in similar pain of needle insertion, anaesthetic infiltration,
and pain of suturing.
... For this reason, distal phalanx injuries were most common in the younger age groups of 0 to 3 years (73.1%), 4 to 6 years (64.8%), and 7 to 9 years (48.1%). Doors are a well-known risk for children's fingers [6,15,16]. In fact, more specific findings have been reported, such as which region of the door is more dangerous (the lock or hinge) or which door is more hazardous (the front door or the inner one) [17]. ...
Background:
The purpose of this study was to identify comprehensive hand injury patterns in different pediatric age groups and to assess their risk factors.
Methods:
This retrospective study was conducted among patients younger than 16-year-old who presented to the emergency room of a general hospital located in Gyeonggi-do, Republic of Korea, and were treated for an injury of the finger or hand from January 2010 to December 2014. The authors analyzed the medical records of 344 patients. Age was categorized according to five groups.
Results:
A total of 391 injury sites of 344 patients were evaluated for this study. Overall and in each group, male patients were in the majority. With regard to dominant or non-dominant hand involvement, there were no significant differences. Door-related injuries were the most common cause in the age groups of 0 to 3, 4 to 6, and 7 to 9 years. Sport/recreational activities or physical conflict injuries were the most common cause in those aged 10 to 12 and 13 to 15. Amputation and crushing injury was the most common type in those aged 0 to 3 and 4 to 6 years. However, in those aged 10 to 12 and 13 to 15, deep laceration and closed fracture was the most common type. With increasing age, closed injuries tended to increase more sharply than open injuries, extensor tendon rupture more than flexor injuries, and the level of injury moved proximally.
Conclusions:
This study provides a comprehensive overview of the epidemiology of hand injuries in the pediatric population.
... Accident prevention measures have been conducted in many ways, including modification of the clearance gap to prevent pinching, attachment of caution label on the product, description of the possible hazard in the operation manual and so on. However, it is almost impossible to prevent all accidents, particularly for door or window [2] which was designed to let part of human body pass through it. ...
... In contrast, more often, injuries are due to blunt trauma (e.g. crush injuries by doors, heavy machinery or during sports) [5]. This type of injury results in compression of soft tissue, mainly the nail bed, between the nail and the underlying bone in addition to the external forces. ...
Introduction:
A stable, mobile and sensate fingertip is of paramount importance to perform daily tasks and sense dangerous situations. Unfortunately, fingertips are easily injured with various extents of soft tissue damage. Delayed and inadequate treatment of nail bed injuries may cause substantial clinical problems. The aim is to increase awareness about nail bed injuries among physicians who often treat these patients.
Presentation of case:
We present a 26-year-old male with blunt trauma to a distal phalanx. Conventional radiographs showed an intra-articular, multi-fragmentary fracture of the distal phalanx. At the outpatient department the nail was removed and revealed a lacerated nail bed, more than was anticipated upon during the first encounter at the emergency department.
Discussion:
Blunt trauma to the fingertip occurs frequently and nail bed injuries are easy to underestimate. An adequate emergency treatment of nail bed injuries is needed to prevent secondary deformities and thereby reduce the risk of secondary reconstruction of the nail bed, which often gives unpredictable results.
Conclusion:
However, adequate initial assessment and treatment are important to achieve the functional and cosmetic outcomes. Therefore awareness of physicians at the emergency department is essential.
... Studies from Saudi Arabia and Glasgow showed that this type of injury accounted for most childhood fingertip injuries in these areas. 2,3 These injuries consistently occurred at home, with the involved finger being frequently crushed at the hinge side of doors. Younger children were mostly affected. ...
To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012.
Comparison of two case series.
University-affiliated teaching hospital, Hong Kong.
A retrospective study of two cohorts of children (age, 0 to 16 years) admitted to Prince of Wales Hospital with finger injuries during two 3-year periods. Comparisons were made between the two groups for age, involved finger(s), mechanism of injury, treatment, and outcome. Telephone interviews were conducted for parents of children who sustained a crushing injury of finger(s) by door.
A total of 137 children (group A) were admitted from 1 January 2003 to 31 December 2005, and 109 children (group B) were admitted from 1 January 2010 to 31 December 2012. Overall, the mechanisms and epidemiology of paediatric finger injuries were similar between groups A and B. Most finger injuries occurred in children younger than 5 years (group A, 55%; group B, 75%) and in their home (group A, 67%; group B, 69%). The most common mechanism was crushing injury of finger by door (group A, 33%; group B, 41%) on the hinge side (group A, 63%; group B, 64%). The right hand was most commonly involved. The door was often closed by another child (group A, 37%; group B, 23%) and the injury often occurred in the presence of adults (group A, 60%; group B, 56%). Nailbed injury was the commonest type of injury (group A, 31%; group B, 49%). Fractures occurred in 24% and 49% in groups A and B, respectively. Traumatic finger amputation requiring replantation or revascularisation occurred in 12% and 10% in groups A and B, respectively.
Crushing injury of finger by door is the most common mechanism of injury among younger children and accounts for a large number of hospital admissions. Serious injuries, such as amputations leading to considerable morbidity, can result. Crushing injury of finger by door occurs even in the presence of adults. There has been no significant decrease in the number of crushing injuries of finger by door in the 5 years between the two studies despite easily available and affordable preventive measures. It is the authors' view that measures aimed at promoting public awareness and education, and safety precautions are needed.
... We found this rate as 17.1% in our study. Door jamming was also determined to be common among children (20). Of 96 cases under 18 years of age, the cause of amputation in about half the cases was door jamming, and the majority of them occurred in children under 5 years of age. ...
... Outside the laboratory, young children's low accuracy has implications for their safety. Young children intentionally wedge their body between two opposing surfaces or between moving parts of equipment (Abbas, Bamberger, & Gebhart, 2004;Doraiswamy, 1999), and accidental entrapment is a leading cause of injury (Tinsworth & McDonald, 2001). Current findings suggest that accidental entrapment injuries may result from children's proclivity for exploring body-environment relations by fitting body parts into tight spaces and their failure to consider entrapment as a severe penalty for errors. ...
... Infants are not financially motivated, but they might care about avoiding injury. We focused on falling and entrapment, two leading causes of accidental injury in infants and children (Doraiswamy, 1999; Drago & Dannenberg, 1999; Mathers & Weiss, 1998). Infants treat falling into a precipice as an aversive penalty, even when rescued by an experimenter . ...
What infants decide to do does not necessarily reflect the extent of what they know. In the current study, 17-month-olds were encouraged to walk through openings of varying width under risk of entrapment. Infants erred by squeezing into openings that were too small and became stuck, suggesting that they did not accurately perceive whether they could fit. However, a second penalty condition revealed accurate action selection when errors resulted in falling, indicating that infants are indeed perceptually sensitive to fitting through openings. Furthermore, independent measures of perception were equivalent between the two penalty conditions, suggesting that differences in action selection resulted from different penalties, not lack of perceptual sensitivity.
... Although the KID does not record specific information on the type of object, based on prior research, we can surmise that a majority of these injuries were related to doors. 13,14,35 Doors are easily accessible to exploring toddlers and young children who are unaware of associated risks. Several passive prevention strategies for door-related amputation injuries have been developed, including the use of doorstops and other door design modifications. ...
Despite the severity of consequences associated with traumatic amputation, little is known about the epidemiology or healthcare resource burden of amputation injuries, and even less is known about these injuries in the pediatric population.
An analysis of patients aged < or =17 years hospitalized with traumatic amputations using the 2003 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. National estimates of amputation-associated hospitalizations, rates, resource use, and demographics were calculated. Potentially significant covariate associations were studied using hospital charges and length of stay (LOS).
In 2003, 956 cases of traumatic amputations among children aged < or =17 years resulted in 21.6 million dollars (standard deviation [SD] = 2.2 million dollars) in inpatient charges and 3,967 days (SD = 354) of hospitalization in the United States. Finger and/or thumb amputations accounted for the majority of injuries (64.0%). Mean (SD) hospital charges and LOS were 23,157 dollars (49,018 dollars) and 4.1 (7.4) days, respectively. Traumatic leg amputations incurred the highest mean hospital charges (120,275 dollars) and longest mean LOS (18.5 days). Older children (15-17 years) experienced a higher hospitalization rate (1.84/100,000) than other age groups. Older age, amputation caused by a motorized vehicle, urban hospital location, children's hospital type, and longer LOS were associated with higher total charges. Amputation caused by lawn mower, motorized vehicle or explosives/fireworks, and children's hospital type were associated with longer LOS.
Pediatric traumatic amputations contribute substantially to the health resource burden in the United States, resulting in 21 million dollars in inpatient charges annually. More effective interventions to prevent these costly injuries among children must be implemented.
... Most injuries arise at home and are due to "jamming/crushing", usually by doors, either by their parents or siblings. (5) In this article, we review important aspects of fingertip injuries relevant to the nonspecialist, including the clinical anatomy and common injuries, and focusing on assessment and treatment. ...
Background:
Fingertip injuries are extremely common. Out of the various available reconstructive options, one needs to select an option which achieves a painless fingertip with durable and sensate skin cover. The present analysis was conducted to evaluate the management and outcome of fingertip injuries.
Materials and Methods:
This is a retrospective study of 150 cases of fingertip Injuries of patients aged six to 65 years managed over a period of two years. Various reconstructive options were considered for the fingertip lesions greater than or equal to 1 cm2. The total duration of treatment varied from two to six weeks with follow-up from two months to one year.
Results:
The results showed preservation of finger length and contour, retention of sensation and healing without significant complication.
Conclusion:
The treatment needs to be individualized and all possible techniques of reconstruction must be known to achieve optimal recovery.
Background
Traumatic finger amputations are a common and well-known hand injury, yet there are few studies addressing long-term epidemiologic data and associated mechanisms of injury. This paper aims to use a large national database to identify the relationship of patient demographics and mechanism of injury in finger amputations.
Methods
The National Electronic Injury Surveillance System (NEISS) was queried for finger amputations in the United States from 2010 to 2019. Patient demographic information was collected and analyzed by gender, race, age, and further statistical analysis was performed to determine correlations with consumer products.
Results
Finger amputations accounted for an estimated 234,304 emergency department visits from 2010 to 2019. Most of the patients were male (79%) and identified as white (46.2%). The most commonly implicated products overall were power saws and related power tools, followed by doors and then lawn mowers. A bimodal age incidence was observed with the highest incidence rates occurring in children ages 0 to 4, followed by a second peak incidence rate in the adults ages 65 to 74. The most common mechanisms of injury were found to differ in patients less than 19 and those 20 and over.
Conclusion
Traumatic finger amputations have a bimodal incidence with changing epidemiology and mechanism of injury with age. The first peak occurs from ages 0 to 4, involves predominantly doors, and has a male to female ratio of 1.30. The second peak occurs from ages 65 to 74, involves mostly power saws, and has a male to female ratio of 6.68.
Level of Evidence
Prognostic, Level IV
Résumé
Introduction
L’objectif principal de l’étude était d’analyser l’épidémiologie des lésions de la main de l’enfant nécessitant une prise en charge chirurgicale en urgence et d’évaluer les caractéristiques de ces blessures.
Méthodes
Il s’agissait d’une étude épidémiologique descriptive, multicentrique et rétrospective des urgences chirurgicales de la main de l’enfant et évaluant une période de dix mois consécutifs.
Résultats
Entre le 1er janvier 2016 et le 31 octobre 2016, 245 patients ont été inclus. Quel que soit l’âge, la plupart des accidents avaient eu lieu au domicile (69 %), 11 % survenaient à l’école (26 cas) et 4 % dans un centre sportif. Toutes lésions confondues, elles étaient le plus souvent localisées sur la face dorsale et sur les doigts plutôt que sur la main. Les lésions les plus fréquemment retrouvées étaient les écrasements de la phalange distale (36 % des cas). Seuls 9 % des ménages utilisaient un système de blocage des portes (8 cas) et les patients de ce groupe lésionnel avaient en moyenne 5 ans. Les panaris/infections aiguës représentaient 27 % des cas. Les plaies de mains ou de doigts représentaient 23 % des cas, la face palmaire étant impliquée dans 70 % des cas. La cause de survenue de la plaie était souvent l’utilisation d’un objet tranchant. Les fractures/luxations représentaient 12 % des cas et enfin les morsures/griffures 2 % des cas.
Discussion
Cette étude montrait que dans une population pédiatrique, les lésions de la main nécessitant une prise en charge chirurgicale sont plus fréquemment des écrasements de type doigt de porte et que le domicile est le lieu de survenue le plus fréquent. Le renforcement des stratégies de prévention devrait être l’objectif principal pour réduire l’incidence des lésions aux mains chez les enfants. Une sensibilisation accrue des parents et une meilleure éducation du public pourraient réduire de manière significative l’incidence de ces blessures.
Niveau de preuve
IV ; série de cas.
Background:
The primary objective of this retrospective study was to analyse the epidemiology and assess the characteristics of all paediatric hand injuries requiring emergent surgery.
Hypothesis:
Paediatric hand emergencies that require surgical treatment have a specific epidemiological distribution.
Methods:
We conducted a multicentre retrospective descriptive epidemiological study of surgical paediatric hand emergencies seen over 10 consecutive months.
Results:
We included 245 patients between the 1st of January and the 31st of October 2016. Irrespective of age, most injuries (69%) occurred at home; 11% (n=26) occurred at school and 4% in a sports centre. Overall, most injuries involved the dorsal aspect and affected the fingers more often than the hand. The most common lesion was crush injury of a distal phalanx (36% of cases). Door guards were in use in only 9% of homes (n=8), and mean age of the patients in this group was 5 years Paronychia/acute infections accounted for 27% of cases. Wounds of the hands of fingers made up 23% of cases, with the palmar aspect being involved in 70% of cases. The wound was often due to the use of a sharp-edged object. Fractures/dislocations accounted for 12% of cases and bites or scratches for 2%.
Discussion:
This study showed that the most common hand injuries requiring emergent surgery in a paediatric population are crush injuries of the fingertip such as door-crush injuries, which most often occur at home. Reinforcing prevention strategies should be the main priority in order to decrease the incidence of hand lesions in children. Raising awareness among parents and improving the education of the public could significantly decrease the incidence of these injuries.
Level of evidence:
IV; retrospective cohort.
Purpose: There are minimal long-term epidemiological data focused on finger amputations in the United States (US). We sought to quantify the incidence and trends in finger amputations over a 20-year period, describe mechanisms of injury by age groups, and examine trends in emergency department (ED)disposition. Methods: The National Electronic Injury Surveillance System was queried over a 20-year period (1997–2016)for finger amputations presenting to US EDs. Using US Census data, national incidence rates were estimated. We evaluated specific mechanisms of injury and ranked common mechanisms for each age group. Trends in hospital admission rates were evaluated and predictors of admission were examined using logistical regression. Results: From 1997 to 2016, a weighted estimate of 464,026 patients sustained finger amputations in the US with an estimated yearly incidence of 7.5/100,000 person-years. A bimodal age distribution was seen, with the greatest incidence in children aged less than 5 years and adults over 65 years. Doors were the most common injury mechanism in children (aged less than 5 years), whereas power saws were most common in teens and adults (aged more than 15 years). Over the study period, there was a significant increase in patients admitted to the hospital; however, this increase was not seen among African Americans. Significant predictors of hospital admission included male gender, age less than 18 years, high-energy mechanisms, non–African American race, and very large hospital size, as defined by the National Electronic Injury Surveillance System. Conclusions: The incidence of finger amputations is bimodal; young children (aged less than 5 years)and the elderly (aged greater than 65 years)are at greatest risk. There is a widening disparity between African Americans and non–African Americans in relation to ED disposition. Doors and power saws are the most common mechanisms of injury; however, these affect different age ranges. This study's results highlight the need for improved age-specific safety guidelines and device safety features. Type of study/level of evidence: Prognostic IV.
Background:
Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries.
Methods:
Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed.
Results:
Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits.
Conclusions:
Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.
Background
The hand is the second most frequently injured region of the body in children. The aim of this study was to evaluate age-related injury patterns, trauma mechanisms, as well as the need for surgery in pediatric patients with injuries to the hand.
Patients and methods
This was a retrospective study analyzing the data between January 2008 and December 2014 at Frankfurt University Hospital. All patients were younger than 18 years old. All patients suffering trauma to the hand or the fingers were included. The injury mechanism, injury pattern as well as need for surgery were analyzed according to different age groups (0–3 years, 4–7 years, 8–12 years and 13–17 years). Major injuries were defined as fractures, dislocations, amputations and injuries of the tendons or nerves. Minor injuries included contusions and superficial wounds.
Results
Overall, 2823 emergency pediatric patients with an injury to the hand or fingers were included (61.5% male, median age 10.3 years). Of the injuries 60.4% were located on the fingers and 39.6% on the hand. Major injuries were found in 703 patients (24.9%) and minor injuries in 2120 patients (75.1%). Of those patients with a major injury, 74.8% suffered a fracture, 9.4% an injury of nerves and tendons and 7.0% an amputation. The most common trauma mechanism for major injuries was sports (24.2%), followed by crushing (17.9%) and falls (14.7%). Overall, 436 patients (15.5%) were surgically treated of which 9.4% were operated on in the operation room and 6.1% in the emergency room.
Conclusion
Almost 75% of all children who presented to the emergency department following trauma to the fingers or the hand revealed minor injuries; however, 25% suffered a relevant, major injury. Overall, 15.5% had to be surgically treated. The most frequently found major injuries were fractures of the hand and the fingers.
Background:
The hand is the second most frequently injured region of the body in children. The aim of this study was to evaluate age-related injury patterns, trauma mechanisms, as well as the need for surgery in pediatric patients with injuries to the hand.
Patients and methods:
This was a retrospective study analyzing the data between January 2008 and December 2014 at Frankfurt University Hospital. All patients were younger than 18 years old. All patients suffering trauma to the hand or the fingers were included. The injury mechanism, injury pattern as well as need for surgery were analyzed according to different age groups (0-3 years, 4-7 years, 8-12 years and 13-17 years). Major injuries were defined as fractures, dislocations, amputations and injuries of the tendons or nerves. Minor injuries included contusions and superficial wounds.
Results:
Overall, 2823 emergency pediatric patients with an injury to the hand or fingers were included (61.5% male, median age 10.3 years). Of the injuries 60.4% were located on the fingers and 39.6% on the hand. Major injuries were found in 703 patients (24.9%) and minor injuries in 2120 patients (75.1%). Of those patients with a major injury, 74.8% suffered a fracture, 9.4% an injury of nerves and tendons and 7.0% an amputation. The most common trauma mechanism for major injuries was sports (24.2%), followed by crushing (17.9%) and falls (14.7%). Overall, 436 patients (15.5%) were surgically treated of which 9.4% were operated on in the operation room and 6.1% in the emergency room.
Conclusion:
Almost 75% of all children who presented to the emergency department following trauma to the fingers or the hand revealed minor injuries; however, 25% suffered a relevant, major injury. Overall, 15.5% had to be surgically treated. The most frequently found major injuries were fractures of the hand and the fingers.
Hand injuries are a frequent emergency department occurrence and account for most upper extremity injuries. Proper assessment and management of hand injuries can reduce morbidity and prevent long-term disability. "Assessment of Acute Hand Injuries" Part I was discussed in the Advanced Emergency Nursing Journal (E. G. Ramirez and K. S. Hoyt, 2014). Part II herein discusses the epidemiology, radiographs, and the management of hand lacerations, fingertip injuries, and fractures. Part III will discuss the management of tendon, ligamentous, neurovascular, and other special hand injuries along with the management of selected chronic hand conditions.
Background: Although fingertip injuries are common, there is limited literature on the epidemiology and hospital charges for fingertip injuries in children. This descriptive study reports the clinical features of and hospital charges for fingertip injuries in a large pediatric population treated at a tertiary medical center. Methods: Our hospital database was queried using International Classification of Diseases, Revision 9 (ICD-9) codes, and medical records were reviewed. Frequency statistics were generated for 1807 patients with fingertip injuries who presented to the emergency department (ED) at Boston Children?s Hospital (BCH) between 2005 and 2011. Billing records were analyzed for financial data. Results: A total of 1807 patients were identified for this study; 59% were male, and the mean age at time of injury was 8 years. Most commonly, injuries occurred when a finger was crushed (n = 831, 46%) in a door or window. Average length of stay in the ED was 3 hours 45 minutes, 25% of cases needed surgery, and, on average, patients had more than 1 follow-up appointment. About one-third of patients were referred from outside institutions. The average ED charge for fingertip injuries was 320,430 each year (in 2014 dollars) for fingertip injuries presenting to BCH. Conclusion: Fingertip injuries in children are common and result in significant burden, yet are mostly preventable. Most injuries occur at home in a door or window. Although these patients generally heal well, fingertip injuries pose a health, time, and financial burden. Increased awareness and education may help to avoid these injuries.
Fingertip crush injuries are common hand injuries in children and often are evaluated initially in an emergency department. Nail bed injuries can be classified into subungual hematomas, simple or stellate lacerations, crush injuries, and avulsions. Emergency department physicians with good knowledge of fingertip anatomy can appropriately manage these injuries so as to prevent long-term fingertip deformities and functional deficits. The management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial with much debate surrounding the necessity of removing the nail plate for repair of a nail bed laceration versus trephination alone of a large subungual hematoma. This article will discuss the management and evaluation of simple nail bed injuries by emergency department physicians to prevent chronic nail and fingertip deformities.
Fingertip entrapment injuries, which involve lacerations to the pulp and nail and often a fracture of the underlying bone, commonly occur in children, usually as the result of a crushing injury. Treatment is either conservative (wound cleaning and fingertip dressing) or surgical (repair of lacerations, reduction and stabilisation of fractures); however, no consensus currently exists regarding the most appropriate treatment modality.
To assess the effects (benefits and harms) of surgical and conservative interventions for fingertip entrapment injuries in children. We aimed to compare: different methods of conservative treatment; surgical versus conservative treatment; different methods of surgical treatment; and different methods of management after initial conservative or surgical treatment.
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, the World Health Organization Clinical Trials Registry Platform and reference lists of articles up to 30 April 2013. We did not apply any restrictions based on language or publication status.
Randomised controlled trials (RCTs) and quasi-RCTs comparing interventions for treating fingertip entrapment injuries in children. The primary outcomes were fingertip function, nail growth, nail deformity and adverse events such as infection.
Two authors independently screened studies for inclusion, assessed the risk of bias in each included trial and extracted data. We resolved disagreements through discussion.
We included two RCTs examining a total of 191 young children, 180 of whom were included in the analyses. The two trials tested different comparisons. Both trials were at high risk of bias, particularly from lack of blinding of participants and personnel, and of outcome assessment. The trials did not record fingertip function, nail growth or nail deformity. The quality of the evidence for the reported outcomes was judged to be 'low' using the GRADE approach (i.e. further research is very likely to have an important impact on our confidence in the estimate of the effect and is likely to change the estimate).One trial compared a seven-day course of antibiotics with no antibiotics after formal surgical repair of fingertip entrapment injuries. One child in each group had an infection at day seven (1/66 antibiotic group versus 1/69 no antibiotic group; RR 1.05, 95% CI 0.07 to 16.37). Both participants with infections had a more severe injury (partial fingertip amputation).The other trial compared two different dressings (silicone net and paraffin gauze) for use after either surgical or initial conservative management of fingertip entrapment injuries. It reported that two of 20 children in the silicone group versus one of 25 in the paraffin group had complications of wound infection (RR 2.50, 95% CI 0.24 to 25.63) and that one of 20 children in the silicone group versus two of 25 in the paraffin group had skin necrosis (RR 0.63, 95% CI 0.06 to 6.41). All complications healed with conservative treatment. The results for mean healing times and mean number of dressing changes were similar between groups but benefits of either silicone or paraffin dressings could not be excluded (silicone mean 4.1 weeks versus paraffin mean 4.0 weeks; MD 0.10 weeks, 95% CI -0.61 to 0.81); (silicone mean 4.3 dressing changes versus paraffin mean 4.2 dressing changes; MD 0.10, 95% CI -0.57 to 0.77). The trial found that a silicone dressing was less likely to adhere to the wound or cause distress for the child at the one-week dressing change.
There is a lack of evidence from RCTs to inform all key treatment decisions for the management of fingertip entrapment injuries in children.Given that the quality of evidence is low from one trial, we do not have conclusive evidence that prophylactic use of antibiotics after surgical repair fails to reduce risk of infection. The two children who experienced infection had more severe wounds.Similarly, the low quality evidence from one trial has not enabled us to draw firm conclusions regarding the effect on healing time or complications (infection, skin necrosis) at four-week follow-up between a silicone net dressing and a paraffin gauze dressing when applied post-surgery or after simple wound irrigation; however, the silicone net dressing may be easier to remove in the first week.Further RCTs are required in this area, preferably comparing surgical with conservative methods of managing fingertip entrapment injuries. Outcome assessment should include fingertip function, nail growth and nail deformity for a minimum of three months post treatment.
Hintergrund
Diese Studie untersucht die Größendimensionen von Kinderfingern zwischen Fensterscheibe und Dichtungseinlauf von Kraftfahrzeugseitentüren bei 4 mm Öffnungsweite im Hinblick auf das Risiko von Einklemmverletzungen automatischer Scheibenschließanlagen.
Material und Methoden
Bei 160 Kindern wurden in einer Querschnittsuntersuchung die Fingerdurchmesser am Grund-, Mittel-, Endglied sowie Mittel- und Endgelenk der rechten Hand ermittelt. Es wurden 6 unterschiedliche, repräsentative technische Querschnittszeichnungen von Dichtungseinläufen und Fensterscheiben bei 4 mm Öffnungsweite von aktuellen Kraftfahrzeugseitentüren in korrekten Größenproportionen und Lagebeziehungen zueinander in ein Koordinatensystem gezeichnet. Die tatsächlichen Weiten zwischen Scheibe und Dichtungseinlauf wurden ausgemessen und hierzu die Durchmesser der Kinderfinger in Relation gesetzt.
Ergebnisse
Nahezu alle Fingerglieder und -gelenke passten bei einer Öffnungsweite von 4 mm in die größte tatsächliche Weite einer Dichtung von 18 mm.
Schlussfolgerung
Die Europäische Richtlinie 74/60/EWG ist in ihrer aktuellen Form ungeeignet Verletzungsrisiken von Kinderfingern zwischen Fensterscheibe und Dichtungseinlauf automatischer Scheibenschließanlagen von Kraftfahrzeugen trotz Einklemmschutzfunktion sicher auszuschließen.
To investigate the etiological factors, intensity of injuries and the possible preventive measures of fingertip injuries and to avert such calamities.
A study was undertaken retrospectively on 200 children who had presented with fingertip injuries to the Paediatric Emergency Department of the King Saud bin Abdulaziz University for Health Sciences, during the years 2010-2011. The markers analyzed included age and sex of the patients, period when the injury occurred (vacation and/or non-vacation), accommodation, where the children dwelled, source of injury, localization of the injury, fracture or tendon damage, and modality of treatment.
The frequency of injuries was highest among younger children (< 5 years). Majority of injuries were found to occur during vacation period among patients who dwell in apartments and villas at residential compounds. House doors were the most common mode of crush injuries. The frequency of fractures was found to be more frequent in boys vs. girls. Suturing and conservative treatment were common mode of treatments. Of the total, 188 patients who attended the emergency had proper movement and alignment by the end of their treatment, while 12 patients demonstrated complications.
Children below 5 years age were involved in fingertip injuries in a large number. Injuries were more common in vacations and in children living in appartments. Preventive measures are necessary to avoid these accidents.
Sir,
Scalp avulsions are usually associated with individuals having long hair, which, apart from being the reason for the injury, is also an impediment to the treating surgeon attempting to salvage the injured scalp.[1] Methods have been described to remove hair from a totally avulsed scalp.[2,3] However, on a partially avulsed scalp, the same cannot be done as the injured part that needs to be shaved cannot be separated from the cranium. We present a simple modification of the above methods for the preparation of a near totally avulsed scalp with only an occipital strip of skin attachment. The anaesthetized patient is positioned exposing the avulsed scalp which is lifted off the cranium [Figure 1]. A clean disposable surgical cap is the placed over the cranium carefully tucking the distal part under the pedicle of the scalp [Figure 2]. The avulsed scalp is then re-draped over the cap and fixed to the skin with temporary anchoring sutures [Figure 3]. The scalp is then shaved and washed to remove all loose hair [Figure 4]. The outer surface of the scalp is then painted and the same is done for the inner layers after removal of the anchoring sutures and the protective cap [Figure 5]. The head is then draped in sterile drapes and is positioned for surgery.
The goal of this study is to describe the epidemiology of hand injuries among children treated in US emergency departments (EDs), including the consumer products and activities most commonly associated with these injuries.
A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System for patients younger than 18 years, who were treated in an ED for hand injuries from 1990 through 2009. Sample weights were applied to calculate national estimates, and US Census Bureau data were used to determine injury rates.
An estimated 16,373,757 (95% confidence interval: 14,082,965-18,664,551) children younger than 18 years were treated in EDs for hand injuries from 1990 through 2009 with a mean annual injury number of 818,688 and rate of 11.6 per 1,000 population. There was a statistically significant decrease in the annual number (by 20.5%) and rate (by 31.5%) of hand injuries during the 20-year study period. Males accounted for 65.3% of hand injuries. Injuries most commonly occurred in the home (57.7%) and were most frequently diagnosed as lacerations (31.3%). Patients aged 10 years to 14 years were most frequently diagnosed with fractures (26.7%) and were 1.71 (95% confidence interval: 1.68-1.75) times more likely to be diagnosed with a fracture than patients in other age groups. Hand injuries commonly occurred with products/activities associated with sports/recreational activities (36.4%).
Hand injuries are a common and preventable source of pediatric morbidity. Prevention efforts should target the home environment and sport/recreational activities.
Epidemiological study, level III.
Knowledge of the elastic properties of children's fingers is very important to understand the potential hazard for jamming injuries that exists in modern motor vehicles with automatic power-operated windows. This study determined the elastic resistance and the point of onset of bone/joint deformation at each of 5 different jam positions of a child's finger under continuous dorsal-palmar compression. An unembalmed finger that recently had been surgically removed from a polydactylic 8 month-old girl was jammed in a custom hydraulic test apparatus. A subminiature force sensor and an electrometric path sensor measured force and deflection values. To visualise the respective point of onset of bone/joint deformation, jamming of the finger was performed under fluoroscopy. The mean force at the point of onset of bone/joint deformation was 78.4 N. The current statutory limit of 100 N for the maximum closing force of an automatic power-operated motor vehicle window is thus well beyond the point at which finger injuries can occur in children. Assuming finger injuries in children can occur at a jamming force below approximately 80 N, a reduction of the statutory limit to us higher than 50 N is reasonable.
© Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: This study examines the dimensions of children's fingers and the risk of jam injuries in a 4-mm gap between glass and gasket of power-operated motor vehicle windows. MATERIAL AND METHODS: The diameter of the proximal, middle, and distal phalanx and of the proximal and distal interphalangeal joint of each finger of the right hand of 160 children was measured in a cross-sectional investigation. Six different drawings in cross section of gaskets and glass window panes of current motor vehicle side door windows at a vertical gap of 4 mm were drawn in correct proportion. The larger actual width of the oblique gap between window glass and gasket was measured and related to the diameters of children's fingers. RESULTS: Almost all fingers and joints fit in the largest actual gap of 18 mm between glass and gasket of one seal design. CONCLUSION: The European guideline 74/60/EWG specifications currently pertaining to closing force restriction do not eliminate the risk of potentially serious injury to children's fingers in motor vehicle power windows.
The aim of this experimental cadaver study was to investigate which kinds of lesions could occur in jam events between the glass and seal entry of power-operated motor vehicle side door windows at two different closing forces. Ten hands of fresh cadaver specimens were used. Three different hand positions chosen to simulate real events in which a finger is jammed between the glass and seal entry of the window of a current motor vehicle were examined. The index, middle, ring, and little finger of each hand were separately jammed both at the proximal and distal interphalangeal joint at closing forces of 300 and 500 N with a constant window glass closing speed of 10 cm/s. Macroscopically visible injuries were documented and radiographs of all fingers were obtained in two standard planes. At a closing force of 300 N, contusion marks of the skin, palmar joint instabilities and superficial skin lesions occurred, whilst at 500 N superficial skin lesions, superficial and deep open crush injuries, and fractures were observed. The results of this study experimentally demonstrate the kinds of finger injuries that could be expected in real jam events between the glass and seal entry in automatic power-operated windows.
Traumatic hand and finger amputations frequently lead to permanent disability.
To investigate their epidemiological characteristics and estimate the prevention potential among children 0-14 years old, through a cross-sectional survey.
Nationwide extrapolations were produced based on data recorded between 1996 and 2004 in the Greek Emergency Department Injury Surveillance System and existing sample weights. Incident and injury related characteristics were analysed to identify preventable causes.
Among 197 417 paediatric injuries, 28 225(14%) involved the hand and fingers resulting in 236 amputations (∼1% of hand injuries). The annual probability to seek emergency department care for a hand injury was 3%. The estimated incidence rate (IR) of hand amputations was 19.7/100 000 person-years. Over 50% concerned children 0-4 years old (male:female=2:1), peaking at 12-24 months. Male preschoolers suffered the highest IR (38.7/100 000). Migrant children were overrepresented among amputees. Of all amputations, 64% occurred in the house/garden and 14% in day-care/school/sports activities, usually between 08:00 and 16:00 (61%). Doors were the product most commonly involved (55% overall; 72% in day-care/school/gym) followed by furniture/appliances (15%) and machinery/tools (7%). Crushing was the commonest mechanism. Inadequate supervision and preventive measures were also frequently reported. 5% of the amputees were referred to specialised units for replantation/reconstructive surgery.
The majority of paediatric hand and finger amputations could be prevented in Greece, particularly among preschoolers, by a single product modification, namely door closure systems, coupled with improved supervision. Paediatricians should incorporate this advice into their routine child-safety counselling. This country-specific profile supports the need for maintaining similar databases as an indispensable tool for assisting decision-making and preventing disabling and costly injuries.
In modern motor vehicles with automatic power windows, a potential hazard exists for jam events of fingers between the window glass and seal entry. This study determined entrapment forces acting on adult fingers at the subjective maximum pain threshold during entrapment in such windows. The length and the girth of the proximal and distal interphalangeal joints of the triphalangeal fingers of the right hands of 109 participants (60 men, 49 women) were measured; the diameter was calculated from girth, which was assumed to be circular. The automatic power window system of a motor vehicle side door was changed to a mechanical system. During entrapment the force distributed across the four proximal interphalangeal joints (PIPs), and separately on the proximal interphalangeal (iPIP) and then the distal interphalangeal (iDIP) joints of the index finger was measured using a customized force sensor. The maximum bearable entrapment force was 97.2 ± 51.8 N for the PIPs, 43.4 ± 19.9 N for the iPIP, and 36.9 ± 17.8 N for the iDIP. The positive correlation between finger diameter and maximum entrapment force was significant. Particularly with regard to the risk to children's fingers, the 100 N statutory boundary value for closing force of electronic power windows should be reduced.
This study examined the mechanisms of injury and the pattern of care for children who presented to the emergency department with uncomplicated nail bed lacerations.
A retrospective chart review was conducted from January 2004 to December 2007 for all children younger than 18 years who presented to a tertiary children's hospital with an uncomplicated nail bed laceration.
There were 84 cases of uncomplicated nail bed injuries for more than a 4-year period. Sixty percent of the subjects were males. The mean age was 5.3 (SD, 4.1) years. Most injuries occurred at home (58%), and the most common mechanism of injury was a door (67%). Approximately 40% of patients were treated by emergency physicians. There was no significant difference in acute and chronic complications or in the length of stay in the emergency department, between patients treated by emergency physicians and by plastic surgeons.
Most nail bed injuries in children occur at home, and the door seems to be the major mechanism of injury. Approximately 57% of these are children younger than 5 years. Only 42% of uncomplicated nail bed lacerations are treated by emergency physicians, yet there is no significant difference in outcomes between plastic surgeons and emergency physicians. Our study suggests that there is a role in public education for primary prevention, and with proper training, pediatric emergency physicians can treat uncomplicated nail bed lacerations.
Fingertip injuries are commonly seen by family and emergency physicians. Many of the cases are simple to treat and do not need specialised treatment by a hand surgeon. However, there are certain conditions where early intervention by a hand surgeon is warranted for better functional and aesthetic outcomes. Common injuries include mallet finger injury, crush injuries to the fingertip with resultant subungual haematoma, nail bed laceration, partial or complete amputation of the fingertips, pulp amputations and fractures of the distal phalanges.
Details were recorded prospectively in a specifically designed questionnaire for all children presenting to the Accident and Emergency Department with isolated finger injuries over a period of 6 months, in order to understand the incidence and aetiology. Among the 426 injuries in 283 children, most occurred at home (59%) more in the <5 year age group (38%), involving the middle finger (25%) and terminal phalanges (47%). "Jamming/crushing" was the commonest reason (48%), mostly caused by a child (59%) at the living room door (32%) and more commonly at the hinge side (49%). Nail injuries were seen in 48% of cases and 16 amputations of terminal phalanges were noticed in 15 children. Tendon injuries were only caused when cut by sharp objects, and were not caused by jamming/crushing. Both children and adults should be educated about causation, reiterating that damage to fingers can be prevented or reduced by observing safety measures.
We characterize non-work-related finger amputations treated in US hospital emergency departments (EDs) and discuss implications for injury-prevention programs.
Finger amputation data from 2001 and 2002 were obtained from the National Electronic Injury Surveillance System All Injury Program (a nationally representative sample of 66 US hospital EDs). National estimates are based on weighted data for 948 cases for finger amputations (including partial and complete) that occurred during non-work-related activities (ie, nonoccupational) activities.
An estimate of 30,673 (95% confidence interval [CI] 24,877 to 36,469) persons with non-work-related amputations were treated in US hospital EDs annually. Of these persons, 27,886 (90.9%; 95% CI 22,707 to 33,065) had amputations involving 1 or more fingers; 19.1% were hospitalized or transferred for specialized trauma care. Male patients were treated for finger amputations at 3 times the rate of female patients. The rate of persons treated for finger amputations was highest for children younger than 5 years (18.8 per 100,000 population; 95% CI 12.3 to 25.2 per 100,000 population), followed by adults aged 55 to 64 years (14.9 per 100,000 population; 95% CI 9.6 to 20.1 per 100,000 population). For children aged 4 years and younger, 72.9% were injured in incidents involving doors, and for adults aged 55 years or older, 47.2% were injured in incidents involving power tools.
National estimates of finger amputations among US residents indicate that young children and older adults are at greatest risk. Parents or other responsible adults should be aware of the risk of small children's fingers around doorways, and adults should take safety precautions when using power tools.
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