Content uploaded by Sohail Quazi
Author content
All content in this area was uploaded by Sohail Quazi on Feb 23, 2025
Content may be subject to copyright.
Content uploaded by Sohail Quazi
Author content
All content in this area was uploaded by Sohail Quazi on Jan 29, 2025
Content may be subject to copyright.
1Volume 07; Issue 02
Case Report
Hand Injuries Due to Top Loader Automatic
Washing Machine: Experience from Oman with
Three Case Reports and Literature Review
Hussain M. AL Lawati1, Zamzam AL Bahri1, Shiyas Mohammed Ali2*,
Sohail J Quazi
1Department of Hand Surgery, Khoula Hospital, Muscat, Oman
2Department of Plastic Surgery, Hamad Medical Corporation, Doha, Qatar
*Corresponding author: Dr. Sohail J Quazi, Department of Plastic Surgery, Hamad Medical Corporation, Doha, Qatar
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing
Machine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7:
240. DOI: 10.29011/2689-0526.100240
Received: 07 January 2025; Accepted: 11 January 2025; Published: 14 January 2025
Archives of Surgery and Clinical Case Reports
AL Lawati HM, et al. Arch Surg Clin Case Rep 7: 240.
www.doi.org/10.29011/2689-0526.100240
www.gavinpublishers.com
Abstract
Washing machines are common in most households and crucial for laundry management. However, they are associated with
risks, especially in children. In this report, we present three cases of severe hand injuries in pediatric patients that resulted from
attempts to unload laundry while the washing machine was still spinning. Fortunately, in all three cases, the injured hands
were successfully treated with revascularization of the aected parts. Compared to revision amputation or other reconstructive
techniques, nger replantation and revascularization oer the most favorable outcomes. Several preventive strategies, such
as more parental supervision and thorough appliance safety training, can reduce the likelihood of such injuries. Increasing
awareness and promoting safe practices can drastically reduce the frequency of potentially fatal accidents.
Keywords: Hand Injuries, Washing machine, Revascularization.
Introduction
Injuries from washing machines are a serious problem, particularly
for young children. In the United States, 19,109 injuries related
to washing machines were reported between 1993 and 2000.
An estimated 11,000 or more children in the United States are
injured by washing machines each year, according to the National
Electronic Injury Surveillance System (NEISS) of the Consumer
Product Safety Commission (CPSC) [1]. In the past, injuries
from earlier washing machine generations—especially those with
manually operated rollers—have generally involved soft tissue and
skin damage and have been less severe. With these older models,
fractures were uncommon [2] However, more serious injuries
surfaced as electrically powered washing machines increased,
especially in the 1930s when wringer machines were widely used
[3]. Successful interventions highlight the importance of treating
hand trauma with advanced surgical techniques and timely medical
attention [4]. Various studies have shown the positive outcomes
of digital replantation and revascularization procedures in trauma
centers due to specialized microsurgical expertise [5]. In addition,
putting safety procedures into place and distributing educational
materials about possible risks to both adult and pediatric audiences
can be crucial in reducing these traumatic events.
Case Presentation 1
A 12-year-old boy tried to remove a piece of cloth from a spinning
washing machine and seriously injured his right index nger.
Examination of the nger revealed signicant soft tissue damage,
severe twisting, and an ischemic appearance. A signicant portion
of the dorsal skin was degloved and there was a circumferential
wound at the level of the proximal phalanx. The ischemia time
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing Ma-
chine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7: 240. DOI:
10.29011/2689-0526.100240
2Volume 07; Issue 02
was four hours (Figure 2). The radiographs showed a diaphyseal fracture in the proximal phalanx, however, there was no damage to the
metacarpophalangeal joint.
Figure 1: Wringer washing machine.
Figure 2.3: Post revascularization and K wire xation of the index nger
After the initial management, the patient was shifted to the operating room so that the nger could be salvaged through revascularization.
The intraoperative ndings conrmed a twisted, ischemic digit with intact exor tendons, both digital arteries were avulsed, while the
extensor tendon and both digital nerves were intact. After all wounds were thoroughly debrided, a single axial 1mm K-wire was used to
stabilize the skeleton. Under a microscope, 10-0 nylon sutures were used to repair the radial digital artery.
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing Ma-
chine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7: 240. DOI:
10.29011/2689-0526.100240
3Volume 07; Issue 02
Despite extensive degloving of the dorsal skin, the two dorsal veins were identied and successfully repaired, leading to improved
nger perfusion. The hand was immobilized in a splint and the patient was admitted to our hospital for close inpatient observation for 5
days. The postoperative period was uneventful and the patient was discharged after 5 days. The patient had good Vascularity and gained
adequate function of the nger in the follow-up period.
Case Presentation 2
A 54-year-old man was trying to get a piece of cloth out of a spinning washing machine when he suered a severe twisting injury to his
right index nger. He arrived at the hospital seven hours after the injury. On physical examination, the nger presented with a double-
level crush injury, appearing deformed, twisted, and congested, with no detectable circulation.
X-rays showed a fracture of the middle phalanx that was fragmented into several pieces (as depicted in Figure 3.2). Subsequently, the
patient was moved to the operating room for an immediate vascular intervention. Intraoperative ndings included a severe crush injury
with circumferential lacerations in the middle and proximal phalanges and the nger twisted around the intact exor tendons. Both
digital nerves were avulsed with the distal stumps absent, and both the radial and ulnar digital arteries were cut. The middle phalanx head
(P2) had a bicondylar fracture with comminution.
The ulnar digital artery was repaired under a microscope with 10-0 nylon sutures. Two veins were also successfully repaired: a dorsal
vein and a volar vein. Due to the severe comminution and bicondylar split of the fracture, xation was not performed; instead, the
fragments were reduced, and the hand was immobilized in a cast. Following the procedure, the color of the nger improved, and normal
perfusion was restored. The patient’s postoperative period was uneventful. The patient was kept under observation for seven days in the
hospital (Figure 3.3). At follow-up, all wounds healed, and the fracture alignment was deemed acceptable.
Figure 3.3: case 2 post-op 7 days
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing Ma-
chine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7: 240. DOI:
10.29011/2689-0526.100240
4Volume 07; Issue 02
Case Presentation 3
A 15-year-old girl sustained an injury to her right index nger
while attempting to retrieve clothes from a spinning- washing
machine. She presented to the hospital four hours after the
injury. On examination, the nger was nearly amputated, with a
circumferential wound at the base of the proximal phalanx. The
nger was congested with no circulation and hanging by exor
tendons. The radiographs indicated a displaced fracture at the
base of the proximal phalanx, coupled with epiphyseal damage.
Subsequently, the patient was then shifted to the operating room
for exploration and revascularization. Intraoperatively, both digital
nerves were avulsed, and both digital arteries were completely
severed. Digital structures were repaired under a microscope using
standard microsurgical techniques.
The nger’s perfusion improved after the procedure and the
color returned to pink. The hand was immobilized in a splint and
hospitalized for 7 days for close observation. The patient was
discharged after 7 days and followed in clinic. He showed good
healing and acceptable range of motion in the follow-up period
Discussion
Washing machines have the potential to cause severe upper-limb
injuries, particularly when hands or ngers are caught in clothing
while the machine is still spinning [6]. The growing usage of
these devices in Oman, a wealthy nation in the Gulf Cooperation
Council, has been linked to an increase in hand injuries, frequently
involving the pediatric population. In Oman, washing machine-
related digit injuries accounted for approximately 0.46% of all
hand emergencies, with 108 cases being reported between January
2015 and June 2019. The primary factors contributing to these
injuries include inadequate safety measures and a lack of adult
supervision [7]. All reported cases involved automatic top-loading
washing machines, whereas injuries from front-loading machines
remain rare. This is likely because front loaders are more expensive
and less commonly used, and they also use 40-60% less water and
30-50% less energy, potentially leading to fewer and less severe
injuries (Figure 5).
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing Ma-
chine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7: 240. DOI:
10.29011/2689-0526.100240
5Volume 07; Issue 02
Figure 5
According to Yang and Jeong (2019), these pediatric hand injuries
can have serious repercussions, including persistent discomfort,
long-term functional disability, and major psychological eects
on the aicted individuals and their families. In two cases, the
injuries resulted from insucient parental supervision, while the
third involved an adult male who was unfamiliar with the machine.
The severity of injuries caused by washing machines can range
from simple lacerations and closed fractures to more serious
crushing injuries often involving ischemic digits. These injuries
typically present with crush avulsion, and twisting due to the
spinning drum, which are often accompanied by fractures. Owing
to the nature of these avulsions and twisting injuries, replantation
and revascularization procedures can be particularly challenging
[8].
To lower the frequency of these injuries, public education is
essential, and washing machine design must include improved
safety features. Injuries have become more frequent and severe
as washing machine technology has advanced to incorporate
increasingly intricate features and stages. Automatic/semi-top
loading, automatic front loading, and twin-tub/semi-automatic
loading are the three main categories into which modern washing
machines fall. Due to their accessibility and aordability, top-
loading machines are the most popular, but because of their
inadequate safety features, they are also linked to the highest
injury rate.
Despite advancements in safety mechanisms leading to a decline
in injuries, we are still a long way from completely eradicating
them [9]. Surprisingly, some modern machines have been linked
to more severe injuries, such as avulsion amputations, burns, and
even fatalities. Injuries typically occur when the hands become
entangled with the laundry during the washing or drying phases.
Injuries related to the dryer phase are often more severe, especially
at higher speeds, because the long delay before the drum comes to
a complete stop can tempt users to unload the machine prematurely
[10]. Reinforcing safety measures is essential to prevent such
injuries. Newer machines are equipped with safety locks that keep
the door closed during operation as well as warning stickers with
diagrams indicating potential hazards. Another eective safety
feature is that the sensor detects even slight openings in the lid and
automatically halts the machine. For optimal safety, two systems
should be integrated into washing machines: one to keep the lid
locked during operation, and another to pause the machine if the lid
is inadvertently opened. Public health education also plays a vital
role in preventing these injuries, which can be promoted through
various channels, such as social media, awareness campaigns, and
school outreach programs.
S. S. Suresh reported three cases of upper limb injuries caused by
washing machines, all involving pediatric patients. Unlike more
severe cases, these injuries primarily involve closed fractures rather
than ischemia or open wounds. Suresh highlighted the potential
of washing machines to cause serious soft tissue injuries, such as
compartment syndrome, which can lead to vascular compromise.
He emphasized the need for further safety improvements to
mitigate these risks [11].
Wolfers, Geraghty, Montorfano, et al described the case of an
adult female who sustained a mangled upper extremity after
placing her arm in a running washing machine. They presented
a case of serious upper extremity injury that required extensive
reconstructive procedures to save a limb with minimum loss
of function eectively. They concluded the need for an expert
microvascular reconstructive team to get good outcomes for severe
hand injuries [12].
Zhang Y. described the case of an adult patient who sustained a
partial amputation of a single digit from a washing machine injury.
The nger was successfully revascularized and salvaged. Zhang
concluded that owing to avulsion, rotational stress, and contusion
of skin and muscles, injuries such as fractures and degloving can
occur. They also suggested that the safety features of washing
machines should be enhanced to prevent such injuries [13]
Kwan, Saw, and Sara reported on four pediatric washing machine
injuries in Malaysia. Two cases involved partial nger amputations,
whereas the other two involved closed-bone injuries. All injuries
occurred during the spinning phase of the machine operation. They
concluded that the safety features, particularly during the spinning
phase, should be improved. Additionally, operating instructions
and safety precautions should be displayed in multiple languages,
and parents should be educated on the risks they pose to their
children [14].
Conclusion
Washing machine injuries can be devastating, although their
severity can vary. Children are particularly at risk, largely due to
Citation: AL Lawati HM, AL Bahri Z, Mohammed Ali S, Quazi SJ (2025) Hand Injuries Due to Top Loader Automatic Washing Ma-
chine: Experience from Oman with Three Case Reports and Literature Review: A Case Report. Arch Surg Clin Case Rep 7: 240. DOI:
10.29011/2689-0526.100240
6Volume 07; Issue 02
inadequate supervision. Every eort should be made to replant
the injured parts as this approach oers the best cosmetic and
functional results compared to revision amputation or other
reconstructive techniques. Several preventive measures can
help reduce the occurrence of these injuries, including parental
education, appropriate supervision, strategic placement of washing
machines in homes, and unplugging machines when not in use. In
addition, the integration of a special trigger system that detects
unintentional opening of the lid, together with clearly displayed
safety instructions in multiple languages, can signicantly reduce
the risk of injuries caused by the washing machine.
Declaration
While preparing this work, the authors used Paperpal.Ai to check
the grammar and improve the text of the article. After using this
tool/service, the authors reviewed and edited the content as needed
and took full responsibility for the publication’s content.
Conict of interest: The Authors disclose no conict of interest.
References
1. Warner BL, Kenney BD, Rice M. (2003) Washing machine-related
injuries in children: A continuing threat. Injury Prevention 9: 357-360.
2. Franz JL, Root HD (1975) Upper extremity wringer injuries. Vascular
Surgery 9: 302.
3. Duncan RE, Moseley T (1969) Wringer injuries in children: Analysis
of 300 cases. Journal of the Florida Medical Association 56: 106-107.
4. Yamano Y (1985) Replantation of the amputated distal nger. Journal
of Hand Surgery 10: 211-218.
5. Tamai S (1982) Twenty years’ experience of limb replantation: A review
of 293 upper-extremity replants. Journal of Hand Surgery 7: 549-556.
6. Warner, B.L., Kenney, B.D., Rice, M. (2003) “Washing machine-related
injuries in children: A continuing threat.” Injury Prevention. 9: 357-360.
7. The Washington Post online (2016) A 3-year-old climbed into the
washing machine and died, then her mother was arrested.
8. Allen JE, Beck AR, Jewett TC Jr (1968) Wringer injuries in children.
Archives of Surgery 97: 1947.
9. Bristol C (2000) Washing machine maker sued over the injury to a
girl’s arm. Mail Tribune.
10. Kenney BD, Warner BL, Alvanos L, Rice M (2001) Washing machine-
related injuries in children: A continuing threat. The 129th Annual
Meeting of the APHA, Atlanta, GA, 21-25.
11. Suresh SS (2008) Washing machine injuries of the upper extremity.
Sultan Qaboos University Medical Journal 8: 89-92.
12. Zhang Y (2017) Washing machine injury of the middle nger: A case
report and literature review. MOJ Surgery 4: 67-68.
13. Wolfers M, Geraghty F, Montorfano L, Bordes SJ, Miller G (2021)
Complex reconstruction of a mangled forearm following washing
machine trauma. Cureus 13: e13673.
14. Kwan MKK, Saw A, Sara T (2005) Automatic top loader washing
machine-related injury: A report of four cases with serious injury. The
Medical Journal of Malaysia 60: 112-114.
