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Washing Machine Injuries of the Upper Extremity: Case reports with a review of the literature

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Washing machines are part of every household and there are various reports of upper extremity injuries due to inadequate safety precautions while operating the machine. Most of the injuries occur when an attempt is made to remove the clothes from the machine and the hand gets caught in the spinning machine. The presentation can vary from minor soft tissue injuries to a mangled upper extremity. The chance of neurovascular damage resulting in compartment syndrome is very high. The author reports three cases of washing machine injuries to draw attention to this not so uncommon injury. The relevant literature is also considered.
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ABSTRACT 

          
               
     

Washing Machine Injuries of the Upper Extremity
Case reports with a review of the literature
S S Suresh
Department of Orthopaedics, Ibri Regional Referral Hospital, Sultanate of Oman
Email: dr.s.s.suresh@gmail.com
ﻊﻣ ﺕﻻﺎﺣ ﺮﻳﺮﻘﺗ -ﻞﻴﺴﻐﻟﺍ ﻦﺋﺎﻜﻣ ﻦﻋ ﺔﲡﺎﻨﻟﺍ ﻱﻮﻠﻌﻟﺍ ﻑﺮﻄﻟﺍ ﺕﺎﺑﺎﺻﺍ
ﺕﺎﻴﺑﺩﺃ ﺔﻌﺟﺍﺮﻣ
ﺶﻳﺭﻮﺳ ﺱﺍ ﺱﺍ
ﺔﻣﺯﻼﻟﺍ ﺔﻣﻼﺴﻟﺍ ﺕﺎﻃﺎﻴﺘﺣﺍ ﺬﺧﺃ ﻡﺪﻌﻟ ﺍﺮﻈﻧ ﻱﻮﻠﻌﻟﺍ ﻑﺮﻄﻟﺍ ﺕﺎﺑﺎﺻﻷ ﺓﺪﻳﺪﻋ ﺮﻳﺭﺎﻘﺗ ﻙﺎﻨﻫﻭ ، ﺖﻴﺒﻟﺍ ﺙﺎﺛﺍ ﻦﻣ ﺎﻤﻬﻣ ﺍﺀﺰﺟ ﻞﻴﺴﻐﻟﺍ ﻦﺋﺎﻜﻣ ﺮﺒﺘﻌﺗ:ﺺﺨﻠﳌ
ﺔﻔﻴﻔﺧ ﺔﺑﺎﺻﻻﺍ ﻥﻮﻜﺗ ﻥﺃ ﻦــﻜﳝ ﺔﻨﻛﺎﳌﺍ ﻲﻓ ﺪﻴﻟﺍ ﺮﺼﺣ ﻲــﻓ ﺐﺒــﺴﺘﺗ ﻲﺘﻟﺍﻭ ﺎﻬﻨﻣ ﺲﺑﻼﳌﺍ ﻊﻓﺭ ﺔﻟﻭﺎﺤﻣ ﺪﻨﻋ ﻞﺼﲢ ﺕﺎﺑﺎﺻﻻﺍ ﻢــﻈﻌﻣ ﺎﻬﻠﻴﻐــﺸﺗ ﺀﺎــﻨﺛﺃ
ﺔﻣﺯﻼﺘﻣ ﺎﻬﻨﻋ ﺞﺘﻨﻳ ﻲﺘﻟﺍﻭ ﺔﻳﻮﻣﺪﻟﺍ ﺔﻴﻋﻭﻷﺍﻭ ﺏﺎﺼﻋﻷﺍ ﺔﺑﺎﺻﻻ ﺮﻴﺒﻛ ﻝﺎﻤﺘﺣﺍ ﻙﺎﻨﻫ ﺓﺪﻳﺪﺷ ﻯﺮﺧﺃ ﺕﻻﺎﺣﻲﻓ ﻥﻮﻜﺗ ﺎﻤﻨﻴﺑ، ﻂﻘﻓ ﺓﻮﺧﺮﻟﺍ ﺔﺠﺴﻧﻻﺍﻞﻤﺸﺗﻭ
ﺕﺍﺫ ﺕﺎﻴﺑﺩﻷﺍ ﻰﻟﺍ ﺎﻀﻳﺃ ﻕﺮﻄﺘﻟﺍ ﺓﺭﺩﺎــﻨﻟﺍ ﺮﻴﻏ ﺕﺎﺑﺎﺻﻻﺍﻩﺬﻫ ﻱﺩﺎﻔﺘﻟ ﺔﻴﻋﻮﺘﻟﺍ ﻞﺟﺃﻦﻣ ﻞﻴــﺴﻐﻟﺍ ﺕﺎﻨﻛﺎﻣ ﺕﺎﺑﺎﺻﻻ ﺕﻻﺎﺣﺙﻼﺜﻟ ﺎﻔﺻﻭ ﺎﻨﻫ ﻡﺪــﻘﻧ ﺰــﻴﳊﺍ
ﺔﻗﻼﻌﻟﺍ
ﻥﺎﻤﻋ ، ﺔﻟﺎﺣ ﺮﻳﺮﻘﺗ ،ﻞﻴﺴﻐﻟﺍ ﻦﺋﺎﻜﻣ ،ﺪﻴﻟﺍ ﺕﺎﺑﺎﺻﺍ ﺮﺴﻛ ،ﻉﺍﺭﺫ ،ﺔﺑﺎﺻﺍ :ﺕﺎﻤﻠﻜﻟﺍ ﺡﺎﺘﻔﻣ





     
     
    




        



 



        
     



     
 
    
.
C A S E 1

   
C A S E R E P O R T

90

    

     


       

         
    

C A S E 2
        




   
  
    
      
        

C A S E 3

 
         
       


        
       
        

D I S C U S S I O N
     
       


  


         
      

Figure 1: Figure 2:


91

   
       











  
     
  


         

    
  
    


      
      
    

        
     
        
    

    
    

   
 

      
    
  

  

   

Figure 3:

Figure 4:

92
     
  



    
     


C O N C L U S I O N
       
   



   

    
     


R E F E R E N C E S
         
   

         
    
        

 
  

        
     
  

        

      

        
         

       





       


 

Figure 5:

    
     
     
       
   

Prenatal MRI Image of a Fetus with Semilobar
Holoprosencephaly
*Sukhpal Sawhney,1 Lovina Machado,2 Rajeev Jain1





INTERESTING MEDICAL IMAGE
ﲔﻨﺟﺪﻨﻋﻲﺼﻔﻟﺍﻒﺼﻧﻍﺎﻣﺪﻟﺍ ﺝﺎﻧﻻﻲﺴﻴﻃﺎﻨﻐﳌﺍ ﲔﻧﺮﻟﺍ ﺭﻮﺻ
ﻞﻤﳊﺍﺀﺎﻨﺛﺃ
ﲔﺟ ﻒﻴﺟﺍﺭ ˛ﻭﺩﺎﺟﺎﻣ ﺎﻨﻴﻓﻮﻟ ˛ﻲﻨﻫﻮﺳ ﻝﺎﺒﺨﺳ
1Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Gynecology and Obstetrics,
Sultan Qaboos University Hospital, Muscat, Oman; 3Department of Radiology and Molecular Imaging, Sultan Qaboos University, College of Medi-
cine & Health Sciences, Muscat, Oman
*To whom correspondence should be addressed. Email: sukh@squ.edu.om
1a.








1b.



Figure 1a: 

94

    
   
 
       
     

C O M M E N T

       


   
 



  






  
         








     
      







      

     
 
    



R E F E R E N C E S
    

    

 
  

        
     

 
  


        

   

 
e ICU Book




        

     
     
      
    
      
   
     

The appendices
include Units and Conversions, Selected Reference
Ranges and Clinical Scoring Systems.
        


    

    
     


        

   
      
  
       
        
          
        

      



B O O K R E V I E W
ﺓﺰﻛﺮﳌﺍ ﺔﻳﺎﻨﻌﻟﺍ ﺓﺪﺣﻭ ﺎﺘﻛ�
ﻮﻨﻳﺭﺎﻣ ﻝﺍ ﻝﻮﺑ :ﻒﻟﺆﳌﺍ
Author:
Publisher: Lippincott Williams and Wilkins. ird Edition 2007
ISBN: 
Price: OR 24
Available at: Al Manahil Educational
Email: manahil@omantel.net.om

Dr. Marino is Chairman of the Department of Medicine and Critical Care Director of Saint Vincent’s Midtown
Hospital in New York City. He is also clinical Associate Professor of New York Medical College in Valhalla. e third
edition of the ICU Book welcomes Dr. Kenneth Sutin, Department of Anaesthesiology and Surgery at Bellevue Hos-
pital Centre and Associate Professor of Anaesthesiology and Surgery at University School of Medicine in New York
City, who adds his expertise to the final 13 chapters of the book.
 
96
       
     

     
  
       
       


     



        

         
     
      


      
     
        


    
      
  




 




      
   
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

Karin Nollain
Department of Anesthesia and Intensive Care Unit, Sultan Qaboos
University Hospital, Muscat, Sultanate of Oman
Email: karin@squ.edu.om
... 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]. ...
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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 affected parts. Compared to revision amputation or other reconstructive techniques, finger replantation and revascularization offer 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.
... 3 Another study was published in Oman which also reported cases with injury to the hand due to washing machines. 6 ...
... Modern automatic washing machines have implemented numerous safety mechanisms to prevent injury during operation, but there are older machines in use, especially among lower socioeconomic populations [3]. Devastating injuries are uncommon but may require limb salvage techniques when they do occur. ...
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Automatic washing machine injuries are more commonly associated with minor injuries in the pediatric population but may cause life and limb-threatening adult injuries in rare instances. This case describes a severe upper extremity injury after a schizophrenic patient placed her arm into a running machine. Herein, we describe the management, complex reconstruction, and repair of radial, ulnar, and metacarpal fractures in addition to transected tendons and vasculature. The patient had an excellent functional outcome with minor restrictions in motion and complete recovery of sensation.
... Washing machine injuries occur when attempts are made to remove clothes from the machine and the hand gets entangled in spinning laundry, leading to soft tissue injuries and fractures. These injuries occur most in children according to the previous reported study [2]. The present washing machine injury occurs in adult is relatively rare. ...
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Inadequate supervision of children has contributed to injuries. However, the association of inadequate supervision with injury events in children has not been quantified. The purpose of this study was to describe and quantify the role of inadequate supervision of children in injury deaths. Injury deaths among children aged 0 to 6 years in Alaska during 1993 to 1995 and Louisiana during 1994 were classified using 10 child safety standards to assess the role of parent/caregiver supervision in the circumstances of injury death. The leading categories of injury death for both states combined were motor vehicle injury and fire-related injury. Of the classifiable injury deaths in both states (157 [77%] of 203 deaths), the most commonly violated safety standard was "children should be supervised by a responsible care provider" (64 deaths [41%]). Of these deaths, the caregiver was absent in 38%, and the caregiver increased the danger to the child in 17%. Male injury deaths more typically involved a supervision standard violation. Drowning and pedestrian deaths typically involved a supervision standard violation, whereas asphyxiation, homicide, and occupant motor vehicle injury deaths did not. Alaska and Louisiana child injury deaths were mostly attributed to preventable violations of 10 child safety standards, most commonly the supervision standard. The methods in this report were useful in identifying target populations and causes of death, which can be used to plan and implement interventions to improve supervision of children.
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To describe washing machine related injuries in children in the United States. Injury data for 496 washing machine related injuries documented by the Consumer Product Safety Commission's National Electronic Injury Surveillance System and death certificate data files were analyzed. Gender, age, diagnosis, body part injured, disposition, location and mechanism of injury were considered in the analysis of data. The upper extremities were most frequently injured in washing machine related injuries, especially with wringer machines. Fewer than 10% of patients required admission, but automatic washers accounted for most of these and for both of the deaths. Automatic washer injuries involved a wider range of injury mechanism, including 23 children who fell from the machines while in baby seats. Though most injuries associated with washing machines are minor, some are severe and devastating. Many of the injuries could be avoided with improvements in machine design while others suggest a need for increased education of potential dangers and better supervision of children if they are allowed access to areas where washing machines are operating. Furthermore, washing machines should only be used for their intended purpose. Given the limitations of educational efforts to prevent injuries, health professionals should have a major role in public education regarding these seemingly benign household appliances.
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The computed tomographic (CT) findings of the spectrum of holoprosencephaly are presented. Five cases are used to demonstrate the subgroups of alobar, semilobar, and lobar holoprosencephaly. Familiarization with the CT findings in holoprosencephaly leads to more accurate and earlier diagnosis.
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Holoprosencephaly is a malformation of the cerebral hemispheres resulting in the absence of the inter-hemispheric fissure along with other defects of brain development. Frequently midline defects of the craniofacial structures are also present. This malformation sequence has been of interest for many years because of the well recognized genetic and environmental pathogeneses, although the molecular pathogenesis remained elusive. Recent studies have begun clarifying the molecular pathogenesis of holoprosencephaly. Herein is reviewed the syndromes associated with holoprosencephaly, the pathology of this disorder, genetic and environment factors, and a current understanding of the molecular pathogenesis of this disorder.
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The importance and seriousness of wringer and mangle injuries have been emphasized. In most wringer injuries the trauma to the hand is comparatively slight, the most serious See Images in the PDF file injury occurring about the elbow and axilla. With mangle injuries of the hand, the mechanism of injury is the same, but in addition to the effect of rolling, there is a thermal burn. The treatment of both injuries is basically the same. Attempts are made to clean the wound as early as possible and this is done at the end of five to seven days, by mechanical debridement. Split-thickness skin grafts should be applied early to prevent secondary infection and to minimize scar formation. The wound should be closed by the fourteenth to the twenty-first day. Later, in the case of palmar defects, the contracted skin graft is excised and full-thicknsess skin grafts are applied. A tube pedicle graft may be necessary if tendons and nerves have been destroyed. Postoperative splinting and physical therapy are necessary to prevent recurrence of contractures and to restore function.