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Injuries of the hand and forearm in young children caused by steam roller presses in laundries
Abstract
Fourteen children (median age 43 months, range 14-82 months; 7 girls and 7 boys) were treated for mangle injuries (one hot steam, and 13 cold roller presses) to the hand and forearm between 1996-2002 at the Department of Hand Surgery, Malmö, Sweden. All children had unilateral skin damage with avulsion or necrosis of skin in nine. Seven of the 14 had signs of compartment and carpal tunnel syndromes and three had fractures (phalanges or hamate bone). Initial treatment included fasciotomy, decompression, and skin revision with split skin grafts and later further skin cover, including one pedicled ulnar flap. IN eight the injuries healed uneventfully, while six had slight consequences (such as minor extension deficit of fingers or slight contracture of the scar). Ten of the 14 children came from immigrant families. Mangle injuries can be prevented through better supervision of children by parents when the mangle is being used, and dissemination of information of the potential hazards in relevant languages in residential areas with large immigrant populations.
... with skin grafts may be efficient [4]. However, treatment of those injuries frequently requires several secondary procedures for an optimal functional result [5]. ...
Management of skin avulsion injuries of the upper extremity may require coverage with large flaps or skin autografts. Cutaneous grafting is frequently combined with artificial skin to optimize the final functional and cosmetic result. The conventional use of bilaminated dermal substitutes consists of a two-stage procedure and requires long immobilization of the operated area. The purpose of this retrospective study is to evaluate the impact of a dermal regeneration template immediately covered by skin grafts in a one-step procedure for reconstructing skin avulsion injuries of the hand and forearm.
We performed this technique in eight patients who presented with extended skin defects of the hand and forearm following skin avulsion injuries. Dimensions of the defects ranged from 160 to 1,250 cm(2). After debridement, Integra(®) Single Layer was applied and covered with unmeshed thin skin autografts; compressive dressings were used for 1 week and mobilization started by the second postoperative week. Histological examination of the grafted areas was performed 2 weeks after surgery. Functional and cosmetic outcome was assessed 12 months postoperatively.
The overall take rate of the dermal substitute and skin graft was 95-98 %. Histological results showed complete incorporation and vascular proliferation of the template, which allowed the neo-vascularization of the overlying autograft. The mean grip strength of the operated hands was at the 83 % of the normal contralateral hands. Pliability and overall appearance of the reconstructed areas was satisfactory (mean Vancouver Scar Scale Score 1.875).
The use of Integra(®) Single Layer dermal substitute and immediate skin overgrafting consists an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.
Scald is one type of burn that s often mentioned alone and occurs mostly in the paediatric population. Inhaled steam is mostly cooled off in the airways, why thermal damage is rarely seen. A sudden exposure to hot steam/inhalation can cause a thermal inhalation injury. A scoping review was performed, with the aim to summarize all published papers in English, about steam-related injuries. The search was conducted using the PubMed® and Cochrane libraries on 19th of May 2021, without a set time period. Out of a total of 1186 identified records, 31 were chosen for review. Burns related to the contact with steam are generally rare and can be both minor and severe. The more severe cases related to steam exposure are mostly workplace accidents and the minor injuries reported in the literature are often related to steam inhalation therapy, especially in the paediatric population. This review describes the challenges that can be found dealing with patients suffering from cutaneous steam burns and/or steam inhalation injuries. A steam injury to the airways or the skin can be directly life-threatening and should be treated with caution. This type of injury can lead to acute respiratory insufficiency and sometimes death. A case of a male patient with extensive cutaneous steam burns and a steam inhalation injury who passed away after 11 days of treatment is also presented to illustrate this review.
Level of evidence: Level V, Therapeutic; Risk/Prognostic Study.
Kinder verletzen häufig ihre Hände. Dabei sind sowohl in der Erstversorgung als auch in der Nachbehandlung Kinderärzte gefragt. Die systematische Untersuchung der verletzten Kinderhand und die Therapie typischer Verletzungen ist allerdings nicht Bestandteil der pädiatrischen Ausbildung. Dieser Artikel soll diese Kenntnislücke schließen und sowohl Pädiatern als auch Berufseinsteigern in der Kinderchirurgie Techniken der Handuntersuchung bei Klein- und Schulkindern vermitteln.
Background:
This study aimed to assess the efficacy and safety of a single-stage procedure using single-layer Pelnac and defatted avulsed skin for the management of degloving injuries of the forearm and hand.
Methods:
This is a prospective study conducted from March 2013 to May 2017. A total of 15 consecutive patients with degloving injuries of the forearm and hand were treated with a single-stage procedure using single-layer Pelnac and defatted avulsed skin as a split-thickness skin graft. Post-operatively, scheduled follow-up was conducted.
Results:
The overall 'take' rate of the Pelnac dermal template and the skin graft was 85-100%. No infections, haematoma or seroma were observed during hospitalization and after discharge. At the final follow-up, patients' subjective satisfaction with the aesthetic appearance of the grafted areas was, on average, 71.0 (SD 8.0, range 55-92). The Vancouver Scar Scale value was 2.1 (SD 1.8, range 1.0-5.5), representing a good result. The response of 'normal or near normal' to the sensory recovery was obtained for 13 patients and 'slight loss' for two patients. The average Disabilities of the Arm, Shoulder and Hand score was 21.2 (SD 13.5, range 0-53), and most patients (14/15) regained the ability to perform the daily activities without pain or restriction by tissue adhesion.
Conclusion:
This single-stage procedure represents an effective technique for the management of degloving injuries of the forearm and hand and should be considered an alternative to other reconstructive procedures.
Kinder verletzen häufig ihre Hände. Während sich die Untersuchung bei Jugendlichen an der von Erwachsenen orientiert, ist die Situation bei Kleinkindern völlig unterschiedlich. Die systematische Untersuchung der verletzten Kinderhand und die Therapie typischer Verletzungen in der Erstversorgung als auch in der Nachbehandlung ist aber nicht selbstverständlich Teil der Ausbildung. Dieser Artikel vermittelt Techniken der Handuntersuchung speziell bei Klein- und Schulkindern.
This chapter deals with three unusual, yet potentially serious, injuries. Nail-gun injuries occur when pneumatic or combustion nailers fire a projectile (a nail) into the body. High-pressure injection injuries occur when an injector or sprayer delivers a liquid into the body, usually the fingers or hands. Wringer or roller injuries occur when a part of the body, usually the hand or arm, is crushed between rollers, leading to compressive-, frictional-, and shearing-type injuries. The authors describe the epidemiology, pathophysiology, diagnosis, and management of these types of injuries.
Injuries are responsible for much child and adolescent mortality in the world.
To study the effect of parental birth country on the risk of fatal unintentional injuries.
We established a cohort by linkages between Swedish national registers through personal identification number. The main variable was country of birth of parents. Children with both parents born in Sweden were the reference group. The cohort was followed up from the starting date of the study (1 January 1961) or date of birth, whichever occurred last, until the exit date, which was death due to unintentional injury, first emigration or end of the follow-up (31 December 2007), whichever came first. We calculated HRs with 95% CIs adjusted for age at exit, parental education and calendar period of birth by Cox proportional hazards models.
We found a significantly higher risk of fatal unintentional injuries among children with a foreign background than among native children. We found a higher risk of fatal transportation-related injuries and drowning among boys with a foreign background and a higher risk of fatal burns/fire and falls among girls with a foreign background than among same sex native children. We also found a higher risk of fatal unintentional injuries among children with a foreign background at older ages than among native children at the same ages.
Injury prevention work against unintentional injuries among children of foreign origin is more complex than that among native children. We recommend designing specific studies to find out the factors responsible and planning preventive interventions aiming at this particular group of children with a foreign background.
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.
From 1990 to 1996, 214 patients aged up to 6 years were treated at our inpatient burns unit. Ages ranged from 3 to 70 months. Scalding was the cause in 186 cases. The median size of the burned areas was 5.0% (range 0.5%-40%). One hundred and nine were deep dermal burns that required surgical treatment, but this was refused in seven instances. Duration of hospital stay was 11 days (2-45). The number of follow-up visits ranged from 0 to 17. Secondary reconstructions for scarring have been done for seven children so far. Ninety-eight (46%) came from immigrant families, mostly from the Middle East and the Balkans. Of the 186 scalded children, 94 (51 %) were immigrants, and they also had a tendency to have more severe injuries. Explanations might be that they were more likely to cook with water and oil, they were unfamiliar with Swedish safety standards and measures, and they had difficulty in communicating (language) and a limited social network. The ensuing scar also may disturb ordelay the child's adaptatio...
Injuries to children's hands with farm machinery, particularly tractors, are common in rural areas. We present 58 cases of hand injuries in children aged from 3 to 7 (mean 4.5), caused by the engine belts of agricultural vehicles, who were referred from the cities in Central Anatolia. The injury patterns among patients were similar. The injury generally starts from the middle phalanx of the third finger, crosses the proximal phalanx of the fourth finger and ends in the hypothenar region. The patients were categorised into five groups and treatment planned accordingly. The most commonly involved digit was the third finger and the thumb the least. Surgical treatment depended on the severity of the injury and included primary closure of the lacerations, tendon repair, fixation of fractures, grafting, and local flaps. Results of these injuries are generally poor, so prevention is more important.
The mechanism of upper extremity trauma in three patients from a round hay baler is analyzed in relation to previously described experimental models of wringer or roller injury. One patient sustained an avulsive injury with typical tearing of the soft tissues. Thermal insult from roller friction heat and the duration of exposure were significant factors determining the extent of tissue injury in the other two patients.
Injuries resulting from wringer washers are still fairly common around the world. Manufacturers' data regarding wringer washers are reported. The literature is reviewed, and 104 new pediatric cases seen between 1970 and 1980 at one pediatric institution are presented. These patients suffered a wide variety of injuries ranging from simple skin abrasions to loss of limbs. Skeletal, nerve, and tendon injuries were encountered. The recommended management stresses the importance of elevation and close observation with no emphasis on compression dressing.
From 1990 to 1996, 214 patients aged up to 6 years were treated at our inpatient burns unit. Ages ranged from 3 to 70 months. Scalding was the cause in 186 cases. The median size of the burned areas was 5.0% (range 0.5%-40%). One hundred and nine were deep dermal burns that required surgical treatment, but this was refused in seven instances. Duration of hospital stay was 11 days (2-45). The number of follow-up visits ranged from 0 to 17. Secondary reconstructions for scarring have been done for seven children so far. Ninety-eight (46%) came from immigrant families, mostly from the Middle East and the Balkans. Of the 186 scalded children, 94 (51%) were immigrants, and they also had a tendency to have more severe injuries. Explanations might be that they were more likely to cook with water and oil, they were unfamiliar with Swedish safety standards and measures, and they had difficulty in communicating (language) and a limited social network. The ensuing scar also may disturb or delay the child's adaptation to the new environment. Our preventive work is now based on a model that states that frequency, type, and severity of injury is dictated by the variables: risk, personality, supervision, and education.
Four hundred and fifty five young children (0-6 years old) were treated for hand injuries between 1996 and 2000. Boys (61%) were injured more often and a higher number of injuries occurred during May and September. Fingertip injuries were the most common injuries (37%), and were often caused by jamming in doors at home. Fractures were caused by falls and punches and tendon/nerve injuries by sharp objects. The incidence of hand injuries increased from 20.4/10,000/year in 1996 to 45.3/10,000/year in 2000. Only 4% of the children had complex injuries but these placed a high demand on resources. The incidence of injuries was not higher amongst children from immigrant families.
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
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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.
To analyse incidences and find risk groups in children hospitalized with hand injuries in a national retrospective study.
All children with a primary hand or forearm injury admitted to Swedish hospitals during 1987-2001 were retrieved from the Swedish Hospital Discharge Register and analysed as to incidence and characteristics.
Among 9855 children included, the median age was 7.0 y and two-thirds were boys. The incidence increased in both younger (0-6 y) and older (7-14 y) children. Wounds and fractures almost doubled, while muscle/tendon injuries decreased. In younger children, wounds and burns were the most frequent diagnoses. In older children, fractures and muscle/tendon injuries were common. Sharp objects caused most of the injuries. University hospitals treated almost half of the children.
The number of children with hand injuries admitted to hospitals in Sweden increased annually. Analyses of causes behind the increase are important to counter this trend.
Wringer arm. A report of 26 cases
- D W Maccollum