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Hospitalized Swedish children with hand and forearm injuries: A retrospective review
Abstract
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.
... The most frequent injury among children, caused by jamming indoors, is a fingertip and nail bed injury with or without fracture. Recent research reports a substantial increase in incidence of children admitted with hand and forearm injuries in Sweden 1987–2001 [1,2] . The reasons for the increase are unknown. ...
... Our idea is that if injuries are to be prevented, the injury mechanisms behind different common or severe diagnoses must be identified. With experience from our earlier studies [1,2,15], we have created seven case categories, typical for hand and forearm injuries in children. In this study we quantify how much these different cases cost in relation to each other. ...
... Bar plot of health-care cost (EUR) by type of case, sorted by total costs for all patients Our data covered a seven year long time period, and we found that length of stay has varied over time with a possible long-term downward trend (Fig 1) in spite of an increased incidence of hand and forearm injuries [1,2]. In particular, there was a dip in 1998–2000 for patients from the town of Malmö and in 1999 for patients from other parts of the region of Skåne. ...
Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996-2003.
Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed.
Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days.
The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.
... Some common findings can be deduced from several large scale studies [2,[6][7][8]. Usually boys are more prone to injury than girls, injuries most commonly occur in the home, and the maleto-female ratio increased with increasing age. However, different details were reported in different countries and environments. ...
... 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.
... Traumemekanismen er overvejende fald og klemskader eller sammenstød med nogen eller noget. Størstedelen af de paediatriske metakarpalfrakturer sker hos børn i aldersgruppen 13-16 år [10,11]. Frakturer i hånden hos børn kan pga. ...
Metacarpal fractures are common. Stable, extra-articular fractures can often be treated non-operatively with or without closed reduction, splinting and then mobilisation with buddy taping. Unstable or displaced extra-articular fractures, where adequate reduction cannot be maintained, and most intra-articular fractures require osteosynthesis. The goal for any treatment is early mobilisation. Intra-articular fractures, open fractures and certain paediatric fractures can lead to poor functional outcome; hence, referral to a hand surgeon is recommended in this review.
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.
Objective: The motor development of the upper extremity and hand is actually a result of learning the intentional and fine motions in correlation with the physical growth, central nervous system differentiation and acquired cognitive abilities which are gained in early childhood. Therefore, such hand injuries in early ages may impair the process as whole. We aimed to investigate the epidemiology, etiology and the treatment outcomes in very young patients suffering from the hand injuries in this study. Material and Methods: A retrospective investigation of records of 507 patients, who admitted to our emergency department at last five years, between 0-6 years of age were analyzed according to etiology, the type of injury, anatomical localization of the injury, treatment approach and outcome. Results: Most of the hand injuries were simple injuries (75.3%) and occured at home (72.6%). The most frequent cause of injuries was contusion (55%) and most frequent injuried site of the hand was detected as finger. Female to male ratio was 1:1.5 and right hand to left hand ratio was 2:1. Conclusion: The hand injuries in the very young population seems to be common and the investigation of the etiology and type of occurrence might give us new and better modalities in preventing such injuries.
Hand trauma in children is common, but often inadequately assessed and treated. The types of injury vary with age depending on the pattern of hand use. Assessment of the injury, particularly in the younger child, can be difficult, given the inability or reluctance of the child to co-operate, both in providing a history and allowing an examination of the injured hand. The established principles of treatment for hand trauma, detailed elsewhere in this text, apply equally to children, but the healing and growth potential of the child has specific implications for management. The management plan also has to take into account the varying capacity of the child for co-operation with active rehabilitation programmes.
Ninety-six children aged 0-6 years with unintentional hand injuries were referred to the Department of Hand Surgery between 2002 and 2003. Either parents, medical staff, or both, completed a questionnaire (response rate 79/96; 82%) about the circumstances of the injury. The incidence of injuries referred for treatment was 33.4/10,000 people/year. Seventy-five percent (59/79) of all injuries occurred at home, and only 8% (6/79) in a day-care centre. The risk was highest between 4 p.m. and 8 p.m. (incidence rate ratio 5.17, 95% confidence interval 2.12 to 17.7) and in 6 year old children (IRR 4.89, 95% CI 1.58 to 37.68). Adults were present when 66/79 children (84%) were injured. Most injuries occurred during play (39/79; 49%). Stuck in front doors (23/79; 29%) (closed by a child) was common. There was no increase in incidence in children with a foreign background (IRR 1.19, 95% CI 0.64 to 2.28). Advice about prevention will be distributed to parents to encourage safer environments in homes.
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.
The incidence of fractures in children in the city of Malmö, Sweden, almost doubled between 1950 and 1979. To see whether a further increase had occurred, we carried out an epidemiological analysis of fractures among children 0–16 years in Malmö 1993–1994. During the study period, 1,673 fractures occurred in 1,610 children. The commonest fracture location was the distal forearm (26%), followed by the phalanges of the hand (16%) and the clavicle (9%). The annual fracture incidence was 235/104 in boys, 149/104 in girls and 193/104 for both genders. This means a decrease in the annual fracture incidence by 9% since 1975–1979. The decrease was not associated with any specific type of fracture or etiological factor. Fractures of the distal forearm among girls were an exception to the general decline, having increased by one third since 1975–1979, which might be explained by the fact that today girls participate to a greater extent in the same sports as boys.
To evaluate the outcome of the World Health Organization (WHO) Safe Community model with respect to child injuries.
A population based quasiexperimental design was used. Cross sectional pre-implementation and post-implementation data were collected in intervention (Motala municipality) and control (Mjölby municipality) areas, both in Ostergötland county, Sweden.
The total relative risk of child injury in the intervention community decreased more (odds ratio 0.74; 95% confidence interval (CI) 0.68 to 0.81) than in a control community exposed only to national level injury prevention programs (0.93; 95% CI 0.82 to 1.05). The relative risk of moderately (abbreviated injury scale (AIS) 2) severe injury in the study area was reduced to almost a half (odds ratio 0.49; 95% Cl 0.41 to 0.57), whereas the risk of minor (AIS 1) injuries decreased only slightly (odds ratio 0.89; 95% CI 0.80 to 0.99). The risk of severe or fatal (AIS 3-6) injuries remained constant.
After introduction of an injury prevention program based on the WHO Safe Community model, the relative risk for child injury in the intervention community decreased significantly more than in a control community exposed only to national injury prevention programs.
Study objective: To study municipal variations in children’s injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome. Design: A cohort study based on individual data on children’s consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child’s mother. Municipal characteristics—that is, population density and municipal safety measures—were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression. Setting: Twenty five municipalities in Stockholm County in Sweden were studied. Participants: Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years. Main results: Municipality injury rates varied between 3.84–7.69 per 1000 person years among 1–6 year olds and, between 0.86–6.18 among 7–15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children. Conclusions: This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.
Three studies on childhood accidents are presented. The aim was to study the importance of different factors regarding the accidents in question. The following factors have then been taken into consideration: the enviromental hazard, the accident proneness, the supervision and the education. Methodologically the investigations were carried out with an epidemiological technique. One is of a descriptive nature and the other two more analytically oriented. The studies are based on two different 1-year-materials consisting of accidents among children recorded in the emergency departments of Ostersund Hospital and the University Hospital in Uppsala. The results indicate that risk factors in the children's physical milieu played an important role in the occurrence of the accidents: clearly identifiable risk factors in the environment could be connected with 52% of the accidents, whereas some deficiency in supervision was noted in 20%. The investigators could identify a number of specific risk factors. Attempts were made to examine how frequency and type of childhood accidents vary with the population structure and social structure in well-defined housing areas, but the results were hard to evaluate because of methodological problems. The results are presented against the background of a detailed discussion on central methodological problems in epidemiological accident research. It is pointed out in particular that epidemiological methods have clear limitations in attempts at studying the low-frequency events that each individual type of accident in fact comprises. It is of great importance that in future research, side by side with the traditional epidemiological methods, other techniques are tested with the aim of obtaining maximal usable information from a detailed study of individual accidents and their backgrounds.
Three pediatric hand injury subtypes and their management have been presented. Finger tip injuries, while often minor and self-healing in children, may require surgical repair if the nailbed is disrupted or if there has been significant skin or pad loss from the tip. The decision between local repair and skin graft or pedicle reconstruction depends on the nature and extent of the injury. Multiple digit injuries should be carefully evaluated and manged with a view toward retention of digit length and restoration of function. Immediate closure of all wounds, while desirable, is not necessary. Minor hand burns are quite easily managed but burn injuries more severe in extent and/or depth must be treated with careful attention to detail. Splinting and elevation of the hand, early incisional decompression, the institution of early and diligent active motion and expeditious wound closure with skin grafts where full thickness loss has occurred will hasten the time of healing, minimize deformity and assist in the recovery of normal hand function.
This paper documents hand injuries in the paediatric population presenting to a Paediatric Accident and Emergency Department over a two month period. Unlike other childhood accidents, they showed no marked male preponderance, nor age pattern. While most injuries were relatively minor and were able to be managed in the Accident and Emergency Department, a small minority were referred for specialist treatment.
Why does Sweden have the lowest childhood injury rate of any country in the world? The answer lies in a combination of factors including the special characteristics of Swedish society and an energetic 35-year campaign. Contributing societal characteristics are a small, relatively homogeneous, health conscious, law-abiding population that values children. Key factors in the campaign have been support of trauma surveillance systems and injury prevention research, ensuring safer environments and products through legislation and regulation, and a broad-based safety education campaign using coalitions of existing groups. Emulating the strategies used in the Swedish campaign would markedly reduce the number of US children killed, injured, and disabled from trauma.
The incidence and pattern of hand fractures occurring in children living in Nottingham has been reviewed. The hand is the second commonest site of fracture in children. The incidence is low in infants, but rises steeply after the age of eight, especially in boys. The most common site is the proximal phalanx. The little finger/fifth metacarpal is the most vulnerable area, especially around the metacarpophalangeal joint. Greenstick fractures are more common in metacarpals, while epiphyseal injuries predominate in the phalanges. Over 45% of fractures occurred either at sport or in a fight. Aetiological factors are discussed in relation to the fracture patterns described.
A retrospective review of 354 pediatric hand fractures was performed with a minimum follow-up period of two years. The incidence of epiphyseal injury was 34% higher than reported elsewhere in the skeleton. Growth disturbance was extremely rare, occurring only in two patients with severe crush injury and infection. Fracture displacement was most common in the border digits with displacement within a given digit most common in the metacarpal; the next most common were the proximal phalanx and distal phalanges; the least common was the middle phalanx. Malunion most often was associated with failure to obtain adequate true lateral and anteroposterior roentgenograms of the individual digits, failure to evaluate postreduction alignment in a position of full finger flexion, and was based on an erroneous assumption that a growth would correct for deficient reduction. Although nondisplaced intra-articular fractures uniformly healed without malfunction, poor functional results were obtained from displaced intra-articular fractures. The following injuries presented particular problems: displaced intra-articular fractures, Salter I distal phalangeal fractures due to crushing injuries, displaced subcondylar fractures, and open fractures.
A review of twenty-two children with a mean age of 1.9 +/- 0.3 years who sustained injuries to the fingers and hand by domestic mincer machine. In each case the child inserted his hand in the machine while in motion. The pattern of injury is discussed and recommendations to avoid these mutilating injuries are made.
Age, sex, type of fracture and the circumstances causing the injury were studied in altogether 8,682 fractures in children, aged 0 - 16, which had occurred 1950, 1955, 1960, 1965, 1970 and 1975 - 1979. For studies of incidence, the years 1975 - 1979 were chosen and for secular trend studies 1950, 1955, 1960, 1965, 1970 and 1975 - 1979. The following conclusions may be drawn: 1. The risk of fracture increased with age up to age 11 - 12 in girls and 13 - 14 in boys. 2. The accumulated risk of fracture was 27 per cent in girls and 42 per cent in boys. 3. Fractures were more common in boys of all age groups. 4. Over the last three decades the risk of fracture was doubled in boys as well as in girls. 5. Over the years more and more fractures were caused by slight trauma whereas the more severe trauma - even if increasing somewhat in risk - contributed a smaller fraction of the injuries. 6. For the various types of fracture the pattern of change could differ - some increased in incidence, whereas some remained unchanged or even decreased. 7. All types of trauma - horse riding accidents excluded - were more frequent in boys. 8. The most commonly fractured region was the distal end of the forearm followed by the phalanges of the hand and the bones of the carpal-metacarpal region. 9. Playing, sports and traffic, in that order contributed 24, 21 and 12 per cent of those fractures in which the circumstances of the accident could be analysed. 10. Traffic accidents increased with one third in boys as well as in girls. 11. The passive participants in traffic - pedestrians and passengers in motor vehicles - were not more frequently injured during the latter part of the period under observation - a tendency of increase in girls was compensated for by a decrease in boys. 12. Sports and various playing activities as a cause of fracture increased with a factor of five. 13. In the upper limb, the left side was most frequently fractured. 14. The occurrence of fractures varied with the seasons with peak values in May and August and low values in July and December. 15. No fracture type in children could completely meet the criteria of a fragility fracture such as seen in old age. 16. Sustaining one fracture carried an increased risk of an additional fracture especially in the very young children. 17. Fractures not requiring reduction increased the most over the years. 18. The subset of children with various diseases suspected to interfere with skeletal development carried an increased risk of fracture. 19. Some age-related fracture patterns could be traced but they were not very distinct.
Injury is our children's greatest health problem, and pediatricians will frequently see finger and hand injuries in the office and emergency room. Many of these will be fingertip crush injuries, which are quite common in toddlers and are often undertreated. Pediatric finger and wrist fractures and sprains generally do well but require proper diagnosis and treatment. Innocent-looking wounds from glass lacerations may disguise extensive damage to underlying nerves, arteries, and tendons. Advances in microsurgery allow replantation of distal amputations even in young children and infants, although often not without complications. Thermal injuries and animal bites require early and aggressive treatment. As with many pediatric hand injuries, these injuries should be preventable, and the adverse consequences can be minimized with appropriate diagnosis and management.
To study the epidemiology of pediatric hand injuries.
Retrospective chart review.
Emergency department of a children's hospital.
All patients with a final diagnosis of hand injury from July through December 1989.
None.
Four hundred sixty-four patients (287 boys and 177 girls; median age, 10 years) with a total of 477 hand injuries were enrolled in the study. The most common types of injuries were lacerations (38.1%), soft tissue injuries (28.7%), and fractures (19.3%) and sprains (8%); most (60.8%) were sustained at home. Children with lacerations and burns were significantly younger than those with other types of hand injuries (P < .0001). Children with fractures, sprains, and sports injuries were significantly older than those with other types of hand injuries (P < .001). The fifth finger was the most commonly fractured digit (37%), and the fifth metacarpal was the most commonly fractured bone (P < .01). Boys were more likely than girls to sustain sports-related injuries (P < .05) and hand injuries resulting from first fights (P < .01). More hand injuries were associated with football than with any other organized sport (P < .01). All but 16 children (3.4%) were managed as outpatients.
Hand trauma accounts for a significant number of pediatric ED visits. Physicians caring for children in the ED setting must be prepared to manage a wide spectrum of pediatric hand injuries.
This is a 5-year retrospective review of hand injuries caused by exercise bicycles among 34 children.
Mean age was 3 years and 5 months. Accidents were caused most commonly by impingement of the fingers between the chain and sprocket wheel (77%), but injuries caused by spinning wheel spokes (23%) were generally more severe. Injuries were usually of the avulsion type and ranged in severity from lacerations (43%) to fractures (19%) to amputations (38%). The central digits (87%) were involved more frequently than the border digits (13%). Replantation was possible for 33% of the amputated digits, with 50% of the fingers surviving.
The avulsive nature of these injuries should be taken into consideration when attempting replantation. Increased community awareness and equipment safety modifications are needed to eliminate this preventable problem.
Fingertip and nailbed trauma caused by doors is common in children, occurring when fingers are either shut in the door itself or are trapped in the hinge as the door is closed. An audit was carried out over five months of all fingertip and nailbed injuries due to trauma from a door. One hundred and eighty eight children, 2% of all attendances in this period, had sustained such trauma, 39% of these occurring in children under four years of age. One hundred and forty seven children (75%) had sustained relatively minor soft-tissue injury to the finger, However the remaining forty seven (25%) of the injuries sustained were more serious e.g. Avulsion of the nail from the nailbed or amputation of part of the fingertip and 29 (15%) of all the cases required a general anaesthetic for exploration, cleaning and repair. The Plastic Surgery department followed up these 29 children and 71 Accident & Emergency follow-up appointments were generated by the remaining injuries. The incidence of significant injury was higher than expected and caused considerable distress to both the children and their parents, It is suggested that home safety protocols should feature advice on how to avoid these injuries.
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.
To characterize the injury pattern and economic impact of major pediatric hand trauma secondary to fireworks.
Retrospective.
Pediatric Level I trauma center.
N/A MAIN OUTCOME MEASUREMENTS: Fractures, amputations, soft tissue defects, length of hospitalization, number and type of procedures performed were obtained from charts, radiographs, and operative reports. Hospital charges were obtained from the billing office.
Records of patients with a diagnosis of fireworks-related injuries admitted over a period of ten years were reviewed. Twenty-two patients were identified to have sustained twenty-two hand injuries. The group consisted of nineteen boys and three girls, with an average age of 9.3 years (range, 4 to 17 years).
There were thirty-one fractures, nineteen amputations, and one dislocation. The nineteen amputations occurred in nine hands. Local skin graft or flap coverage was required in six hands acutely, and delayed soft tissue procedures were performed on four hands. Four hands had digital neurovascular injuries; two required microsurgical repairs at the time of injury, and two were irreparable. Resource use included: average hospital stay of 4.3 days (range, 0 to 20), average number of trips to the operating room, 1.2 (range, 0 to 3), and average hospital charges of 1,035 to $39,489).
This study illustrates the severity of pediatric hand injuries associated with fireworks and the significant burden placed on medical resources in treating these injuries. Efforts toward public education and legislative reforms may help to prevent these unnecessary injuries.
Contact with hot oven doors is an important cause of burns in pediatric patients. These burns are of particular concern because of their frequent localization to the hands, with the resulting negative implications for financial cost, long-term cosmesis, and hand function. A 5-year review of pediatric oven door burn cases admitted to a burn referral center was conducted. Of the 14 cases identified, the median age was 12 months. The median total body surface area (TBSA) was 1.75% (range, 0.5%-4.5%). Twelve of 14 cases involved 1 or both hands. The median length of hospital stay was 10 days. In 7 cases, burns were sustained from contact to an external surface of the oven. Based on the results obtained, we propose several prevention strategies.
Over a seven-year period, 136 children and adolescents with hand injuries were prospectively studied at the Accident and Emergency Department of Asir Central Hospital, Abha, Kingdom of Saudi Ara bia, to determine the pattern of hand injury.
The male:female ratio was 1.7:1.0, both left and right hands were relatively equally injured. The age group ranged from two months to 16 years (average 5.3 years). The finger most commonly injured was the middle finger (24.6%) followed by the index finger (18.7%). The most common type of hand injury was crush injuries caused by doors at home (52.2%), heavy objects (6.6%) and injuries caused by grinding machines (6.6%).
Since youngsters are often unaware of the dangers in their environment it is necessary to redesign the doors of our homes with safety devices to prevent injuries. Application of hydraulic auto matic door closures is a simple but useful way of ensuring smooth and safe closing of doors in homes.
To identify the incidence, causes, and details of hand fractures in children.
A retrospective chart review.
Records of children under 16 years of age who had sustained a hand fracture within the last 5 years were collected from the patient population of British Columbia's Children's Hospital. A total of 242 hand fractures in 232 patients were documented. These patients were reviewed for age at time of injury, gender, location of the incident, mechanism of injury, number of radiographs taken, and fracture specifics. Radiographs with obscure details or incomplete folders were excluded.
The patients consisted of 57 (24.6%) females and 175 (75.4%) males, with a mean age of 11.1 +/- 3.3 years. Incidence was low in early childhood but rose sharply after age 9 and peaked at 12 years of age. Sporting activities were the most common cause in both sexes. The fifth metacarpal was the most frequently involved bone (21.1% of total). Nonepiphyseal fractures accounted for 60.2% of the fractures, and the remaining 39.8% were epiphyseal fractures, predominantly Salter-Harris type II (90.4%). Fractures with comminution, severe displacement, intraarticular involvement, and condylar involvement were seen in 12.4%, 12.4%, 20.5%, and 15.1%, respectively. An average of 4.2 radiographs were taken per patient.
Almost all fractures healed in 2 to 3 weeks with excellent functional outcome. Knowledge of epidemiology and etiology of hand fractures can serve as an essential first step in devising strategies to reduce the incidence of these hand injuries. It is hoped that studies such as the present study may serve as a first step in planning measures to reduce the occurrence of hand fractures.
The purpose of this study was to estimate the frequency and describe the epidemiology of hand and forearm fractures in the United States. We extracted cases with ICD-9-CM diagnostic codes of 813.0 to 817.1 from the 1998 National Hospital Ambulatory Medical Care Survey. In 1998 there were 1,465,874 estimated cases of hand/forearm fractures, accounting for 1.5% of all emergency department cases. Radius and/or ulna fractures comprised the largest proportion of fractures (44%). The most affected age group was 5 to 14 years of age (26%). Private insurance paid for 49% of the cases. Most of the fractures occurred at home (30%); the street/highway was the second most likely fracture location (14%). Accidental falls caused the majority (47%) of fractures. Large database analysis provides important information that can be used to target interventions toward vulnerable populations and to allocate adequate resources for treating upper extremity fractures.
Hands are frequently injured in children. To date, the literature has focused on the type and treatment of hand injuries. This study examines the epidemiology of hand and fingertip injuries in children who present to an emergency department (ED).
Retrospective chart review.
Pediatric emergency center of an urban ED.
All patients over a period of 8 months who presented with a chief complaint of hand injury.
A total of 17,859 charts were reviewed during the study period; 382 patients were enrolled in the study (male preponderance of 1.4:1; median age, 10 y).
The most frequent injury setting was outdoors (47%). The most frequent injuries were lacerations (30%), followed by fractures (16%). Only five patients required hospitalization (1.3%). The digits are the most commonly injured part of the hand, particularly the thumb (19%). Fingertips are involved in 21% of cases. Radiographs and consultations were obtained in 64% and 16% of cases, respectively. Infection occurred in 14 (3.7%) patients.
Hand injuries occur in a bimodal distribution in children. Children younger than 2 years suffered fingertip injuries in the home, and children aged 12 to 16 years suffered hand injuries. Sports injuries tend to present late and are the most common cause of hand fractures.
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.
To identify, over a period of 12 months, all attendances at an accident and emergency department by children over the age of 5 years with an injury to a wrist, hand, or finger, and to examine those sustained as a result of a blow from a ball.
The case notes of all children aged 6-13 years attending the Accident and Emergency Department of the Royal Aberdeen Children's Hospital in the year 2001 as a result of a wrist, hand, or finger injury sustained from a blow by a ball were reviewed, and the cause, type, and severity of the injury noted.
A total of 187 children were identified; 69% were boys and football was the main sport involved. Most (93%) were radiographed, and 40% were positive; most fractures were sustained outwith school. Hand dominance was not significant.
These injuries are common and may be preventable with modification of rules, equipment, and coaching. A register of youth sporting injuries may show if there are any detrimental long term effects.
To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome.
A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression.
Twenty five municipalities in Stockholm County in Sweden were studied.
Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years.
Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children.
This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.
Little is known about the magnitude of hand injuries at national levels. This paper quantifies and characterises the incidence of hand injuries that require acute medical attention at Emergency Departments in The Netherlands and Denmark. Except for the incidence rate and the referral after treatment, the overall picture of hand injuries is similar for both countries: hand injuries show a peak for teenagers, result mainly from home and leisure accidents, are mainly caused by objects and falls, the majority affect fingers and result mainly in superficial injuries, open wounds and fractures, a small proportion of the victims is admitted into hospital. We conclude that hand injuries are a real burden to society and are worthwhile to be prevented with special attention for home and leisure accidents and occupational accidents. Data recording on the backgrounds of accidents and their long term consequences should be improved.
Risks for and causes of hand and forearm injury: a study of children 0 to 6 years old
- Steen Ljungberge
- Dahlinlb Carlssonk
- Doraiswamy NV