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Head Injury from Fan Blades Among Children

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Azmi Alias at Hospital Kuala Lumpur
Azmi Alias
Ravi Krishnapillai
Ravi Krishnapillai
Ravi Krishnapillai
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Hong Wah Teng
Hong Wah Teng
Hong Wah Teng
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Ahmad Zubaidi a Latif at Sultan Zainal Abidin University
Ahmad Zubaidi a Latif
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Abstract and Figures

Head injury caused by fan blades is rare among children. We analysed 14 cases of such injury and discuss the causes, type of injury and preventive measures. A retrospective analysis of 14 cases of children who were admitted to the Pediatric Neurosurgical Unit of Hospital Kuala Lumpur after sustaining head injuries caused by fan blades between January 2000 and December 2002 was performed. The causes of fan-blade head injury included jumping on the upper bunk of a bunk-bed, climbing on a ladder, climbing up onto a table, and being lifted by an adult. Thirteen patients were injured by ceiling fans and one by falling onto an uncovered table fan. School-aged boys were the predominant victims. Mean patient age was 7.9 years (range, 1.0-12.2 years). There was a twin peak incidence of when the accidents occurred: just before lunch in the afternoon and bedtime at night. The types of injury were scalp lacerations, compound depressed fractures and multiple intracranial haemorrhages. Two patients had the complication of wound infection, and one of these patients developed cerebral spinal fluid leak. One patient died from severe head injuries. Safety awareness among parents and caretakers are important as fan-blade head injury among children is preventable.
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168 ASIAN JOURNAL OF SURGERY VOL 28 • NO 3 • JULY 2005
070/2001
Original Article
© 2005 Elsevier. All rights reserved.
Introduction
The home can be a dangerous place for children; they spend
most of their time there and it is where most accidents happen.
Over 1 million children in the United Kingdom are injured in
accidents at home every year,
1
of which the majority can be
prevented.
Head injury from fan blades is rare among children and
limited data are available in the literature. A retrospective
analysis involving 14 cases of head injury caused by fan blades
among children who presented to our institute was carried
out. The causes, type of injury and preventive measures are
discussed.
Head Injury from Fan Blades Among Children
Patients and methods
We conducted a retrospective analysis of 14 children who
sustained head injuries caused by fan blades between January
2000 and December 2002. The patients’ clinical notes, com-
puted tomography (CT) brain scans, and operative records
were analysed.
Results
A total of 14 children were included, of whom 10 were boys
(71.4%) and four were girls (28.6%). Mean age was 7.9 years
(range, 1–12.2 years). Among the ethnic groups, Malays were
Azmi Alias, Ravi Krishnapillai, Hong Wah Teng, Ahmad Zubaidi Abd Latif and Johari Siregar Adnan, Department
of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
OBJECTIVE: Head injury caused by fan blades is rare among children. We analysed 14 cases of such injury and
discuss the causes, type of injury and preventive measures.
METHODS: A retrospective analysis of 14 cases of children who were admitted to the Pediatric Neurosurgical
Unit of Hospital Kuala Lumpur after sustaining head injuries caused by fan blades between January 2000 and
December 2002 was performed.
RESULTS: The causes of fan-blade head injury included jumping on the upper bunk of a bunk-bed, climbing on
a ladder, climbing up onto a table, and being lifted by an adult. Thirteen patients were injured by ceiling fans and
one by falling onto an uncovered table fan. School-aged boys were the predominant victims. Mean patient age was
7.9 years (range, 1.0–12.2 years). There was a twin peak incidence of when the accidents occurred: just before lunch
in the afternoon and bedtime at night. The types of injury were scalp lacerations, compound depressed fractures
and multiple intracranial haemorrhages. Two patients had the complication of wound infection, and one of these
patients developed cerebral spinal fluid leak. One patient died from severe head injuries.
CONCLUSION: Safety awareness among parents and caretakers are important as fan-blade head injury among
children is preventable. [Asian J Surg 2005;28(3):168–70]
Key Words: children, fan blade, head injury
Address correspondence and reprint requests to Dr. Azmi Alias, Department of Neurosurgery, Hospital Kuala
Lumpur, Kuala Lumpur 50586, Malaysia.
E-mail: azmidr@hotmail.com • Date of acceptance: 27 May 2004
ASIAN JOURNAL OF SURGERY VOL 28 • NO 3 • JULY 2005 169
070/2001
■ FAN-BLADE HEAD INJURY ■
predominant (71.4%), followed by Indians (21.4%) and
Chinese (7.1%). There was a twin peak incidence of when
the accidents occurred: prior to lunch in the afternoon and
bedtime at night. The causes of fan-blade head injury are
shown in Table 1. Thirteen patients were injured by spinning
ceiling fans, and one was injured after falling onto an uncov-
ered spinning table fan. Most had right-sided head injuries
(79%) involving the frontal region (57%). All patients had scalp
lacerations, with wound length ranging from 3 cm to 6 cm.
The types of head injuries sustained are shown in Table 2.
Nine patients underwent toilet and suturing under local
anaesthesia. Four patients required wound debridement and
elevation of depressed fracture under general anaesthesia, one
had craniectomy and evacuation of blood clots. Two patients
(14.3%) had the complication of wound infection, and one of
these patients developed cerebral spinal fluid leak. Both were
treated conservatively with local dressings and antibiotics.
One patient (7.1%) died from severe head injuries. This 6-year-
old boy was accidentally hit by a spinning ceiling fan while
playing with siblings on the upper bunk of a bunk-bed. He
sustained a compound depressed fracture of the right frontal
bone with underlying intracerebral, subdural and extradural
haemorrhage. He was brought to the hospital with a Glasgow
coma scale score of 5/15. An emergency craniectomy and
evacuation of blood clots were performed, but he died 4 days
later.
Mean hospital stay was 5 days (range, 2–14 days). The
duration of follow-up ranged from 2 to 12 weeks, with a mean
of 4 weeks.
Discussion
Physical interaction and recreational activities are essen-
tial components of healthy development in children. How-
ever, inappropriate playgrounds can result in unintentional
injuries. Bunk-beds are convenient and favoured by many
parents, especially when living in an environment of limited
space. Ceiling fans are commonly used as alternatives to
air-conditioners because they are relatively cheap and easy to
maintain.
Activities such as playing and jumping on bunk-beds can
be dangerous, especially when the bed is placed near a ceiling
fan. Children can fall from a height or get hit by the spinning
blades of a ceiling fan. Various injuries can occur following
falls from the upper bunk of bunk-beds, such as head injury,
multiple broken bones and soft tissue injury.
2
However, re-
ported cases in the literature on head injury caused by spin-
ning fan blades are limited.
3–5
Activities such as carrying a
child on one’s shoulders, lifting up a child by an adult, a child
climbing on a ladder or onto a table or school desk can bring
children within the reach of ceiling fans.
The causes of fan-blade head injury in this series were
potentially preventable. Although the majority of patients
recovered uneventfully, one patient died from severe head
injuries and two had complications of wound infection.
A fan blade is a relatively blunt object, but can become an
effective cutting edge as the fan rotates, resulting in high-
velocity penetrating injuries with potential hazards to the
skull and brain. The severity of injury depends much on the
speed of the rotating fan and the mechanism of the child’s fall.
This, however, was not observed in this series. Boys outnum-
bered girls as, by nature, they are more frequently involved in
physical activities. Most of the accidents occurred when the
children were playing without the presence of supervisory
adults.
As a preventive measure, bunk-beds or other high furni-
ture should be placed at a distance away from a ceiling fan. Air-
conditioners should be considered as an alternative. Small
children should not be allowed to sleep or play on the upper
bunk of a bunk-bed. Lifting up small children high above one’s
head or leaving a spinning table fan uncovered is asking for
Table 1. Causes of fan-blade head injury
Cause n (%)
Ceiling fan injury
Jumping on the upper bunk of a bunk-bed 8 (57.1)
Climbing on a ladder 2 (14.3)
Lifted by an adult 2 (14.3)
Climbing up onto a table 1 (7.1)0
Table fan injury
Falling onto an uncovered table fan 1 (7.1)0
Table 2. Types of head injuries sustained
Injury n (%)
Compound linear fracture 4 (28.6)
Compound depressed fracture 3 (21.4)
Compound depressed fracture with 3 (21.4)
pneumocranium
Extradural haemorrhage 3 (21.4)
Multiple intracranial haemorrhage 1 (7.1)0
170 ASIAN JOURNAL OF SURGERY VOL 28 • NO 3 • JULY 2005
070/20
■ ALIAS et al ■
trouble. Children can be injured by the fan blades if they fall
against the fan or touch it.
It is the responsibility of adults to create play environ-
ments that are challenging for children but also safe. Using
age-appropriate equipment, maintaining home safety, limit-
ing equipment height, increasing safety awareness, combined
with adult supervision, can greatly reduce the incidence and
severity of injuries.
Conclusion
Fan blades are potential hazards that can cause, some-
times fatal, head injury. However, such injury is preventable.
Accidents are often the result of ignorance and carelessness.
By increasing safety awareness, the majority of accidents in
the home can be prevented.
References
1. Consumer Safety Unit. Home Accident Surveillance System, 19
th
Annual
Report. London: Department of Trade and Industry, 1995.
2. Macgregor DM. Injuries associated with falls from beds. Inj Prev
2000;6:291–2.
3. Bouckaert MM. Fan blade injury. S Afr Med J 1999;89:837–9.
4. de Villa GH, Nicholoff TJ Jr. Fan blade injury of the face. J Philipp
Dent Assoc 1998;50:32–5.
5. Sedhom AW, Leathers RD, Belton MJ, Ghobrial G. Fan blade injury
to the maxillofacial region: a case report. J Oral Maxillofac Surg 1998;
56:98–100.
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