Download PDF
Z Orthop Unfall 2020; 158(03): 298-303
DOI: 10.1055/a-0965-7542
Original Article

The Importance of Primary Reconstruction in the Treatment of Blast Related Hand Injuries During Childhood

Die Bedeutung der primären Rekonstruktion bei der Behandlung von Handverletzungen durch Sprengkörper im Kindesalter
Nado Bukvic
1   Department of Pediatric Surgery, Clinical Hospital Center, Rijeka, Croatia
,
Suzana Srsen Medancic
1   Department of Pediatric Surgery, Clinical Hospital Center, Rijeka, Croatia
,
Harry Nikolic
1   Department of Pediatric Surgery, Clinical Hospital Center, Rijeka, Croatia
,
Ana Bosak Veršic
1   Department of Pediatric Surgery, Clinical Hospital Center, Rijeka, Croatia
,
Frane Bukvic
2   Department of Orthopaedic Surgery, Clinical Hospital Sveti Duh, Zagreb, Croatia
,
Nadomir Gusic
3   Department of Surgery, General Hospital, Pula, Croatia
,
Marin Marinovic
4   Department of Surgery, Clinical Hospital Center, Rijeka, Croatia
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Introduction Blast injuries are common during wartime but are also related to various holiday festivals worldwide. Despite strict legislations, these devices still cause serious injuries leaving permanent disabilities. Children are affected in numerous cases with the hand being the most affected body region. The aim of our study was to profile the blast related hand injuries and to review treatment modalities that we used.

Methods A retrospective study of patients treated for blast-devices related hand injuries between 2006 and 2015 was performed.

Results 112 patient with blast related hand injuries were treated in our department during the 10-year period. Most of the patients were male. The dominant hand was injured in 83.9% of the patients. Associated injuries were observed in 14.3% of patients. 90 children were treated on an out-patient basis, mostly due to hand burns (86.7%) or uncomplicated blast injuries (13.3%). 22 children required hospitalization due to severe blast and crush injuries and amputations. Surgery was carried out as the urgent procedure and involved debridement with primary repair. In the case of amputations debridement and sufficient skin ensuring complete wound coverage was the procedure of choice.

Conclusion Blast related injuries of the hand during childhood are frequent and can cause different and complex defects. Besides prevention of these injuries, primary reconstruction of the affected hand is of outmost importance in preventing long-term consequences.

Zusammenfassung

Einleitung Verletzungen durch Sprengkörper sind während Kriegszeiten üblich, können aber auch bei verschiedenen Gelegenheiten weltweit auftreten. Trotz strenger Gesetzgebung verursachen Sprengkörper immer noch ernsthafte Verletzungen, die dauerhafte Behinderungen nach sich ziehen. In zahlreichen Fällen sind Kinder betroffen, wobei die Hand die am stärksten betroffene Körperregion ist. Das Ziel unserer Studie ist es, die explosionsbedingten Handverletzungen zu beschreiben und die von uns angewendeten Behandlungsmodalitäten zu beurteilen.

Methoden Über die zwischen 2006 und 2015 wegen Handverletzungen durch Sprengkörper behandelten Patienten wurde eine retrospektive Studie durchgeführt.

Ergebnisse 112 Patienten mit Handverletzungen durch Sprengkörper wurden in dieser Zeit in unserer Klinik behandelt. Die meisten Patienten waren männlich. Bei 83,9% der Patienten war die dominante Hand verletzt. Die damit verbundenen Verletzungen wurden bei 14,3% der Patienten festgestellt. 90 Kinder wurden aufgrund von Handverbrennungen (86,7%) oder unkomplizierten Explosionstraumata (13,3%) ambulant behandelt. 22 Kinder mussten wegen schweren Explosions- und Quetschverletzungen sowie Amputationen hospitalisiert werden. Diese Kinder wurden notoperiert, wobei eine Wundausschneidung mit primärer Wiederherstellung vorgenommen wurde. Bei der Amputation wurde sichergestellt, dass ausreichend Haut zur Abdeckung zur Verfügung stand.

Schlussfolgerung Handverletzungen durch Sprengkörper kommen im Kindesalter häufig vor und können zu unterschiedlichen und komplexen Verletzungen führen. Um Langzeitfolgen zu vermeiden, ist neben der Vorbeugung solcher Verletzungen, die primäre Rekonstruktion der betroffenen Hand von größter Bedeutung.

Key words

explosive injuries - hand - children - primary reconstruction

Schlüsselwörter

explosive Verletzungen - Hand - Kinder - Primärrekonstruktion


Publication History

Article published online:
19 September 2019

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References:

  • 1 Billock RM, Chounthirath T, Smith GA. Pediatric Firework-Related Injuries Presenting to United States Emergency Departments, 1990–2014. Clin Pediatr (Phila) 2017; 56: 535-544
    CrossrefPubMedGoogle Scholar
  • 2 Tu Y, Granados DV. 2012 fireworks annual report: fireworks-related deaths, emergency department-treated injuries, and enforcement activities during 2012. US Consumer Product Safety Commmision; 2013. Online (last access: 20.03.2018): http://www.cpsc.gov/global/research-and-statistics/injury-statistics/fuel-lightersand-fireworks/fireworks_report_2012
    Google Scholar
  • 3 Tu Y, Granados DV. 2013 Fireworks annual report: fireworks-related deaths, emergency department-treated injuries, and enforcement activities during 2013. US Consumer Product Safety Commission; 2014. Online (last access: 20.03.2018): http://www.cpsc.gov/en/media/documents/research-statistics/injury-statistics/fuel-lighters-and-fireworks/2013-fireworks-annual-;report/
    Google Scholar
  • 4 Vassilia K, Eleni P, Dimitrias T. Fireworkrelated childhood injuries in Greece: a national problem. Burns 2004; 30: 151-153
    CrossrefPubMedGoogle Scholar
  • 5 Berger LR, Kalishman S, Rivera FP. Injuries from fireworks. Pediatrics 1985; 75: 877-882
    PubMedGoogle Scholar
  • 6 Canner JK, Haider AH, Selvarajah SS, Hui X, Wang H, Efron DT. et al. DT. US emergency department visit for fireworks injuries, 2006–2010. J Surg Res 2014; 190: 305-311
    CrossrefPubMedGoogle Scholar
  • 7 Moore JX, McGwin jr G, Griffin RL. The epidemiology of firework-related injuries in the United States: 2000–2010. Injury 2014; 45: 1704-1709
    CrossrefPubMedGoogle Scholar
  • 8 Gopalakrishnan R, Shivakami T, Sugapradha GR. Prevalence and patterns of cracker blast injuries of the hand. Int Surg J 2016; 3: 831-836
    PubMedGoogle Scholar
  • 9 Puri V, Mahendru S, Rana R, Deshpande M. Firework injuries: a ten year study. J Plast Reconstr Aesthet Surg 2009; 62: 1103-1111
    CrossrefPubMedGoogle Scholar
  • 10 Pillinga T, Govender P. Profile and management of the firework-injured hand. S Afr Fam Pract 2016; 58: 48-53
    CrossrefPubMedGoogle Scholar
  • 11 Hazani R, Buntic RF, Brooks D. Paterns in Blast Injuries to the hand. Hand 2009; 4: 44-49
    CrossrefPubMedGoogle Scholar
  • 12 Giessler G, Leopold A, German G, Heitmann C. Blast injuries of the hands. Patterns of trauma and plastic surgical treatment. Unfallchirurg 2006; 109: 956-963
    CrossrefPubMedGoogle Scholar
  • 13 Moore RS, Tan V, Dormans JP, Bozentka DJ. Major pediatric hand trauma associated with fireworks. J Orthop Trauma 2000; 14: 426-428
    CrossrefPubMedGoogle Scholar
  • 14 Adhikari S, Bandyopadhyay T, Sarkar T, Saha JK. Blast injuries to the hand: Pathomechanics, patterns and treatment. J Emerg Trauma Shock 2013; 6: 29-36
    CrossrefPubMedGoogle Scholar
  • 15 Gandhi SD, Abzug JM, Herman MJ. The Mangled Extremity in Children, Pediatric Orthopedic Surgical Emergencies. New York: Springer Science, Business Media; 2012: 17-27
    Google Scholar
  • 16 Bakota B, Kopljar M, Jurjevic Z, Staresinic M, Cvjetko I, Dobric I. De Faoite. Mangled Extremity – Case Report, Literature Review and Borderline Cases Guidelines Proposa, lColl. Antropol 2012; 36: 1419-1426
    PubMedGoogle Scholar
  • 17 Urso-Baiarda F, Lyons RA, Laing JH, Brophy S, Wareham K, Camp D. A prospective evaluation of the Modified Hand Injury Severity Score in predicting return to work. Int J Surg 2008; 6: 45-50
    CrossrefPubMedGoogle Scholar
  • 18 Swanson AB. Evaluation of impairment of function in the hand. Surg Clin North Am 1964; 44: 925-940
    CrossrefPubMedGoogle Scholar
  • 19 Matheron AS, Hendriks S, Facca S, Liverneaux PA. Hand injuries due to firework devices: a series of 58 cases. Chir Main 2014; 33: 124-129
    CrossrefPubMedGoogle Scholar
  • 20 Cheema TA. Complex injury of the hand. London: JP Medical Ltd.; 2014: 193
    Google Scholar
  • 21 Bernstein ML, Chung KC. Early management of the mangled upper extremity. Injury 2007; 38: S3-S7
    PubMedGoogle Scholar
  • 22 Byrd HS, Cierny 3rd G, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg 1981; 68: 73-82
    CrossrefPubMedGoogle Scholar
  • 23 Byrd HS, Spicer TE, Cierney 3rd G. Management of open tibial fractures. Plast Reconstr Surg 1985; 76: 719-730
    CrossrefPubMedGoogle Scholar
  • 24 Andrew J, Sheean AJ, Tintle SM, Rhee PC. Soft tissue and wound management of blast injuries. Curr Rev Musculoskelet Med 2015; 8: 265-271
    CrossrefPubMedGoogle Scholar
  • 25 Brown KV, Ramasamy A, Mcleod J, Sepley S, Clasper JC. Predicting the need for early amputation in ballistic mangled extremity injuries. J. Trauma 2009; 66: S93-S97
    PubMedGoogle Scholar
  • 26 Wei FC. Toe to hand transplantation. In: Green DP, Hotchkiss RN, Peterson WC, Wolfe SW. editors Greenʼs operative hand surgery. Philadelphia: Elsevier; 2005: 1835-1863
    Google Scholar
  • 27 Khan MAA, Javed AA, Rao DJ, Corner JA, Rosenfield P. Pediatric Traumatic Limb Amputation: The Principles of Management and Optimal Residual Limb Lengths. World J Plast Surg 2016; 5: 7-14
    PubMedGoogle Scholar