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J Hand Microsurg 2018; 10(02): 93-100
DOI: 10.1055/s-0038-1642069
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Patterns of Complex Carpal Injuries in the Hand from Fireworks

Zhi Yang Ng
1   Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Florida, United States
,
Alan Shamrock
2   Division of Hand Surgery, Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
,
David L. Chen
2   Division of Hand Surgery, Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Seth D. Dodds
2   Division of Hand Surgery, Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida, United States
,
Harvey Chim
1   Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, Florida, United States
› Author Affiliations Funding None.
Further Information

Publication History

Received: 22 January 2018

Accepted: 07 March 2018

Publication Date:
25 April 2018 (online)

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Abstract

Purpose To describe the various patterns of complex carpal and metacarpal fracture dislocations observed in a consecutive series of firework injuries and the operative management performed.

Materials and Methods We performed a retrospective study of seven consecutive patients (six males; mean age = 22 ± 13, range, 8–39 years) who presented to a level I trauma center with firework injuries to the hand between July 2014 and January 2016.

Results All injuries were sustained while a lighted firework was held in the hand. The mean length of hospital stay was 13.9 ± 13.8 (range, 4–46) days with an average of 3 ± 2.6 (range, 1–7) surgeries required for both bony and soft tissue reconstruction. Three patterns of injury were seen: type I—no carpal involvement; type II—carpometacarpal joint (CMCJ) dislocations and isolated carpal dislocations; type III—CMCJ dislocations with axial carpal dissociation. One patient had a type I injury, three had a type II injury, and three had a type III injury. Of patients with a type III injury, two of the three had simultaneous axial-radial and axial-ulnar involvement as well as a midcarpal dissociation with divergent dissociation of the carpus and metacarpals.

Conclusion The severity of carpal injuries resulting from fireworks is highly variable but is likely to follow predictable patterns due to the position of the hand and the location of the firework prior to explosion. Surgical reconstruction can be challenging, but adequate outcomes with a functional hand can be achieved through a systematic approach.

Type of Study/Level of Evidence Therapeutic level IV.

Keywords

fireworks - blast injuries - carpal - hand - wrist - axial dislocations