Automatic top loader washing machine related injury. A report of four cases with serious injury.
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We are reporting four cases of serious washing machine related injury that presented within a period of 5 months. All patients were young children with the mean age of 9 year-old and three had their dominant hand injured. The washing machines involved were the automatic top loader type and all injuries occurred during the spinning phase. Serious automatic washing machine injury is not uncommon in Malaysia. We feel that there is a need to improve the safety features especially during the spinning phase. The operating instructions and safety precautions on the washing machine should be displayed in different languages that can be understood well. Parents should also aware of the potential risks of this seemingly benign household appliance. (+info)
Characteristics of pediatric traumatic amputations treated in hospital emergency departments: United States, 1990-2002.
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OBJECTIVE: To examine the characteristics of children with traumatic amputations and the products associated with these injuries. METHODS: Data regarding amputation injuries to children younger than 18 years treated in US emergency departments from 1990 to 2002 were obtained from the National Electronic Injury Surveillance System. Data included demographics, product involved, and body region injured. RESULTS: An estimated 111,600 children younger than 18 years with amputation injuries were treated in US emergency departments from 1990 to 2002. The average age was 6.18 years (median: 4 years; mode: 1 year old). Males experienced 65.5% of these injuries. Finger amputations accounted for 91.6% of all amputations, ranging from 95.2% among 0- to 2-year-olds to 87.9% among 13- to 17-year-olds. Complete amputations accounted for 70.2% of all amputations among 13- to 17-year-olds compared with 52.6% of amputations among 0- to 2-year-olds. Adolescents also had the highest proportion of amputations resulting in hospital admission (26.6% for 13- to 17-year-olds compared with 11.9% for 0- to 2-year-olds). Adolescents had the highest proportion of amputation injuries involving lawn mowers (14.1% for 13- to 17-year-olds compared with 1.4% for 0- to 2-year-olds) and the highest proportion of amputations involving tools (29.3% for 13- to 17-year-olds compared with 2.5% for 0- to 2-year-olds). The percentage of amputations involving doors peaked in the youngest age group and decreased as age increased (65.8% of all amputations for 0- to 2-year-olds compared with 14.1% for 13- to 17-year-olds). CONCLUSIONS: To our knowledge, this is the first study to use a nationally representative sample to broadly investigate amputation injuries among children. The majority of traumatic amputation injuries occur to young children, to males, and to fingers and the majority involve doors. Adolescents experience a higher proportion of more serious amputation injuries. Effective interventions exist but are inadequately used to prevent many of these injuries, including door stops and modifications, bicycle-chain and spoke guards, wearing closed-toe footwear while bicycling, a no-mow-in-reverse default feature on ride-on lawnmowers with the override switch located behind the mower operator, and a SawStop system on power saws. Use of these technical countermeasures and changes in relevant product standards to promote their implementation and use could lead to a decrease in pediatric traumatic amputations. (+info)
The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation.
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BACKGROUND: Continuous axillary brachial plexus block with local anesthetic has been shown to improve tissue perfusion after replantation surgery of the extremity. The present study aimed to investigate whether continuous axillary brachial plexus block with ropivacaine infusion can improve the survival of the reconstructive fingers secondary to an increase in its skin temperature in patients receiving replantation surgery of the crushed fingers. METHODS: Under general anesthesia, 18 patients received replantation or toe-to-hand transplantation of their crushed digits. They were randomly divided into two groups. Under ultrasound guidance, continuous axillary brachial plexus analgesia was effected by a loading dose of 10 ml 0.75% ropivacaine, followed by an infusion of 4-5 ml per hour for up to three days (Group A). Patients who did not receive continuous analgesia postoperatively served as a control (Group B). An infrared thermometer was used to hourly assess the skin temperature of the surgical and non-surgical sites in both groups for 24 h after the surgery. In addition, the survival (the rate of re-operation or amputation) of the reconstructive digits was also evaluated in both groups. RESULTS: The skin temperature of the digits (T1) on both groups did not show any significant difference at any point of time after the surgery albeit there was a trend of increased skin temperature on the reconstructive digits in patients receiving continuous axillary brachial plexus block (Group A) as compared to those without receiving the block (Group B). Also, the difference in skin temperature (dT) differed slightly at 0, 9 and 21 hours postoperatively in Group A in comparison with Group B (0.75 +/- 0.65 vs. -2.33 +/- 1.24, 0.53 +/- 0.34 vs. -3.02 +/- 1.27, -0.125 +/- 0.55 vs. -2.33 +/- 0.91, p < 0.05). However, no patients in both groups received a second operation or amputation of the graft. CONCLUSIONS: The result of this study demonstrated that axillary brachial plexus block with continuous infusion of 0.75% ropivacaine can increase the skin temperature, an index of tissue perfusion, of the reconstructive digits for 24 h after microvascular surgery of the crushed fingers. However, graft survival was good in both groups. (+info)
Radiological hand involvement in systemic sclerosis.
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BACKGROUND: The osteoarticular and soft tissue structures of the hand may be involved in systemic sclerosis (SSc), causing functional disability. OBJECTIVE: To assess radiological hand features in a cross sectional study of SSc patients and in controls. METHODS: Hand radiology was done systematically in patients with SSc seen over a two year period and in unselected controls with rheumatoid arthritis or digital trauma. Two independent investigators blind to the diagnosis carried out the radiological assessment. RESULTS: 120 consecutive SSc patients (median (range) age, 56.5 (20 to 90) years; disease duration, 6 (0 to 42) years) and 42 controls (22 with rheumatoid arthritis and 20 with digital trauma) were studied. Radiological abnormalities in SSc patients included erosion (21%), joint space narrowing (28%), arthritis (defined by concomitant erosion and joint space narrowing) (18%), radiological demineralisation (23%), acro-osteolysis (22%), flexion contracture (27%), and calcinosis (23%). In univariate and multivariate analysis, the resorption of distal phalanges was significantly associated with digital ulcers, extra-articular calcification, and pulmonary arterial hypertension; flexion contracture was associated with the diffuse cutaneous form and high HAQ (Health Assessment Questionnaire) disability score. Calcinosis was most often seen in patients with digital ulcers, but was similarly observed in patients with the diffuse or limited cutaneous subtypes. CONCLUSIONS: Flexion contracture was associated with disability and occurred in patients with the diffuse cutaneous subtype of SSc, consistent with the tendency towards fibrosis and functional impairment of this subtype. Calcinosis and acro-osteolysis were both associated with vascular complications, highlighting a potential role of vascular injury in such lesions. (+info)
Multiple bone fractures found in a young sarcoidosis patient with long stable disease.
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A 22-year-old Japanese man was found to have bilateral hilar lymphadenopathy (BHL), and was diagnosed with sarcoidosis in 1995. He was followed without treatment until 2002, when a bone fracture due to osseous sarcoidosis was found in his left thumb. Despite systemic treatment with corticosteroid and methotrexate, a new bone lesion developed in his right foot and his right middle finger was fractured. The patient also suffered multiple organ involvements including brain and muscle lesions. This is the first report of a sarcoidosis patient who presented with BHL, and developed bone fractures after a long stable period of more than 5 years. (+info)
Toddlers at risk for paper shredder injury in the home: easy access and severe injury.
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A 2-year-old girl sustained severe injury to 2 fingers from a home paper shredder. This case illustrates the risk of injury from paper shredders, which are increasingly common household items. Toddlers are at risk of finger injury and amputation. The US Consumer Product Safety Commission performed an investigation of reported injuries and the characteristics of paper shredders that might have contributed to the injuries, and we summarize their findings. (+info)
Acute finger injuries: part I. Tendons and ligaments.
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Improper diagnosis and treatment of finger injuries can cause deformity and dysfunction over time. A basic understanding of the complex anatomy of the finger and of common tendon and ligament injury mechanisms can help physicians properly diagnose and treat finger injuries. Evaluation includes a general musculoskeletal examination as well as radiography (oblique, anteroposterior, and true lateral views). Splinting and taping are effective treatments for tendon and ligament injuries. Treatment should restrict the motion of injured structures while allowing uninjured joints to remain mobile. Although family physicians are usually the first to evaluate patients with finger injuries, it is important to recognize when a referral is needed to ensure optimal outcomes. (+info)
Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.
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Family physicians can treat most finger fractures and dislocations, but when necessary, prompt referral to an orthopedic or hand surgeon is important to maximize future function. Examination includes radiography (oblique, anteroposterior, and true lateral views) and physical examination to detect fractures. Dislocation reduction is accomplished with careful traction. If successful, further treatment focuses on the concomitant soft tissue injury. Referral is needed for irreducible dislocations. Distal phalanx fractures are treated conservatively, and middle phalanx fractures can be treated if reduction is stable. Physicians usually can reduce metacarpal bone fractures, even if there is a large degree of angulation. An orthopedic or hand surgeon should treat finger injuries that are unstable or that have rotation. Collateral ligament injuries of the thumb should be examine with radiography before physical examination. Stable joint injuries can be treated with splinting or casting, although an orthopedic or hand surgeon should treat unstable joints. (+info)