Content uploaded by Wing Yee Clara Wong
Author content
All content in this area was uploaded by Wing Yee Clara Wong on Mar 25, 2016
Content may be subject to copyright.
A preview of the PDF is not available
Mechanism and epidemiology of paediatric finger injuries at Prince of Wales Hospital in Hong Kong
Abstract and Figures
To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012.
Comparison of two case series.
University-affiliated teaching hospital, Hong Kong.
A retrospective study of two cohorts of children (age, 0 to 16 years) admitted to Prince of Wales Hospital with finger injuries during two 3-year periods. Comparisons were made between the two groups for age, involved finger(s), mechanism of injury, treatment, and outcome. Telephone interviews were conducted for parents of children who sustained a crushing injury of finger(s) by door.
A total of 137 children (group A) were admitted from 1 January 2003 to 31 December 2005, and 109 children (group B) were admitted from 1 January 2010 to 31 December 2012. Overall, the mechanisms and epidemiology of paediatric finger injuries were similar between groups A and B. Most finger injuries occurred in children younger than 5 years (group A, 55%; group B, 75%) and in their home (group A, 67%; group B, 69%). The most common mechanism was crushing injury of finger by door (group A, 33%; group B, 41%) on the hinge side (group A, 63%; group B, 64%). The right hand was most commonly involved. The door was often closed by another child (group A, 37%; group B, 23%) and the injury often occurred in the presence of adults (group A, 60%; group B, 56%). Nailbed injury was the commonest type of injury (group A, 31%; group B, 49%). Fractures occurred in 24% and 49% in groups A and B, respectively. Traumatic finger amputation requiring replantation or revascularisation occurred in 12% and 10% in groups A and B, respectively.
Crushing injury of finger by door is the most common mechanism of injury among younger children and accounts for a large number of hospital admissions. Serious injuries, such as amputations leading to considerable morbidity, can result. Crushing injury of finger by door occurs even in the presence of adults. There has been no significant decrease in the number of crushing injuries of finger by door in the 5 years between the two studies despite easily available and affordable preventive measures. It is the authors' view that measures aimed at promoting public awareness and education, and safety precautions are needed.
Figures - uploaded by Wing Yee Clara Wong
Author content
All figure content in this area was uploaded by Wing Yee Clara Wong
Content may be subject to copyright.
... [2,[6][7][8] The average age of our patients was 7-years, while it varies between 2 and 6 years in most studies on fingertip trauma in children. [2,[9][10][11] Epidemiological data agree on the predominance of boys, and doors are the causative agent in more than half of cases. [1,9,12] There is no absolute predominance on the left or right side. ...
... The frequency of nail bed sores varies between 20% and 30%, most of which are transverse wounds, and nail avulsion is more common. [10,13,16,17] When the matrix is affected, the sequelae are always greater because it is the organ that produces the tablet. [9] We observed 60.98% of matrix involvement. ...
... [1,2,18] The association with a fracture of the distal phalanx is around 20%-50% with a clear predominance of those located at the level of the phalanx tuft. [6,10,13,19] Fingertip trauma is a real emergency, the consultation and management of which take place in the first 24 h. [10,13,19] There are three main factors that influence the choice of the appropriate flap for covering tissue loss: her size, its location (proximal dorsal or ventral fingertip) and the functional requirements of the patient. ...
Objectives: We aim to describe the management of fingertip injuries treated by flaps in the paediatric surgery emergency ward and evaluate the long-term results. Patients and Methods: Through a 2-year prospective study, we analysed all fingertip injuries treated by flaps in the paediatric emergency ward. We collected patients’ data and the clinical and imaging characteristics of the lesions. The type of flap was chosen on a case-by-case basis. We evaluated aesthetic and functional results. Results: Forty-two fingertip injuries required the use of flaps. The average age was 7 years, and boys were more affected. The smashed fingertip was the most common mechanism; pulp lesions and amputation were located mainly in zone I or II. We performed Atasoy flaps, palm flap, free skin grafts, McGregor flap and the cross finger flap. Our results were good to excellent in 66.67%. Conclusions: The best management of fingertip injuries in children remains prevention.
... Crushing injury of the finger by a door is common [11]. It should also be noted that injuries due to outdoor activities are generally more serious than those due to indoor activities [12,13]. ...
... Because crushing injury by a door is a common cause of hand trauma in this age range, safety devices such as finger guard devices and triangular-shaped stoppers can be applied on the hinge side of doors. Magnets installed on the back of a door and opposing wall surface can be an effective way to prevent unintended door closures [11]. Moreover, because outdoor activities such as sports cause more serious trauma to the hand, injury-preventing strategies, including stretching, bracing, or taping, should precede these activities [20]. ...
PurposePediatric hand trauma is common and sometimes causes deformity or disability. The incidence and etiologies of hand trauma in children are different from those in adults. This study analyzed the characteristics of pediatric hand trauma cases and patients over a 15-year period. Methods
We conducted a retrospective medical record review of 3,432 children (2,265 boys, 1,167 girls, under 18 years of age) with hand injuries from January 2005 to December 2019. We evaluated the sex distribution and injury etiologies. Injuries were classified by type as burns, amputations, crushing injuries, lacerations, extensor and flexor tendon injuries, open and closed fractures, and nerve injuries. ResultsAmong the pediatric hand injury patients, males were predominant (1.94:1). Simple lacerations (58.4%) were the most common injury type, followed by fractures (22.8%). Lacerations and burns tended to be common in younger age groups, while tendon injuries, nerve injuries, and crushing injuries were more frequently encountered in older age groups. Conclusions
Hand trauma prevention strategies should be established considering the frequent trauma etiologies in specific age groups. An awareness of age-specific characteristics of pediatric hand trauma patients will be helpful to prevent hand trauma.
... Some studies suggest burns and crushing injuries are most common [5], while others highlight lacerations as predominant among younger children [6]. Despite extensive research on fingertip crushing [7][8][9], burns [10,11], and fractures [12,13] in pediatric hand injuries, there is a notable gap in understanding lacerations specifically. ...
Purpose: This study analyzed the epidemiology of pediatric hand lacerations in children under 6 years old, focusing on age-related characteristics and the household objects that caused these injuries.Methods: We conducted a retrospective study of patients under 6 years old who presented with hand lacerations at our emergency department from January 2016 to December 2023. Data were collected on demographics, injury-related factors (the affected hand and finger, injury location, and injury-causing object), need for surgical intervention, and damage to deep structures. Patients were categorized as infants (0–1 years), toddlers (1–3 years), or preschoolers (3–6 years). We recorded the frequency, surgical intervention rates, and affected deep structures for each injury-causing object.Results: Of 153 children treated for hand lacerations, toddlers were the most frequently injured (47.7%), followed by preschoolers (44.4%) and infants (7.8%). The index and middle fingers were particularly vulnerable in toddlers and preschoolers, while infantile injuries more commonly affected the palm. Among 31 identified objects, knives/blades, particularly cutting knives (13.7%) and broken glass (13.1%), were the leading causes, with injuries occurring primarily at home. Surgical intervention was necessary in 11.1% of cases, with eyebrow razors (33.3%) most often requiring surgery and causing damage to deep structures, including arteries, nerves, and flexor tendons.Conclusion: The study highlights the significant role of developmental behaviors in pediatric hand laceration risk. Many injuries were caused by everyday household objects, including eyebrow razors, that are often underestimated as potential dangers. Preventive measures and guardian education are crucial to reduce the incidence of these injuries.
... Interestingly, despite the differences in geographical localization (Rosberg and Dahlin 2004;Shah et al. 2012, Liao and Chong 2019), some universal trends regarding the epidemiology and aetiology of hand injury in children and teenagers have been identified. Most importantly, key roles have been identified for sex and age (Mayranpaa et al. 2010;Liu et al. 2015), with the incidence of hand injury being highest in those aged 12-15 years old (Cebula et al. 2020, Liao andChong 2019). Johnson et al. and Vadivelu et al. report that the most common aetiology of hand injuries is sport. ...
Introduction Understanding the incidence and causality of paediatric hand injuries may be vital in injury prevention, training and treatment priority. However, few papers have addressed this subject. Aim The aim of the study was to identify the epidemiology and cause of hand injuries in the paediatric population. Material and methods The study group in the retrospective study included 291 patients (74 female, 271 male) aged 1–18 years old (mean age = 12.2; SD = 4.5). The cause of injury and diagnosis were taken from the hospital database. Institutional Review Board (IRB) approval was obtained. Results Data on the type of injury was collected and divided into nine groups, seven of which were used in the analysis: 5.2% were dislocations, 8.9% open fractures, 42.6% closed fractures, 12.7% isolated tendon injuries, 18.3% multiple tendon injuries, 4.8% subamputations and 15.4% amputations. Also, 54.5% of all injuries concerned the right upper limb, 45.4% the left, and 0.01% both upper limbs. Sex did not influence the injury incidence. However, age influenced the occurrence of closed fractures (mean age = 9.8; SD = 5.6; p < 0.02), isolated tendon injuries (mean age = 13.3; SD = 4.5; p < 0.04) and amputations (mean age = 10.5; SD = 4.9; p < 0.007). The main causes were sport training (29.8%), agricultural machine accidents (15.3%) and contact with sharp objects (14.5%). Conclusions Our current results show clear age-based trends in the epidemiology and causation of certain hand injuries in the paediatric population. These should be taken into account in special prevention programs.
... Although the importance of pediatric hand injuries prevention strategy has been pointed out before, these injuries are a frequent reason for presentation to the pediatric emergency department with various locations, mechanisms, and types of injuries. Epidemiological studies of pediatric finger injuries have been reported, but many of them targeted only fingertip injuries [1][2][3][4][5][6] or restricted the type of injury, such as fractures 7,8 and burns. 9,10 In addition, there is little information about the comprehensive epidemiological investigation of pediatric hand and finger injuries, including those to the fingertips, palms, and dorsum of the hand. ...
Objective:
The hands and fingers are frequently injured among children. Therefore, this study aimed to describe the epidemiological characteristics of hand and finger injuries among Japanese children and identify preventive strategies.
Methods:
This was a retrospective review of data of pediatric patients who visited the Kitakyushu City Yahata Hospital in Japan, between April 2018 and March 2019. All patients 15 years or younger who experienced hand and finger trauma were included. Data on age, sex, injured part, location of the incident, mechanism of injury, objects, diagnosis, consultation with specialists, treatments, and outcomes were collected and analyzed by classifying the participants based on age into the following 5 age groups: younger than 1, 1 to 2, 3 to 5, 6 to 10, and 11 to 15 years.
Results:
A total of 554 patients were included in this study (male, 57.2%; median age, 4.5 years). The most commonly injured part of the hand was the index finger (22.4%), followed by the middle (18.9%) and ring (16.8%) fingers. A total of 111 patients (15.1%) had palm or dorsal hand injuries. Burn by touching hot objects at home was the leading cause of injuries to the palms during infancy, whereas door-related contusion and abrasion of the index, middle, and ring fingers were most common in preschool children. Sports-related fingertip fractures and sprains most frequently occurred in the thumb and little fingers of school children. Approximately half of the patients (53.3%) did not require any specific treatment. Most patients (98.2%) were treated at the outpatient department.
Conclusions:
This study provides the epidemiology of age-specific hand and finger injuries among Japanese children. Therefore, the childhood hand and finger injury prevention strategy should focus on age as a characteristic.
... Yet, merely a few studies have been published investigating epidemiological aspects on a national and international level. Analysis often focuses on a specific anatomical structure of the hand [12,13], on a distinct type of injury [14][15][16], failing to emphasize hand injuries alone [17][18][19][20] or include only a specific patient population, i.e. athletes [21][22][23][24] or children [25][26][27]. ...
Background
Hand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization.
Objective
The objective of this study is (1) to provide epidemiological information on hand injuries and their patterns and (2) to visualise the frequencies of affected areas of the hand in relation to the most common trauma mechanisms using color-coded heatmaps.
Methods
This prospective single-center observational trial conducted at a surgical emergency department in Germany collected data of hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, diagnostic and therapeutic measures were analyzed. Color-coded heatmaps were generated marking anatomic danger zones.
Results
435 patients with a mean age of 39.5 were included. Most patients admitted on their own initiative (79%). Leisure and sport injuries were most frequent (75%). Digiti II–V were injured most commonly (43%), followed by metacarpals (19%) and the thumb (14%). Blunt trauma and cuts accounted for most injuries (74%). Hand-graphics depicted color-coded frequencies of the affected areas of the palmar and dorsal aspect of the hand for the most common types of injury, as well as the most frequent circumstances of accident. Elective surgery was recommended in 25% of cases, and hand surgical follow-up was proposed in over 50% of cases.
Conclusions
The dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.
... У взрослых механизм отчленения сегментов конечностей чаще всего связан с работой на производстве. У детей младших возрастных групп наиболее распространены отчленения в результате сдавления в дверных проёмах, механизмах тренажеров, цепей велосипедов, у более старших -в результате действия различных инструментов -бензопил, топоров [7][8]. ...
Objective. Traumatic complete and partial finger amputations are rare in comparison with adults. There are significant differences between mechanism of trauma, principles of treatment children with this type of injury in comparison with adults.
Clinical case. A 15-years old child suffered from injury by axe, which caused the traumatic fingertip amputation of III and IV digits of his right hand. Replantation of both amputated parts was performed. Arteries and nerves were repaired with no veins anastomosed. As a result - survival of replanted parts.
Discussion. A submillimeter diameter of vessels and potential venous congestion are basic problems that a surgeon deal with when perform the replantation of fingertips. Respectively, a difficulty in post-operative care of patient appears.
Conclusion . Replantation of amputated part of finger is a golden standard of treatment of children with a described type of injury. The correct deliverance of amputated parts, the shortest time of ischemia as possible, a qualitive operation and post-operative care play an important role in successful survival of the replanted segments.
The aim of this study was to evaluate the characteristics of paediatric hand fractures (PHF) at a tertiary hospital in South China based on sex, age, mechanism of injury and anatomical region. A retrospective observational study was performed on children aged 15 years and younger who were referred for actual or suspected hand fractures between January 2016 and December 2020. Medical records and radiographs were reviewed for age at the time of injury, sex, site and fracture pattern and mechanism of injury. A total of 436 consecutive children with 478 hand fractures were reviewed. Hand fractures was more common in boys (281/436; 64.4%) than in girls (155/436; 35.6%), although most fractures occurred in children aged 0-3 years (198/436; 45.4%). Distal phalanges were the most commonly injured bones (184/478; 38.5%), and the base fractures were most common (151/476; 31.7%); the fifth digit was most commonly injured (150/478; 31.3%). Crush injuries were the leading cause of fracture in children younger than 6 years of age (207/325; 63.7%), whereas punch injuries were the major cause of injury in older age groups (55/153; 35.9%); 60.1% of the fractures were managed nonsurgically. This study showed patterns of PHF in a tertiary hospital in South China. It illustrates the local variability across sex, age group, injury type and injury mechanism. Such demographic data will be valuable for optimally resourcing healthcare systems locally and help guide prevention policies.
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.
To investigate the etiological factors, intensity of injuries and the possible preventive measures of fingertip injuries and to avert such calamities.
A study was undertaken retrospectively on 200 children who had presented with fingertip injuries to the Paediatric Emergency Department of the King Saud bin Abdulaziz University for Health Sciences, during the years 2010-2011. The markers analyzed included age and sex of the patients, period when the injury occurred (vacation and/or non-vacation), accommodation, where the children dwelled, source of injury, localization of the injury, fracture or tendon damage, and modality of treatment.
The frequency of injuries was highest among younger children (< 5 years). Majority of injuries were found to occur during vacation period among patients who dwell in apartments and villas at residential compounds. House doors were the most common mode of crush injuries. The frequency of fractures was found to be more frequent in boys vs. girls. Suturing and conservative treatment were common mode of treatments. Of the total, 188 patients who attended the emergency had proper movement and alignment by the end of their treatment, while 12 patients demonstrated complications.
Children below 5 years age were involved in fingertip injuries in a large number. Injuries were more common in vacations and in children living in appartments. Preventive measures are necessary to avoid these accidents.
To understand the epidemiology, sites, and mechanism of finger injuries in children and to consider safety measures.
Accident and emergency department of a children's hospital in Glasgow.
A prospective study was carried out with a specifically designed questionnaire. Altogether 283 children presenting with isolated finger injuries were identified over six months. Available safety measures to avoid or reduce damage from such injuries were considered.
Finger injuries were common (38%) in those under 5 years. Most of these occurred at home (59%), commonly (48%) because of jamming between two closeable opposing surfaces, and mostly (79%) in doors at home and school. The doors were commonly (85%) closed by someone and often (60%) by a child. Sixteen (6%) were treated for amputation.
Finger injuries are common, especially at the preschool age, and are mostly caused by jammed fingers in doors, at home. Safeguards should be considered according to location, like home or institutions, and expense.
To review the past 10 years of research relevant to psychiatry on injuries in children and adolescents.
A literature search of databases for "wounds and injuries, excluding head injuries," was done with Medline and PsycINFO, yielding 589 and 299 citations, respectively. Further searching identified additional studies.
Progress is occurring in prevention, pain management, acute care, psychiatric treatment, and outcomes. The emotional and behavioral effects of injuries contribute to morbidity and mortality. Psychiatric assessment, crisis intervention, psychotherapy, psychopharmacological treatment, and interventions for families are now priorities. Research offers new interventions for pain, delirium, posttraumatic stress disorder, depression, prior maltreatment, substance abuse, disruptive behavior, and end-of-life care. High-risk subgroups are infants, adolescents, maltreated children, suicide attempters, and substance abusers. Staff training improves quality of care and reduces staff stress.
Despite the high priority that injuries receive in pediatric research and treatment, psychiatric aspects are neglected. There is a need for assessment and for planning of psychotherapeutic, psychopharmacological, and multimodal treatments, based on severity of injury, comorbid psychopathology, bodily location(s), and prognosis. Psychiatric collaboration with emergency, trauma, and rehabilitation teams enhances medical care. Research should focus on alleviating pain, early psychiatric case identification, and treatment of children, adolescents, and their families, to prevent further injuries and reduce disability.