Session VIII - Upper Extremity

Major Pediatric Hand Trauma Associated with Fireworks

Virak Tan, MD; Richard S. Moore, Jr., MD; John P. Dormans, MD; David J. Bozentka, MD, The Children's Hospital of Philadelphia, Philadelphia, PA, Duke University Medical Center, Durham, NC

Introduction: Fireworks result in approximately 12,600 injuries each year in the United States, and over fifty percent of the cases occur in the pediatric population. Although the incidence is well documented, there is a paucity of data on the impact and type of orthopaedic injuries sustained. The purpose of this study is to characterize the injury pattern and analyze the economic impact of major hand trauma secondary to fireworks in the pediatric population.

Methods: All records (including charts, operative reports, radiographs, and hospital charges) of patients in the trauma registry at this institution with a diagnosis of fireworks-related injuries were reviewed. Between 1987 and 1997, 22 patients were identified as having sustained 22 hand injuries from fireworks. Of the 22 patients, 10 had injuries to the dominant hand, 10 to the non-dominant hand, one to both hands, and one did not have a hand injury. The study group consisted of 19 boys and 3 girls with an average age 9.3 years (range 4-17).

Results: Of the 22 hands injured, there were 31 fractures, 19 amputations, and 1 dislocation. The 19 amputations occurred in 9 hands; with 13/19 occurring at or distal to the DIP joint, 4/19 between the MCP and DIP joints, and 2/19 through the thumb IP joint. Local skin graft or flap coverage was required in 8 hands, and late reconstructive procedures were done on 3 hands. Nail bed repairs were necessary in 7 digits not associated with amputations. Five hands had neurovascular injuries. Of these, 2 required microsurgical repairs at the time of injury, one required a late neurovascular pedicle reconstruction, and two could not be repaired.

Sixteen patients sustained other associated injuries including abrasions to the face, chest, and thigh area. Of the 13 patients who had facial trauma, 8 had significant ophthalmic injuries. The one patient with no hand injury had an isolated globe rupture.

Resource utilization included: average hospital stay of 4.3 days (range 0-20, SD 4.1), average number of trips to the operating room of 1.2 (range 0-3, SD 0.7), and average hospital costs of $11,403 (range $1,035-$39,489).

Discussion and Conclusion: To date, the majority of the medical literature dealing with fireworks-related injuries has focused on ophthalmic injuries. This study demonstrates the severity of hand injuries associated with fireworks as well as the significant burden placed on medical resources in treating these injuries. Efforts toward public education and legislative reforms are necessary to prevent these unnecessary injuries.