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Severe Hand Injuries from Fireworks: Injury Patterns, Treatment, and Fireworks Types
Brinkley K Sandvall, MD; Kari A Keys, MD; Jeffrey B Friedrich, MD
University of Washington, Seattle, WA
Introduction: Fireworks-related hand injuries can be devastating. We hypothesize that thumb and first webspace injuries from fireworks are common, have distinct injury patterns, and are associated with certain fireworks types. The purpose of this study was to characterize injury and treatment patterns of fireworks-related hand injuries and determine if there was an association with certain fireworks types.
Materials & Methods: A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify fireworks type, injury patterns, and treatment.
Results: Of 105 patients with operative fireworks-related hand injuries, 12 did not have thumb or first webspace injuries, and 6 underwent complete hand amputation through the wrist or forearm. The distribution of revision amputations among 105 patients with operative hand injuries is displayed in Figure 1. In the thumb and/or first webspace injury group, 88 patients (84%) sustained 92 hand injuries (Table 1). There were 12 thumb soft tissue-only injuries (13%), 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). 15 hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. 23 hands (25%) required thumb revision amputation. Number of surgeries for acute reconstruction ranged 1 to 7 (mean 1.6), with 17 patients (19%) requiring three or more. 63 hands had deep first webspace injuries, and 11 (17%) required flaps acutely for first webspace reconstruction. Six hands required secondary reconstruction of a first webspace contracture. An external fixator was applied to six hands to maintain the first webspace; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells / mortars (59%) were the fireworks types most commonly associated.
Conclusion: Among operative hand injuries, fireworks most commonly fracture the thumb, destabilized the thumb CMC joint, and deeply damaged the first webspace. The first webspace requires particular consideration as deep injury may result in adduction contracture and require secondary reconstruction with tissue outside the zone of injury if not prevented.
FIGURE 1. Revision Amputations  |  |
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