Pediatric hand injury induced by treadmill

Clinical outcomes of hydrofiber foam dressing in the treatment of abrasion wounds: A retrospective study

Mopeds are a popular mode of transportation in Taiwan, yet collision accidents often lead to abrasion requiring medical attention. While hydrofiber foam dressing (HFD) have proven to help control exudates, reduce the frequency of dressing changes, and preserve more viable tissue, there is currently no established clinical guideline for the treatment of abrasion wounds with dressings. Therefore, the aim of this study was to investigate the clinical outcomes of abrasions treated with hydrofiber foam dressings. A total of 127 patients treated with HFDs between June 2018 and January 2021 were included in this study. Abrasions were categorized into 3 grades: grade I (n = 0) involving the epidermal layer, grade II (n = 89) involving the dermal layer, and grade III (n = 38) involving subcutaneous layer, bone or tendon. Statistical analysis showed that there was a significant difference in healing time (P < 0.001) and the number of outpatient department (OPD) visits (P = 0.013) between grade II and grade III. However, there was no significant difference in the number of dressing pieces used. This study offers a clinical reference for the use of hydrofiber foam dressings in treating different grades of abrasion wounds caused by moped accidents.

Outcomes of Early Surgical versus Non-Surgical Management of Pediatric Hand Friction Injuries Caused by Treadmills

INTRODUCTION

Pediatric hand friction injuries caused by running treadmills are ever more prevalent due to the increasing presence of home exercise equipment. These and other related injuries have received recent attention in the media, leading to mass product recalls in some cases. These friction injuries are similar to deep thermal burns and these patients are usually cared for in the pediatric burn unit at our institution. We sought to describe our recent experience managing 22 patients with these injuries.

METHODS

Patients were queried from our urban pediatric burn center database. After IRB approval, a retrospective chart review of all patients admitted for a treadmill-related hand injury over a 5-year period was performed. Data collected included patient demographics, initial treatment methods (surgical vs. non-operative), type of dressing used, hospital length of stay (LOS), and compliance with follow-up. We collected patient-centered outcomes included the time to healing and the need for subsequent surgical and/or non-surgical interventions to treat the sequelae of these injuries.

RESULTS

Our center treated 22 hand friction injuries caused by treadmills over the 5-year period. Five patients (23%) underwent early surgical intervention (<30 days from injury), with a median time from injury of 7 days (IQR 1.75-13.5). This cohort required additional interventions to treat postoperative sequelae with 2 (40%) requiring additional surgery and 3 (60%) managed non-surgically. Of the 17 (77%) who were initially treatednon-operatively , 5 (29%) healed completely with dressing changes only and required no further treatment. Eleven (65%) had injury-related sequelae and were managed successfully with non-surgical interventions. Only 1 patient (6%) required scar modification by z-plasty. Average LOS was 14 hours and median number of weekly follow-up visits was 4 until complete healing.

CONCLUSION

Given the excellent outcomes observed in patients treated without acute surgical intervention in this case series, non-operative non-operative management appears to be feasible, safe and may reduce the need for operative intervention. These injuries, although small, are deep and require a prolonged period of dressing changes and aggressive therapy including post-healing time commitment to scar management in order to achieve best outcomes. Our study supports the need for increased community awareness of this type of injury.

Early wound repair versus later scar repair in children with treadmill hand friction burns

The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.

Treadmill Hand Injuries Among Children: A Retrospective Case Series From Hospitalized Patients

Background: With the progress of modernization, treadmill hand injury in pediatric population is taking on a global trend in recent years. The purpose of this study was to investigate the epidemiology and clinical features in a developing country, thereby providing some experience in the treatment and prevention of this particular type of injury. Methods: A 5-year retrospective review of patients with treadmill hand injury in Burn and Plastic Surgery ward at Children' Hospital of Chongqing Medical University was conducted. Demographics, injury details, therapy performed, length of hospital stay, complications, and outcome were analyzed. Results: Forty-six patients were surveyed, with a mean age of 3.5 ± 2.0 years old, including 24 males and 22 females. Injuries (77.8%) occurred between dinner to bedtime, and 95.7% happened indoors. Fingers were the most vulnerable part, of which the middle finger, ring finger, and index finger were the top three ones. The mean body surface area (BSA%) was 0.3 ± 0.2, but at least in deep dermal. Dressing changes, full-thickness skin grafts (FTSG), and Negative Pleasure Wound Therapy (NPWT) assisted FTSG were performed. The scar contracture, as the most severe complication, occurred in 26 patients, of which 22 originally received dressing changes at the time of injury. Conclusion: Treadmill hand injury in children should be highly regarded. Compared with conservative dressing changes, surgical intervention from a professional team may achieve more satisfactory prognosis and fewer complications. A prevention strategy based on "Time-Space-Person" was summarized according to its epidemiological characteristics, may help to decrease the incidence of this specific type of injury theoretically.

Treadmill associated head injuries on the rise: an 18 year review of U.S. emergency room visits

OBJECTIVE

The treadmill is the most commonly used aerobic exercise equipment with studies showing many gym-related injuries are attributed to treadmills. The purpose of this study is to examine the incidence of treadmill-associated head injuries within the US.

METHODS

Retrospective data from 1997 to 2014 was collected via the National Electronic Injury Surveillance System, which provides annual es7timates of injuries associated with consumer products. Patients over 18 years who sustained treadmill-associated head injuries were included, and the estimated annual incidence was determined.

RESULTS

An estimated 4929 patients presented to US emergency departments with a head injury while exercising on a treadmill between 1997 and 2014. A >1000% increase in the number of head injuries was observed over the study period (p-value <0.001). Patients over 50 had a 14 times greater risk of admission than younger patients (p-value <0.001). Injuries were greater in women than men.

CONCLUSION

Our study demonstrates a significant increase treadmill-associated head injuries from 1997 to 2014. This phenomenon is most pronounced in older and female populations. The exact etiology of this large increase remains unclear. Education on the proper use of treadmills as well as further investigation into the cause of the increase are warranted.

A rare case of severe third degree friction burns and large Morel-Lavallee lesion of the abdominal wall

Background

Morel-Lavallee lesions (MLLs) are rare internal degloving injuries typically caused by blunt traumatic injuries and most commonly occur around the hips and in association with pelvic or acetabular fractures. MLL is often overlooked in the setting of poly-trauma; therefore, clinicians must maintain a high degree of suspicion and be familiar with the management of such injuries, especially in obese poly-trauma patients.

Case presentation

We present a 30-year-old female pedestrian struck by a motor vehicle who sustained multiple long bone fractures, a mesenteric hematoma, and full-thickness abdominal skin friction burn which masked a significant underlying abdominal MLL. The internal degloving caused significant devascularization of the overlying soft tissue and skin which required surgical drainage of hematoma, abdominal wall reconstruction with tangential excision, allografting, negative pressure wound therapy, and ultimately autografting.

Conclusion

MLL is a rare, often overlooked, internal degloving injury. Surgeons must maintain a high index of suspicion when dealing with third degree friction burns as they may mask underlying injuries such as MLL, and a delay in diagnosis can lead to increased morbidity.

Analysis of 344 Hand Injuries in a Pediatric Population

Background

The purpose of this study was to identify comprehensive hand injury patterns in different pediatric age groups and to assess their risk factors.

Methods

This retrospective study was conducted among patients younger than 16-year-old who presented to the emergency room of a general hospital located in Gyeonggi-do, Republic of Korea, and were treated for an injury of the finger or hand from January 2010 to December 2014. The authors analyzed the medical records of 344 patients. Age was categorized according to five groups.

Results

A total of 391 injury sites of 344 patients were evaluated for this study. Overall and in each group, male patients were in the majority. With regard to dominant or non-dominant hand involvement, there were no significant differences. Door-related injuries were the most common cause in the age groups of 0 to 3, 4 to 6, and 7 to 9 years. Sport/recreational activities or physical conflict injuries were the most common cause in those aged 10 to 12 and 13 to 15. Amputation and crushing injury was the most common type in those aged 0 to 3 and 4 to 6 years. However, in those aged 10 to 12 and 13 to 15, deep laceration and closed fracture was the most common type. With increasing age, closed injuries tended to increase more sharply than open injuries, extensor tendon rupture more than flexor injuries, and the level of injury moved proximally.

Conclusions

This study provides a comprehensive overview of the epidemiology of hand injuries in the pediatric population.

The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review

OBJECTIVE

The aim of this systematic review was to discuss the comparison of split-thickness skin graft (STSG) and full-thickness skin graft (FTSG) use as the treatment for volar digital and palmar burns in children.

METHODS

We conducted PubMed and Cochrane Library searches using keywords "hand injuries", "contracture" and "skin transplantation". The search was limited to studies published from 1st January 1980 until 31st December 2013 and used English language. We selected the studies based on specific inclusion and exclusion criteria. We assessed the quality of the studies by using Newcastle-Ottawa Scale (NOS) for cohort studies.

RESULTS

We included eight articles in our systematic review. One of those studies is a prospective cohort study and the others are retrospective cohort studies. Based on combined range of motion (ROM) evaluation in three studies, STSG group yielded poorer functional outcomes than FTSG group. However, there is no study which can fairly show that FTSG was significantly superior to STSG to achieve good functional outcomes.

CONCLUSION

Currently, there is no strong, high-quality evidence to prove that FTSG is superior to STSG to cover pediatric palmar burns. Either FTSG or STSG can be utilized with consideration of several influential factors especially splinting and physiotherapy.

Emergency department-reported injuries associated with mechanical home exercise equipment in the USA

The goal of this study was to generate national estimates of injuries associated with mechanical home exercise equipment, and to describe these injuries across all ages. Emergency department (ED)-treated injuries associated with mechanical home exercise equipment were identified from 2007 to 2011 from the National Electronic Injury Surveillance System. Text narratives provided exercise equipment type (treadmill, elliptical, stationary bicycle, unspecified/other exercise machine). Approximately 70 302 (95% CI 59 086 to 81 519) mechanical exercise equipment-related injuries presented to US EDs nationally during 2007-2011, of which 66% were attributed to treadmills. Most injuries among children (≤4 years) were lacerations (34%) or soft tissue injuries (48%); among adults (≥25 years) injuries were often sprains/strains (30%). Injured older adults (≥65 years) had greater odds of being admitted, held for observation, or transferred to another hospital, compared with younger ages (OR: 2.58; 95% CI 1.45 to 4.60). Mechanical exercise equipment is a common cause of injury across ages. Injury awareness and prevention are important complements to active lifestyles.

Epidemiology of pediatric hand injuries presenting to United States emergency departments, 1990 to 2009

BACKGROUND

The goal of this study is to describe the epidemiology of hand injuries among children treated in US emergency departments (EDs), including the consumer products and activities most commonly associated with these injuries.

METHODS

A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System for patients younger than 18 years, who were treated in an ED for hand injuries from 1990 through 2009. Sample weights were applied to calculate national estimates, and US Census Bureau data were used to determine injury rates.

RESULTS

An estimated 16,373,757 (95% confidence interval: 14,082,965-18,664,551) children younger than 18 years were treated in EDs for hand injuries from 1990 through 2009 with a mean annual injury number of 818,688 and rate of 11.6 per 1,000 population. There was a statistically significant decrease in the annual number (by 20.5%) and rate (by 31.5%) of hand injuries during the 20-year study period. Males accounted for 65.3% of hand injuries. Injuries most commonly occurred in the home (57.7%) and were most frequently diagnosed as lacerations (31.3%). Patients aged 10 years to 14 years were most frequently diagnosed with fractures (26.7%) and were 1.71 (95% confidence interval: 1.68-1.75) times more likely to be diagnosed with a fracture than patients in other age groups. Hand injuries commonly occurred with products/activities associated with sports/recreational activities (36.4%).

CONCLUSION

Hand injuries are a common and preventable source of pediatric morbidity. Prevention efforts should target the home environment and sport/recreational activities.

LEVEL OF EVIDENCE

Epidemiological study, level III.

Management of treadmill hand injuries using soft tissue distraction

Background:

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age.

Objectives:

In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients.

Materials and Methods:

In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed.

Results:

A total of 8 patients (3 girls and 5 boys) following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just 1 patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers.

Conclusions:

Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients.

Paediatric injuries due to home treadmill use: an emerging problem

INTRODUCTION

The use of home exercise equipment is increasing and treadmills are becoming more popular. This has brought with it an emerging but preventable problem. We present our experience, highlight the importance and promote public awareness of this type of injury. To our knowledge this has not been reported previously in the UK.

METHODS

A retrospective review was conducted of the medical records at two regional burn units of children who sustained treadmill-related injuries between July 2003 and July 2009. Data on patient demographics, mechanism of injury, management, surgical intervention and outcome were recorded.

RESULTS

Twenty-nine children (15 boys, 14 girls) sustained treadmill-related injuries. The mean age was 3.8 years (range: 1-13 years). All injuries occurred at home and the majority of children trapped their hand under the running belt when an adult was using the machine. Most of the injuries were to the upper limb (97%) with less than 1% of the total body surface area burnt. More than two-thirds of patients had deep burns and 17 (58%) required surgical intervention. Five patients developed hypertrophic scars. All patients achieved a good functional outcome.

CONCLUSIONS

Treadmills can pose a significant danger to children. These injuries are preventable. Regulatory authorities, manufacturers and parents should take steps to prevent this emerging health problem.

Paediatric treadmill friction injuries

AIM

The aim of this study was to report on the severity and incidence of children injured by treadmills and to promote the implementation of safety standards.

METHOD

This retrospective review of children with treadmill friction injuries was conducted in a single tertiary-level burns centre in Australia between January 1997 and June 2007.

RESULTS

The study revealed 37 children who sustained paediatric treadmill friction injuries. This was a presentation of 1% of all burns. Thirty-three (90%) of the injuries occurred in the last 3.5 years (January 2004 to June 2007). The modal age was 3.2 years. Thirty-three (90%) injuries were either full thickness or deep partial friction burns. Eleven (30%) required split thickness skin grafts. Of those who became entrapped, 100% required skin grafting.

CONCLUSION

This study found that paediatric treadmill friction injuries are severe and increasing in incidence. Australian standards should be developed, implemented and mandated to reduce this preventable and severe injury.

Pediatric treadmill injuries: a public health issue

BACKGROUND

Treadmill injuries in children tend to be severe and are becoming increasingly common. We present an overview of this problem to promote public awareness, education, and to advocate a prevention strategy for this preventable injury.

METHODS

Medical records of all children with treadmill-related injuries during a 6-year period (January 2001-November 2006) from 2 tertiary pediatric hospitals were reviewed. Data on patient demographics, injury related data, types of surgical procedure, and outcome of treatment were collected.

RESULTS

Forty-four children with treadmill-related injuries were admitted in a 6-year period (2001-2006). Each year, the incidence increased with 17 (39%) cases occurring in 2006 so far. The median age of injury at the time of incident was 2.8 years (range, 8 months-12 years). There was a higher incidence in males (55%) compared with females (45%). Most of these injuries were to the hand (75%), full-thickness burns (59%), <1% of total burn surface area (TBSA) (73%), and occurred while the treadmill was in use by an adult (34%). Twenty-one (47%) children required skin grafting surgery.

CONCLUSION

Treadmill-related burn injuries in children are a serious public health issue and warrants considerable attention. Adult supervision is paramount, and prevention strategies should include child safety features in equipment designs.