Treadmill injuries to the upper extremity in pediatric patients

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.

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.

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.

Home exercise equipment-related injuries among children in the United States

This study investigated home exercise equipment-related injuries to children in the United States. Data from the National Electronic Injury Surveillance System were analyzed for children 18 years old and younger. An estimated 241 573 children with home exercise equipment-related injuries were treated in US hospital emergency departments from 1990 through 2008, averaging 12 714 children per year. There was a statistically significant increase in the annual number (41.9%) and rate of home exercise equipment-related injuries during the study period. Children younger than 10 years accounted for 71.4% of these injuries. Laceration (37.2%) was the leading injury diagnosis, and the most commonly injured body regions were the head (28.6%), finger/hand (22.0%), and foot (10.9%). The majority of injuries were associated with stationary bicycles (26.5%), treadmills (25.3%), and jump ropes (21.5%). The increasing number and rate of home exercise equipment-related injuries to US children underscores the need for increased efforts to prevent these injuries.

Initial management of acute pediatric hand burns

Hand burns, in particular, are one of the leading causes of hand injury in children and can result in significant impairment of hand function. Appropriate initial management of hand burns in children is imperative to optimize function and minimize long-term scarring, and it is for this reason that the American Burn Association advocates referral of pediatric hand burns to a verified burn center.

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.

Pediatric hand friction burns from treadmill contact

BACKGROUND

Treadmills have become relatively common in American homes. This machine can be dangerous for children because they can sustain friction burns to the hands when the moving treadmill is touched. With aggressive wound care and physical therapy, most of these burns will heal without surgery. However, some patients will require reconstructive surgery to release contractures. We report our experience with a series of patients who suffered friction burns to the hand from contact with a moving treadmill. The purpose of this study is to further understand the incidence and outcomes of this type of injury.

METHODS

A retrospective chart review of all patients referred between September 2002 and June 2005 to our hand surgery clinic for treadmill friction burns on the hand(s) was conducted. Pertinent data collected included sex, age, injury distribution, and surgeries performed. An analysis of data maintained by the Consumer Product Safety Commission was used to understand the incidence of exercise equipment-induced injuries.

RESULTS

Thirteen pediatric patients were evaluated for friction burns on the hand. Their total injuries included 24 fingers, 1 hand, and 1 forearm. Three patients (23%) required surgery for release of flexion contractures. All wounds of the remaining 10 patients healed, and with the implementation of hand therapy programs did not require subsequent surgery.

CONCLUSIONS

Treadmill friction burns to the hands of children can lead to limitations of the motion of the hand. Because this problem is completely preventable, parents and treadmill manufacturers are encouraged to be proactive in preventing these injuries. In addition, prompt initiation of wound care and hand therapy is integral to a favorable outcome.

Epidemiology of exercise equipment-related injuries to young children

OBJECTIVES

The objective of this study was to describe and identify the type, cause, and epidemiology of injuries related to exercise equipment to children younger than 5 years reported to US emergency rooms.

METHODS

A retrospective review of data for children 4 years old and younger from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for the years 1994 to 2001 was conducted. A total of 1679 children were identified obtaining treatment at a participating emergency room.

RESULTS

There were an estimated 46,440 exercise equipment-related injuries (95% confidence interval, 38,081-55,079 injuries) to children 4 years old and younger treated in hospital emergency departments in the United States during the 8-year study period. The annual rate of injury among children was 28.32 per 100,000. Most injuries involved the head, foot, and hand regions. Injury diagnosis included lacerations (49%), soft tissue injuries (29%), and fractures and dislocations (9%). Most hospital admissions were for amputations (36%), fractures (34%), and lacerations (20%).

CONCLUSIONS

Injuries can result from children's exposure to exercise equipment in the home. Parental awareness of the dangers of home-based exercise equipment and the potential hazards of exercise equipment-related injuries on the limbs and head region is recommended.

Characteristics of pediatric traumatic amputations treated in hospital emergency departments: United States, 1990-2002

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.

Pediatric hand injury induced by treadmill

Korea has recently seen an increase in pediatric hand injuries associated with treadmills. This study was conducted to identify the frequency, patterns, treatment and outcome of these injuries, in the hope of developing preventive programs. A retrospective review of the medical records of 25 children, all with treadmill-induced friction hand injuries, was conducted at the Hallym Burn Centre, Hangang Sacred Heart Hospital, Seoul, Korea, during the period of January 2002 to March 2004. The injuries constituted 1.4% of the total number of pediatric burn injury admissions. Male toddlers were affected more than female. The mean age of the children was 3.9+/-3.2 (3, 1-15) years old. Most injuries occurred in spring. Treadmill friction inflicted deep second or third degree burns, small in area (1.6+/-1.0% of TBSA). All lesions involved the hands and forearms, with 60% on the right. Most patients (64%) underwent surgical management 13+/-5 days after the injury. The volar surface of the hand was more affected than the dorsal side (27 versus 8). Treatment was mainly with full thickness skin graft (60%) and long-term surgical outcomes were excellent. Such injuries may be prevented by educating the public about the potential risks of the treadmill, and by the development of additional safety designs. Changes in management protocols and treatment policies would improve the provision of appropriate care.

Home Treadmill Friction Injuries: A Five-Year Review

Treadmills are popular home fitness machines in American homes. Young children are at risk for friction injuries if they contact moving treadmills. The purpose of this study was to determine the impact of treatment of treadmill friction injuries in children. A review of 1,211 pediatric patients younger than 6 years treated at the Intermountain Burn Center between July 1997 and June 2002 was conducted. Forty-eight of these cases (4%) were treadmill friction injuries. The mean TBSA of these burns was 0.5%. The volar surface of the hand was the most common site of injury. Twenty-two (46%) of the 48 identified patients had full-thickness injuries that were treated surgically. Medical costs associated with treadmill friction injuries averaged US 2,385 dollars. The number of treadmill friction accidents resulting in friction injuries to children less than 6 years of age deserves serious attention and increased public awareness.

Treadmills: A Preventable Source of Pediatric Friction Burn Injuries

Treadmills are a burn risk for children. A child's hand can get trapped in the conveyor belt, causing friction burns to the underlying tissue. The purpose of this retrospective study was to review the characteristics and treatment of treadmill-related burns in children from 1998 to 2002. Ten patients, at a mean age of 3.4 years, sustained injuries associated with treadmill use. Trapping of the hand between the conveyor belt and the base was the most frequent injury mechanism. Burn location was predominantly on fingers and palms. Four patients required operative intervention. All patients required specialized wound care as well as scar management and occupational therapy. Treadmills pose a danger to children. Current safety devices are ineffective for preventing serious hand injuries in children. New design modifications and public awareness are needed to improve child safety.

Pediatric hand treadmill injuries

The great popularity of physical fitness in modern society has brought many pieces of exercise equipment into our homes for convenience and privacy. This trend has come with an increasing rate of injuries to children who curiously touch moving parts, including treadmill belts. Experience with a recent series of treadmill contact burns to children's hands is described in this article. A retrospective chart review at a tertiary referral center from June 1998 until June 2001 found six children sustaining hand burns from treadmills. The patients' ages at presentation ranged from 15 to 45 months (average of 31 months, three boys and three girls). All injuries occurred in the home while a parent was using the treadmill. Burns involved the palmar aspect of the hand, mostly confined to the fingers, and the severity ranged from partialto full-thickness burns. All patients were initially managed with collagenase and bacitracin zinc/polymyxin B powder dressings to second- and third-degree burns, along with splinting and range-of-motion exercises. Two patients required skin grafting at 2 weeks and 2 months for full-thickness tissue loss and tight joint contracture, respectively. At an average follow-up of 12 months, all patients had full range of motion and no physical limitation. The rate of children injured by exercise equipment is expected to increase. Friction burns to the hands remain a concern, although early recognition and appropriate management are associated with excellent functional outcomes. Protective modification of exercise machines seems to be the best approach to eliminating these injuries.

Acute management of exercise treadmill-associated injuries in children

BACKGROUND

Exercise treadmills have grown in popularity in the past few years. The addition of this type of equipment in the home offers opportunity for injury, particularly in children.

METHODS

Patients were identified both prospectively and retrospectively by review of the trauma registry and medical records. Patient data, medical treatment, and hospital costs were obtained from medical records. Functional outcome was assessed by the modified Michigan Hand Outcomes Questionnaire.

RESULTS

Nine patients were observed with 14 injuries. The average age was 3.4 years, with average clinical follow-up of 9.1 weeks. The primary injury was friction burn (eight of nine), with one patient sustaining a thumb distal tuft fracture. Two patients required operations and all patients had a good functional outcome (124.5 of 125 on the Michigan Hand Outcomes Questionnaire).

CONCLUSION

Treadmill-associated injuries primarily involve hand injury in children. These injuries usually do not require surgical intervention and are preventable. Prevention modalities include additional manufacture safety features, warning labels, and parental education.