Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types

Sandvall, Brinkley K.; Keys, Kari A.; Friedrich, Jeffrey B.

doi:10.1016/j.jhsa.2017.01.028

Cited by 32 publications

(34 citation statements)

References 12 publications

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“…As all fireworks are illegal in our state, it is difficult to conclude whether a blanket ban on all fireworks has affected which fireworks cause severe injury from our data alone. In the description by Sandvall et al 3 of 105 firework injuries, the proportion of injuries due to legal fireworks was much higher than the proportion of injuries due to illegal fireworks. It is interesting to note that the ratio of their injuries due to mortars (legal in their state) to bottle rockets (illegal) was roughly 50:1, whereas in our study the ratio was 2:1.…”

Section: Discussionmentioning

confidence: 93%

Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization

Ortíz

Özkan

Chen

et al. 2019

Hand (New York, N,Y.)

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Background: Firework injuries to the hand can be devastating due to the explosive and ballistic nature of these devices. The aim of this study was to describe the injury and treatment characteristics of patients requiring surgery for fireworkrelated hand injuries and to investigate which factors are associated with an increased utilization of health care resources. Methods: A retrospective chart review of patients undergoing surgery for firework-related hand injuries at two American College of Surgeons level I trauma centers between 2005 and 2016 was performed. Twenty cases were identified. These patients were evaluated for demographics, injury characteristics, number and types of surgical interventions, length of stay, and utilization of health care resources. Bivariate analyses were performed to investigate which factors were associated with increased consumption of health care resources. Results: Injuries ranged from digital nerve injuries to traumatic amputation. Patients underwent a median of 3 surgical operations. More than half the patients underwent flap or skin graft coverage of a soft tissue defect. The median length of hospital stay was 7 days. Factors found to be associated with an increased utilization of surgical and hospital resources included a first web space injury, thumb fracture, and traumatic amputation of any digit. Conclusions: The morbidity inflicted by firework injuries to individual patients is substantial. Patients with severe injuries undergo a median of three surgical operations and have a long duration of initial hospital stay. Knowing which factors are associated with an increased utilization of resources can help prognosticate these preventable injuries.

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Section: Discussionmentioning

confidence: 93%

Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization

Ortíz

Özkan

Chen

et al. 2019

Hand (New York, N,Y.)

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“…* p < 0.05 compared to saline control group and 2) the release of chemicals that pollute waterways. Injuries to limbs and fingers occur predominantly in males during the teen years and such accidents are recorded and reported at many levels of the health care system in the U.S. [3][4][5][22][23][24]. These acute injuries and burns are significant adverse health effects and largely preventable by the use of proper safety procedures.…”

Section: Discussionmentioning

confidence: 99%

Toxicity of particles emitted by fireworks

et al. 2020

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Background: Particle matter (PM) has been associated with increased morbidity and mortality rates across the world. This study was designed to test the hypotheses that pyrotechnic firework displays introduce significant amounts of toxic metals into the atmosphere and are hazardous to human health. Size-selective emissions from 10 different fireworks displays were collected during particle generation in a dynamic, stainless steel chamber and tested for toxicity in cells. A subset of 2 particle types were tested in vivo in mice. At doses that did not produce cytotoxicity in an LDH assay, in vitro reactive oxygen species (ROS) formation was measured in bronchial epithelial airway (BEAS-2B) and human pulmonary microvascular endothelial (HPMEC-ST1.6R) cell lines treated with sizefractionated particles from the emissions of fireworks. Results: Significant increases in ROS, in both cell types, were dependent upon the type of firework but not particle size. The in vitro ROS activity was correlated with lung inflammation produced in groups of mice treated by oropharyngeal aspiration with 0, 50, or 100 μg fireworks PM 10 /mouse. Trace metal analyses of the PM 10 samples showed significant differences in metal content among fireworks type. Interestingly, the PM 10 sample for the fireworks type producing the greatest in vitro ROS response in BEAS-2B cells contained~40,000 and~12,000 ppm of lead and copper, respectively. This sample also produced the greatest inflammatory response (i.e., increased neutrophils in bronchoalveolar lavage fluid) in mice. Conclusions: These findings demonstrate that pyrotechnic display particles can produce adverse effects in mammalian cells and lungs, thus suggesting that further research is needed to expand our understanding of the contribution of metal content to the adverse health effects of fireworks particles. This information will lead to the manufacture of safer fireworks.

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“…Numerous studies have demonstrated that the hands are the most commonly affected body part in firework injuries2 4 5 7 and the majority of patients are young men2 4 who take more risks. Once immediate life-threatening conditions have been treated and broad-spectrum antibiotics administered, the priority is to perform thorough yet accurate debridement of devitalised tissues and achieve skeletal stabilisation.…”

Section: Discussionmentioning

confidence: 99%

“…Although the spectrum of injuries caused by fireworks is diverse, studies have demonstrated that the majority of injuries affect the hands,4 particularly the thumb5 of male patients much more likely to be injured than female patients 6. These preventable injuries can be devastating and pose a significant surgical challenge due to the combination of burn and blast forces.…”

Section: Introductionmentioning

confidence: 99%

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Firework-related blast injury to the hand and treatment algorithm

2019

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Firework injuries, which most commonly affect hands, are increasing in frequency and severity. We present a pictorial case of a devastating hand injury following a firework explosion in a young male patient. The blast resulted in splaying of the hand with multiple fractures, neurovascular compromise and soft tissue loss. Reconstruction involved a third-ray amputation, fracture fixation, nerve and soft tissue repair resulting in an adequate hand with near-normal appearance. Firework-related hand injuries pose a significant surgical challenge due to the combination of burn and blast forces that can compromise the function of intact vessels and nerves making salvage and reconstruction particularly difficult. Here, we propose a treatment algorithm based on current literature. Our case demonstrates, what initially appeared to be an unsalvageable injury can be reconstructed to produce a functional hand if appropriate surgical measures are taken.

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Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types

Cited by 32 publications

References 12 publications

Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization

Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization

Toxicity of particles emitted by fireworks

Firework-related blast injury to the hand and treatment algorithm

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