HALLOWEEN PUMPKIN CARVING SAFETY TIPS (part 2)

Halloween Safety Tips That Are No Trick:  Orthopaedic Surgeons offer Halloween Injury Prevention Tips

Every Halloween, kids across the country parade
 neighborhoods in search of the most glorious prize:
candy.   The build-up for Halloween is almost as exciting as the day itself with pre-Halloween festivities like pumpkin-picking, pumpkin carving and selecting the perfect costume for the big day.  And though the holiday calls for fun, the American Academy of Orthopaedic Surgeons (AAOS) stresses the importance of taking proper precautions to avoid injuries this Halloween.

HALLOWEEN INJURY STATISTICS: A nine-year study examined holiday-related pediatric emergency room visits between 1997 and 2006.  Results of this study show Halloween among the top three holidays producing the most ER visits:

• Finger/hand injuries accounted for the greatest proportion of injuries on Halloween (17.6 percent).
• Of the finger/hand injuries sustained on Halloween, 33.3 percent were lacerations and 20.1 percent were fractures.
• Children ages 10-14 sustained the greatest proportion of injuries (30.3 percent).

Source:  D’Ippolito A, Collins CL, Comstock RD. Epidemiology of pediatric holiday-related injuries presenting to US emergency departments. Pediatrics. 2010 May;125(5):931-7.

for more information :   http://handctr.blogspot.com/2010/10/hand-surgeons-warn-of-pumpkin-carving.html

Hand Surgeons Warn of Pumpkin Carving Dangers

Hand Surgeons Warn of Pumpkin Carving Dangers




Hand Surgeons Warn of Pumpkin Carving Dangers


Use caution during the Halloween season, and take steps to prevent hand injuries when carving.

“Every Halloween season we see four or five patients—both adults and children—who come into our office with severe injuries to their hands and fingers,” says Jeffrey Wint, MD, an ASSH member from The Hand Center of Western Massachusetts, Springfield, MA. “Treatment can often run three to four months from the time of surgery through rehabilitation.”

To prevent hand injuries, the ASSH suggests the following safety tips

Carve at a Clean, Dry, Well-lit Area

Wash and thoroughly dry all of the tools that you will use to carve the pumpkin: carving tools, knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

Always Have Adult Supervision

“All too often we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own,” says Wint. “Even though the carving may be going great, it only takes a second for an injury to occur.”

Leave the Carving to Adults

Never let children do the carving. Wint suggests letting kids draw a pattern on the pumpkin and have them be responsible for cleaning out the inside pulp and seeds. When the adults do start cutting, they should always cut away from themselves and cut in small, controlled strokes.

Sharper is not Better

“A sharper knife is not necessarily better because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it,” says Wint. “An injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.”

Use a Pumpkin Carving Kit

Special pumpkin carving kits are available in stores and include small serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue. “If they do get jammed and then wedged free, they are not sharp enough to cause a deep, penetrating cut,” says Wint.

Help for a pumpkin carving injury

Should you cut your finger or hand, bleeding from minor cuts will often stop on their own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room visit may be required.

Copyright © American Society for Surgery of the Hand 2009.

modified altered and changed by www.handctr.com from assh.org

see also http://www.handctr.com/Jeffrey%20C%20Wint.htm

http://www.assh.org/Public/Safety/Pages/PumpkinCarvingSafety.aspx

Mallet finger (baseball finger)

MALLET FINGER (BASEBALL FINGER)

A mallet finger occurs when the extensor tendon at the tip of a finger ruptures. The rupture of this tendon can involve the tendon alone, be associated with a small bone fragment or fracture or can be associated with a fracture that requires significant care.

The force applied to the finger can come from something as simple as tucking in a bed sheet or can come from a direct blow to the end of a finger. Mallet finger has also been known as baseball finger.

Mallet finger.

A mallet finger often begins with pain at the distal joint of the finger.  At times there is an immediate loss of motion while at other times the finger seems to stay straight for a while and only later starts to lose its ability to be extended actively at the tip.  At times there is an injuries are typically closed in that the skin and nail is intact but at times there is an injury to the skin or nail bed as well. In severe cases the injury is associated with an open injury to the joint or bone, a so called open or compound fracture.

In adults the injury can involve the joint surface.  In children it can involves the growth plate or physis.

The diagnosis is often made based upon the type of injury and the appearance of the finger.  The fingertip will droop down and there is a loss of active motion.  Often the finger can be passively pushed up to straighten it but the independent active motion to extend the digit at the tip has been lost

X-rays are often taken to further delineate the injury and see how much if any bone, joint or

Types of splints used to treat mallet finger. A, Dorsal aluminum splint. B, Commercial splint.

Reproduced with permission from Culver JE Jr: Office management of athletic injuries of the hand and wrist. Instr Course Lect 1989;38:473-482.

 growth plate is involved

Treatment depends largely upon the extent the soft tissue and underlying boney injury.

Tendon rupture without bone injury

Most of these mallet finger injuries can be treated with splinting.  The splint can be applied in a variety of ways depending upon the injury.  Typically the split is left in place full time for six to eight weeks with a time for part time splinting after that depending upon what daily activity is done by the patient with a typical part time period of 3 – 4 weeks.  In some situations pinning of the joint is used rather than a splint

Tendon rupture with a small bone fragment

These injuries typically are treated like non-boney injuries

Tendon rupture with a large bone fragment involving the joint.

 These injuries may respond to splinting and splinting is often used however a small bump may always be present a t the joint.  At times if the doctor feels that that the bone fragment is large enough and the joint may be unstable surgery may be offered.  During surgery pins or small screws may be used and the joint itself may be pinned to prevent motion during the healing process.

  

Above: X-rays showing fracture at the insertion of the extensor tendon. In the first image on the left the fragment is displaced.  This will heal with a bump but will be able to be treated with a splint.  IN the image on the right the joint has subluxed.  This will  need to have surgical repair.

In adults with severe open injury more immediate surgery may also be offered

Children

In children the doctor needs to differentiate between these injuries that require reduction or realignment of the bone without surgery and those who may have a portion of the nail bed significantly torn or retained within the fracture site or growth plate.  Often children will not have a tendon injury but a fracture through the physis which appears to be a mallet injury.  X-rays often will reveal this.

 

Mallet deformity from a fracture across the growth plate in a child is different than the adult fracture or tendon avulsion

Late or Delayed Treatment in adults

Delayed treatment of mallet finger deformity may consist of splinting initially and at times surgical methods are offered to correct chronic deformities and other associated joint and tendon problems that may accompany the chronic situation

Results

Most mallet fingers heal well, although often there is a slight loss of full extension. The slight extension loss typically has no effect on hand of finger function, but if left untreated it can cause other issues to occur in the finger due to tendon imbalance. While treatment of a closed mallet finger is not an acute emergency, the improper, partial or untreated injury can lead to further problems such as a swan neck deformity.

 Swan neck deformity from tendon imbalance and laxity at the proximal joint.