SNOWBLOWER INJURIES TO THE HAND

A retrospective review of 22 patients who sustained snowblower injurie s to the hand was performed. There were 17 men and 5 women, ranging in age from 20 to 68 years (average age, 39.7 years). Fifty percent were manual laborers, 25% were unemployed, 15% were office workers, and 10 % were not categorized. The dominant hand was involved in 86% of patie nts. In all patients, injuries occurred during an attempt to unclog ma nually the snowblower of wet snow. Patients were evaluated initially i n the emergency room, where their wounds were irrigated and debrided, subungual hematomas drained, and nail bed lacerations repaired. Patien ts with more extensive injuries were taken to the operating room for d efinitive treatment including open or closed reduction of fractures, f ingertip replacement as composite grafts or skin grafts, revision ampu tations, tenorrhaphies, and digital nerve repairs. All injuries occurr ed distal to the metacarpophalangeal joints. Only 1 patient sustained an injury to the proximal phalanx. Ten patients injured only 1 finger, 6 patients injured 2 fingers, and 6 patients injured 3 fingers. The m iddle and ring fingers were most commonly injured (39.6% and 33.3% res pectively), followed by the index and little fingers (16.7% and 8.3% r espectively), and the thumb (2.1%). Phalangeal fractures were the most common type of injury, occurring in 29.2% of patients, and usually in volved the distal phalanx. This was followed in frequency by nail bed injuries (22.9%), amputations (22.9%), tendon lacerations (14.6%), sof t-tissue avulsions (6.3%), and digital nerve injuries (4.2%). Snowblow er injuries can involve bone, soft tissue, nail bed structures, nerves , and tendons, and may even result in amputation of one or several fin gers. These injuries are localized to the distal portions of the finge rs. The middle and ring fingers are most commonly involved, with relat ive searing of the thumb. Fractures are the most frequent injury, foll owed by nail bed injuries and amputations. Snowblower injuries are oft en managed as open fractures with intravenous antibiotics; irrigation and debridement; and repair of bone, soft tissue, and nail bed structu res.