Major pediatric hand trauma associated with fireworks

Objectives: To characterize the injury pattern and economic impact of major pediatric hand trauma secondary to fireworks. Design: Retrospective. Setting: Pediatric Level 1 trauma center. Intervention: N/A Main Outcome Measurements: Fractures, amputations, soft tissue defects, len gth of hospitalization, number and type of procedures performed were obtain ed from charts, radiographs, and operative reports. Hospital charges were o btained from the billing office. Patients/Participants: Records of patients with a diagnosis of fireworks-re lated injuries admitted over a period of ten years were reviewed. Twenty-tw o patients were identified to have sustained twenty-two hand injuries. The group consisted of nineteen boys and three girls, with an average age of 9. 3 years (range, 4 to 17 years). Results: There were thirty-one fractures, nineteen amputations, and one dis location. The nineteen amputations occurred in nine hands. Local skin graft or flap coverage was required in six hands acutely, and delayed soft tissu e procedures were performed on four hands. Four hands had digital neurovasc ular injuries; two required microsurgical repairs at the time of injury, an d two were irreparable. Resource use included: average hospital stay of 4.3 days (range, 0 to 20), average number of trips to the operating room, 1.2 (range, 0 to 3), and average hospital charges of $11,582 (range, $1,035 to $39,489). Conclusions: This study illustrates the severity of pediatric hand injuries associated with fireworks and the significant burden placed on medical res ources in treating these injuries. Efforts toward public education and legi slative reforms may help to prevent these unnecessary injuries.