Purpose
The purpose of this study was to characterize injury patterns and outcomes of fireworks-related
hand injuries and determine if there was an association with certain fireworks types.
Methods
A retrospective cohort study was conducted on patients treated at a trauma center
between 2005 and 2015. A total of 105 patients sustaining operative hand injuries
due to fireworks were identified. Medical records were reviewed to identify injury
patterns, treatment outcomes, and fireworks types.
Results
Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There
were 12 thumb soft tissue–only injuries (13%) and 80 thumb fractures/dislocations
(87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%)
and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained
both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands
(25%) required thumb revision amputation. The number of surgeries for acute reconstruction
ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands
had deep first web space injuries, and 11 (17%) required flaps acutely for first web
space reconstruction. Six hands required secondary reconstruction of a first web space
contracture. An external fixator was applied to 6 hands to maintain the first web
space; none of these required secondary web reconstruction. Excluding isolated pin
removals and dressing changes under anesthesia, 19 patients (22%) required later-stage
surgeries. Shells/mortars (59%) were the most common fireworks type causing injury.
Conclusions
Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize
the thumb CMC joint, and deeply damage the first web space. The first web space requires
particular consideration because deep injury may result in adduction contracture and
require secondary reconstruction if not prevented.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: March 21, 2017
Accepted:
January 25,
2017
Received:
April 29,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
