Indian Pediatrics 1998; 35:763-765 

Pattern of Hand Injuries

Hand is one of the most commonly injured parts of the body(1). It is an intricate mechanical device and a sensory area almost as important as the face in communication with both the animate and the inanimate elements of the world around us. A seemingly trivial injury could have tragic consequences leaving behind some physical impairment, thus placing a great responsibility on the treating surgeon(2). Treatment should, therefore, restore function and should also not affect growth adversely and this should have absolute priority over restoration of appearance. There is little epidemiological data on hand injuries among children in literature(3). At the Christian Medical College and Hospital Ludhiana, we have treated a large number of hand injuries and have attempted to study the pattern and causes of hand injuries in children.

Subjects and Methods

One hundred and fifty five consecutive children with hand injuries who attended the Casualty Department of the Christian Medical College Hospital, Ludhiana, over a period of one year from May 1993 to April 1994 were prospectively studied to deter- mine the circumstances and causes of hand injuries. During the period of study a total of 428 patients with hand injuries attended the Casualty Department. For the study, hand injury was defined as all soft tissue injuries distal to the wrist crease and all bony injuries distal to the carpus. Patients with associated major life threatening systemic injuries were excluded. A detailed history from the patient, or his attendant was taken. A meticulous clinical examination in the casualty and operating room was undertaken and appropriate treatment given.

Results

There were 155 (36.2%) children below 16 years, out of a total of 428 patients with hand injuries. Injuries in children below five years were higher than in other age groups (Table 1). The mean age of the injured children was 6.5 years. Hand injuries were higher among males with a male to female ratio of 2.3:1. In 86 patients (55.5%) injuries occurred between 12 noon and 6.00 PM (Table II). Over a third of the injuries (61/155) were caused by Toka (fodder cutting machine) (Table III). This was higher than injuries sustained by other causes. The right hand was injured in 95 (61.3%) cases. In 3 cases (1.9%) both hands were injured. Only one finger was injured in 69 (44.5%) children, whereas two or more fingers were involved in 86 (55.5%). Hand injuries in children occurred more frequently in October and were least, common in August. Open amputations followed by lacerations were the two main types (65.8%) of injuries observed (Table IV).
 

Discussion

The high occurrence (36.2%) of hand in- juries in children compares well with other reports(4,5). Over one half of the injuries occurred in children less than five years of age. This may be due to the curiosity in this age group for exploring and experimenting with the surroundings, ignorant of the dangers involved. Older children may have better developed instincts and this may protect them from injury. In consonance with earlier reports(6), a male prep onderence was documented, possibly because boys were more involved in sports and fights. Hand injuries occurred most often between 12.00 noon and 6.00 PM as also observed by others(7); however, no specific reasons could be ascribed. Farm has been referred to as a place of enchantment for the young(8) but in our circumstances children are often called to help out, thus accounting for the high number (39.4%) of Toka injuries. Hand injuries being highest in the farm sector could be attributed to poor implementation of safety norms and repetitive hand movements being called for during the entire process of work. Another factor could be over-familiarity with the machine, making children bold enough to endanger themselves without switching off the machine.
 

Amputations (40.6%) formed the largest group as the injuries caused by the Toka were significantly higher than the injuries caused by other agents.

Children by nature are inquisitive and are often called to help in the farm thus they are prone to injuries. The incidence of mishaps and their effects can be reduced by supervising what children do. We should also alter the environment suitably like ensuring presence of safety devices. This can to a large extent reduce the incidence of hand injuries in children.

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