Articles Posted in Limb Injuries or Loss

Approximately 300,000 injuries involving doors need treatment at an emergency room each year in the U.S. Most of the victims are children of preschool age and under, and most injuries from doors result in some kind of amputation. These door-related injuries are completely preventable and there are some inexpensive devices that could be put on doors to prevent these amputation injuries. There are door closing devices that prevent a door from slamming and prevent injuries from the open side of the door. Most serious injuries, however, result from the door’s the hinge side, where the closing pressure from the door can exceed 80,000 pounds per square inch.

Some companies have created hinge protectors that eliminate the possibility of hinge accidents. A casing made of plastic is placed around the sides of the door that blocks contact with the hinge face. There are door stoppers that can also help prevent unexpected door closures. You can also paint or tape near the hinge and door knob side of the door to remind kids to stay away from that part of the wall.

Water sports are becoming more popular around the world. People are spending more time racing boats, water skiing, scuba diving and skin diving. Injuries because of boat propellers are also becoming more frequent. One study looked at the ten year period from 1963-1973 and studied nine cases of injury by boat propeller. Some resulted in an amputation as a result of the propeller itself. Others needed surgical amputation due to mangled extremities.

Injuries on boats are not simply a national occurrence. The below examples are listed not for shock value but to illustrate the need to use caution when on or near boats. These were recent news items from 2012 and 2013 illustrating the mechanism of injury due to water sports and/or while on a watercraft.

Microsurgery is one of the latest types of surgery to develop. It involves doing surgery to blood vessels and nerves underneath a microscope. It is the type of surgery that makes doing replantation of amputated body parts possible. Vessels and nerves of around one millimeter in diameter have been reattached successfully. Microsurgery is used in trauma surgery as well as in plastic surgery, general surgery, ophthalmology, orthopedic surgery, neurosurgery, pediatric surgery, maxillofacial surgery, and otolaryngology.

Microsurgery was first used by otolaryngologists in about 1921. The first monocular surgical microscope was built and was eventually used in people who had fistulae. Binocular microscopes were then used starting in 1922. Other ear operations were done using a binocular microscope soon after.

Children have a higher likelihood of being injured or killed from trains than adults. They like to play on train tracks and have a lesser ability to detect the speed of a train coming towards them. Their bodies are more frail than adult bodies and the forces on the bodies from the train are great.

One study looked at the pattern of sustained injuries in kids who are injured in train tracks and train accidents. It was a retrospective review of those patients who showed up on two different trauma registries for the years 1984 through 1994. The patients attended a level I trauma center in a single metropolitan area. A total of 17 patients were treated for injuries at the level I trauma center. Those who were injured in a car that was struck by a train and those that were pronounced deceased at the scene were excluded from the study.

Fingertip accidents are commonplace amputations at home or on the job. Fingertips can slam in doors, in car doors, while chopping food or when clearing out a lawnmower or snowblower. These types of injuries can involve crushing of the fingertip, tearing of the fingertip or cutting off of the fingertip, including the thumb. The nailbed, soft tissue and bone (phalanx) can be involved in the injury. The tips of the fingers are injured more commonly than the rest of the finger because they are the least likely to escape harm’s way.

These types of amputations are very painful because there are a lot of nerves in the area. They also tend to bleed quite a lot due to a rich blood supply. When an amputation happens, you should elevate the stump and cover the wound with a sterile dry dressing. Apply pressure if needed. If there is a part of the finger that is cut off, it should be wrapped in a moist sterile gauze and placed in a baggie. You should then place the baggie in some ice water. Don’t put the amputated part directly on ice and do not use dry ice to keep the amputated part cold.

Traumatic hemipelvectomies are rare traumatic injuries with a forty percent mortality rate. It happens when half of the pelvis from the pubic symphysis to the sacroiliac joint is pulled away from the rest of the body in an open or closed injury. Because this is a situation that often results in death, it is important for the trauma team to do angiography to assess the circulation to the area, x-rays to determine the extent of the fracture and possibly a CT scan of the pelvis to determine what the injury looks like in three dimensions. Only aggressive surgical treatment can save the person’s life.

Because prehospital care has gotten so good, more and more people are arriving to the trauma centers alive rather than dead. This is a very unstable fracture with ligamentous injury and bony injury with external bleeding in some cases. The pelvic neurovascular bundle is usually destroyed, affecting sensation to the affected, partially-amputated leg.

Finger amputations may sound small but they really cause a lot of changes in the way the patient performs certain activities, such as punching the buttons on a phone or using a keyboard. This is why the surgeon will attempt to put the finger back on if it is severed from the hand.

When a finger is initially severed, the bystander should wrap the amputated finger in moist, cool gauze. The finger should not be immersed in water because it can become waterlogged. Simply use a paper towel if you have no medical gauze. Put the finger on ice with a Ziploc bag. Do not use dry ice for this part of the process. If there will be an attempt to reimplant the finger, there should be immediate medical attention with a surgeon who can put arteries, veins and nerves back together. The time from amputation to reimplantation should be less than 12 hours.

Finger Amputation in Children

Finger Amputation in Children

Finger amputations in children are different from finger amputations in adults. Children often get their fingers amputated by being slammed indoors or getting their fingers caught in the hinge side of the door. In adult cases, the finger is not generally reattached if it is only detached. In kids, every attempt is made to reattach a single amputated finger.

Subway accidents can have devastating consequences for those involved. In fact, many people do not survive pedestrian versus subway collisions. While the subway system is designed with the intent to be safe, they are not immune to issues. When things do go wrong, people suffer from permanent severe injury and death.

One study conducted a retrospective review using information between 1989 and 2003. In the study, they found 41 patients who were involved in a subway accident and that had presented to Bellevue Hospital in New York City for treatment. The researchers collected pertinent information such as the patient’s age, gender, Injury Severity Score, the time of the accident, and the mechanism by which the accident happened.

Above the elbow amputations are also called trans-humeral amputations and are more difficult than below the elbow amputations to fit with prostheses that are comfortable and functional. When the injury happens at the level of the elbow or above, the person must have a transhumeral amputation with the attempt made to have the stump as long as possible. Longer stumps can help the individual use the prosthesis more effectively.

Another above the elbow amputation that is more severe is through the shoulder with shoulder disarticulation. These are the hardest to place with a prosthesis that the patient can easily use and tend to be unwieldy and more for aesthetics than for functionality. The more joints that have to be replaced, the harder it is to have a functional prosthetic.

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