Exercise Treadmills: A Cause of Significant Hand Burns in Young Children

Early wound repair versus later scar repair in children with treadmill hand friction burns

The incidence of pediatric treadmill hand friction burns has been increasing every year. The injuries are deeper than thermal hand burns, the optimal treatment remains unclear. This was a retrospective study of children who received surgery for treadmill hand friction burns from January 1, 2015, to December 31, 2019, in a single burn center. A total of 22 children were surveyed. The patients were naturally divided into two groups: the wound repair group (13 patients), which was admitted early to the hospital after injury and received debridement and vacuum sealing drainage initially, and a full-thickness skin graft later; and the scar repair group (9 patients), in which a scar contracture developed as a result of wound healing and received scar release and skin grafting later. The Modified Michigan Hand Questionnaire score in the wound repair group was 116.31 ± 10.55, and the corresponding score in the scar repair group was 117.56 ± 8.85 (P>0.05), no statistically significant difference. The Vancouver Scar Scale score in the wound repair group was 4.15 ± 1.21, and the corresponding score in the scar repair group was 7.22 ± 1.09 (P<0.05). Parents were satisfied with the postoperative appearance and function of the hand. None in the two groups required secondary surgery. If the burns are deep second degree, third degree, or infected, early debridement, vacuum sealing drainage initially, and a full-thickness skin graft can obviously relieve pediatric pain, shorten the course of the disease, and restore the function of the hand as soon as possible.

Pediatric Treadmill Friction Burns to the Hand: Outcomes of an Initial Nonoperative Approach

Treadmill burns that occur from friction mechanism are a common cause of hand burns in children. These burns are deeper and more likely to require surgical intervention compared to hand burns from other mechanisms. The purpose of this study was to identify the factors associated with healing time using an initial nonoperative approach. A retrospective chart review was performed examining children (<15 years) who were treated for treadmill burns to the hand between 2012 and 2019. Patient age, burn depth, total body surface area of the hand injury, and time to healing were recorded. Topical wound management strategies (silver sheet, silver cream, non-silver sheet, and non-silver cream) and associated treatment durations were determined. For patients with burns to bilateral hands, the features, treatment, and outcomes of each hand were assessed separately. Cox regression analysis was used to evaluate the association between time to healing and patient characteristics and treatment type. Seventy-seven patients with 86 hand burns (median age 3 years, range 1-11) had a median total body surface area per hand burn of 0.8% (range 0.1-1.5%). Full-thickness burns (n = 47, 54.7%) were associated with longer time to healing compared to partial-thickness burns (HR 0.28, CI 0.15-0.54, P < .001). Silver sheet treatment was also associated with more rapid time to healing compared to treatment with a silver cream (HR 2.64, CI 1.01-6.89, P = .047). Most pediatric treadmill burns can be managed successfully with a nonoperative approach. More research is needed to confirm the superiority of treatment with silver sheets compared to treatment with silver creams.

Children With Facial Burns Treated in United States Emergency Departments, 2000 to 2018

OBJECTIVE

To investigate the characteristics and trends of facial burns among children.

METHODS

Data from the National Electronic Injury Surveillance System database were retrospectively analyzed for children <20 years old treated in United States (US) emergency departments (EDs) from 2000 to 2018 and national facial burn estimates were calculated.

RESULTS

During 2000 to 2018, there were an estimated 203,180 children <20 years old treated in US EDs for facial burns, averaging 10,694 burns or 130 burns per million children annually. Boys accounted for 66.4% of cases, and 41.9% were patients <5 years old. The most common type of burn was thermal (51.9%), followed by scalds (30.7%). The 2 most common injury mechanisms were light/lit (22%) and spilled/splashed (15.1%). Fuels and fuel burning equipment (13.1%) were most commonly associated with burns. Overall, the number of facial burns decreased significantly by 53.1% during the 19-year study period with 6525 cases treated in 2018. Although the number of thermal and radiation burns decreased significantly by 69.6% and 63.5%, respectively, the number of scald burns remained relatively constant.

CONCLUSIONS

Although the number of children treated in US EDs for facial burns decreased significantly from 2000 to 2018, these injuries remain common. Contrary to the observed decline in thermal and radiation burns, scald burns did not demonstrate a significant temporal trend. These findings indicate a need for increased prevention efforts, especially focused on scalds. Because the type of burn, mechanisms involved, and consumer products associated with facial burns vary by age group, prevention strategies should be developmentally tailored.

Upper Extremity Friction Burns in the Pediatric Patient: A 10-year Review

Background

Upper extremity friction burn due to powered home equipment is a growing problem in the pediatric population. The purpose of this study was to review the etiology, presentation, characteristics, and treatment of this particular type of pediatric mechanism of injury.

Methods

A retrospective chart review using International Classification of Diseases, version 9, codes for patients treated at a large tertiary care, free-standing children's hospital was performed to identify all patients presenting with an upper extremity friction burn from 2003 to 2012.

Results

Sixty-nine patients sustained upper extremity friction burns. The average age at the time of injury was 3.3 years (range, 0.7-10.6) with presentation to our center occurring 16.6 days (range, 0-365 days) following injury. Mean follow-up was 23.3 months (range, 2-104). Mechanism of injury included treadmills (n = 63) and vacuum cleaners (n = 6). Twenty-eight operations were performed on 21 patients (30%). All patients requiring a surgical intervention sustained injury via treadmill mechanism (P = 0.0001). Unlike treadmill burns, vacuum cleaner injuries affected the dorsal hand or a single digit (P = 0.00004). Scar hyperpigmentation was more prevalent in these patients compared with the treadmill group (P = 0.003). All vacuum-induced burn patients had full range of motion and function with conservative treatment alone, whereas only 55.6% of treadmill burn patients had full recovery of range of motion and 50.8% recovery of full hand function.

Conclusions

Friction burns from vacuum cleaners are less prevalent, have different injury patterns, and can be treated conservatively with excellent functional outcomes. Treadmill friction burns result in more significant injury and risk for dysfunction, requiring surgical intervention.