title: Major pediatric hand trauma associated with fireworks.
abstract: OBJECTIVE
  To characterize the injury pattern and economic impact of major pediatric hand trauma secondary to fireworks.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Pediatric Level I trauma center.
  
  
  METHODS
  N/A MAIN OUTCOME MEASUREMENTS: Fractures, amputations, soft tissue defects, length of hospitalization, number and type of procedures performed were obtained from charts, radiographs, and operative reports. Hospital charges were obtained from the billing office.
  
  
  METHODS
  Records of patients with a diagnosis of fireworks-related injuries admitted over a period of ten years were reviewed. Twenty-two 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 dislocation. The nineteen amputations occurred in nine hands. Local skin graft or flap coverage was required in six hands acutely, and delayed soft tissue procedures were performed on four hands. Four hands had digital neurovascular injuries; two required microsurgical repairs at the time of injury, and 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 resources in treating these injuries. Efforts toward public education and legislative reforms may help to prevent these unnecessary injuries.
authors.affiliation: Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Moore
authors.forename: V
authors.initials: V
authors.lastname: Tan
authors.forename: J P
authors.initials: JP
authors.lastname: Dormans
authors.forename: D J
authors.initials: DJ
authors.lastname: Bozentka
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000673:Amputation, Traumatic / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001753:Blast Injuries / Q000191:economics* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D006230:Hand Injuries / Q000191:economics* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015143:Philadelphia / Q000453:epidemiology; D011159:Population Surveillance; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data