Firecracker injuries to the hands can cause permanent functional loss and disfigurement. We assessed the injuries and treatment of 16 men, three women, five boys and two girls injured around New Year’s Eve between 1999 and 2004. In 16 of the adult patients, who included a typist and a teacher, it was necessary to amputate one or more digits. Four patients lost both the thumb and the index finger, four lost the thumb and the rest lost other digits. Only soft tissue injuries were sustained by 10 of the 26 patients. Twenty patients (77%) benefited from initial debridement and primary closure alone, but the other six needed more than one procedure, and half of this group developed sepsis. The psychological impact was important in adults. Associated injuries included the loss of an eye in one patient, facial lacerations in 10 and a perforated eardrum. The mean hospital stay was 5 days. Public education and legislative reform may help prevent these unnecessary injuries.
Between 1993 and 2000 we conducted a prospective study of 50 patients presenting late with ankle fractures. They all had with persistent pain, swelling, ankle deformity and difficulty with walking. Reasons for presenting late included fracture blisters, under-treatment, refusal of surgery and neglect. The mean age of patients was 44.1 years (20 to 82). The mean delay between injury and treatment was 18.4 weeks (4 to 64). All patients underwent open reduction and internal fixation. Operations were more demanding when done after 24 weeks or in cases of Weber C fractures. Anatomical reduction was achieved in 88% of cases and clinical and radiological deformity corrected in all. All fractures went on to union and patients attained satisfactory motion. There were improvements in pain, swelling and walking. Three cases of deep sepsis were treated with debridement and antibiotics. Ankylosis developed in two patients and arthritis in seven. The encouraging results suggest that symptomatic, malunited and displaced intra-articular ankle fractures should be treated surgically, even when presented late.
