The U.S. Consumer Product Safety Commission reports that in 2008, about 7,000 people in the U.S. were treated in hospital emergency rooms for fireworks injuries. Seven people died from their injuries. Nearly two-thirds of the injured are males. Children under 15 account for 40 percent of the injury cases. The most commonly injured sites of the body are the hands, fingers, eyes and legs. Researchers estimate more than 40 percent of fireworks injuries are caused by intentional misuse of the device. Malfunction or device failure causes 35 percent of the injuries.
The weeks leading up to and just after the 4th of July holiday appear to be the most dangerous time of the year. In the most recent report, 70 percent of fireworks injuries occurred between June 20, 2008 and July 20, 2008.
Many people believe smaller fireworks are safe; but these can still be dangerous. Firecrackers caused 900 injuries in 2008. 300 people were injured by bottle rockets and 300 by Roman candles. Even sparklers are unsafe, causing 800 injuries in 2008. The National Fire Protection Association estimates the temperature at the tip of a burning sparkler can reach as high as 1200 degrees F.
Reconstructing the Thumb
In some cases, a fireworks injury can cause severe hand trauma and loss of the thumb and/or finger(s). Jim Higgins, M.D., Plastic Surgeon with Union Memorial Hospital in Baltimore, MD, says the thumb is an important digit. It enables us to pinch, grasp, grip and maneuver objects with precision.
If the thumb is severed, doctors may be able to reattach it to the hand. However, if the thumb is severely damaged or destroyed, there isn’t anything to attach. In that case, one option is a digit transplant, or removing a toe from the foot and using it as a replacement for the thumb.
Higgins says the reconstruction is done in several stages. The first step is to clean the wound site and remove dead tissue. Next, soft tissue and skin from the hand is moved over the site to prepare the area for the transplant. In the third step, one of toes (usually the big toe or the second toe) is carefully removed. Then it is sewn onto the hand, connecting blood vessels and nerves from the hand to the new thumb (i.e., the toe).
After reconstruction, smaller surgeries are done to release scar tissue and improve the appearance. Therapy is needed to gain strength and function of the new thumb. Higgins says younger patients are very resilient and often regain close to normal sensation and function in the reconstructed thumb. Most are eventually able to resume all normal activities, including sports participation.
The effects on the foot vary. If doctors remove the second toe, patients will see minimal to no changes in the ability to walk, run or play sports. However, if the big toe is used for the transplant, patients will have a substantial loss in the ability to sprint or do activities that require speed.
Higgins recommends patients wanting thumb reconstruction seek help from a physician who has experience with that type of surgery. He says a patient who chooses not to have reconstruction immediately can often still have the surgery years later.
Centers for Disease Control and Prevention, http://www.cdc.gov/HomeandRecreationalSafety/Fireworks
National Council on Fireworks Safety, http://www.fireworksafety.com
National Fire Protection Association, http://www.nfpa.org
Prevent Blindness America®, http://preventblindness.org/safety/fireworksafety.html
US Consumer Product Safety Commission, http://www.cpsc.gov/info/fireworks/index.html
D’Ippolito, A., et al., “Epidemiology of Pediatric Holiday-Related Injuries Presenting to US Emergency Departments,” Pediatrics, May 2010, Vol. 125, No. 5, pp. 931-937.
Frank, M., et al., “Not another 4th of July Report,” Emergency Medicine Journal, February 2008, Vol. 25, No. 2, pp. 93-97.
Greene, Michael and Demar Granados, “Fireworks-Related Deaths, Emergency Department-Treated Injuries, and Enforcement Activities during 2008,” Bethesda: US Consumer Product Safety Commission, 2009.
Hall, John, Jr., “Fireworks,” Quincy: National Fire Protection Association, 2009.
Puri, V., et al., “Firework Injuries,” Journal of Plastic Reconstructive and Aesthetic Surgery, September 2009, Vol. 62, No. 9, pp. 1103-1111.