The firework injured hand : profile and management.
Aim: The study aimed to profile the firework injured hand and review of the management of such injuries from a surgical and rehabilitation perspective. Methodology: A quantitative methodological approach using a retrospective file audit was employed in order to address the objectives of the study. The study population was sampled from two identified provincial hospitals in the uMgungundlovu district and comprised of all patients who had sustained firework injuries from the 30th of December to the 5th of January during 2009-2014 (n = 65). Results were analysed using non-parametric statistics (viz. frequency counts and percentage matrices) through SPSS version 21 and Microsoft Excel 7. Results and Discussion: The analysis and discussion are organized across three content areas, namely, the profile of the firework injured hand, medical and surgical interventions and rehabilitative interventions. The results showed that the profile of the firework injured hand is varied depending on the blast capacity; however the thumb, index and middle fingers are predominantly affected at the level of the distal phalanges and distal interphalangeal joints resulting in amputation due to severe soft tissue injury and fractures. Hand Injury Severity Scores were completed retrospectively to ascertain the level of injury of which nearly half the cases surveyed fell within the severe category. Medical and surgical interventions were found to occur within the first three to six hours after injury and involved primarily washout, cleaning, debridement and suturing with formalization of amputation being the predominant course of action rather than reconstruction. Rehabilitation was focused on assessment and hand therapy to ensure functional outcomes. It was noted that there were inconsistencies in assessment procedures however the treatment modalities appeared consistent. Conclusions: On the basis of this study, it is recommended that the firework injured hand be treated according to the resulting diagnosis, that is, digital amputation, fracture, soft tissue injury and the coinciding symptoms of oedema, pain and stiffness which negatively impact on the outcome of hand function after this devastating injury. The limitations of the study are discussed and recommendations for future research in this field are offered.