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

Abstract

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.

Fig. 1.

Twenty-eight operations performed in 21 patients (all treadmill-induced injuries) including surgical debridement (n = 5), excision/primary closure (n = 1), contracture release (n = 7), full-thickness skin grafting (FTSG) (n = 9), split-thickness skin grafting (STSG) (n = 5), and tendon repair (n = 1).

Fig. 2.

Treadmill-induced burns involving the volar surface of multiple digits. While most patients were treated conservatively with local wound care (A, B), patients with more severe, full-thickness burns required surgical intervention including skin grafting (C). Due to persistent flexion contracture of the index finger, the patient on the bottom left required secondary contracture release (D).

Fig. 3.

Vacuum-induced burns to the right dorsal hands of 2 children. These burns healed with conservative treatment alone.