Pediatric Lawnmower Injuries: a 25-year Review

Abstract

Background: Despite regulations currently in place, the incidence of lawnmower injuries in children has not decreased for several decades in the United States. In fact, studies in several countries show that the incidence of riding lawnmower injuries are actually on the rise worldwide. Those injuries tend to be devastating and limb-threatening. The purpose of this study was to evaluate a pediatric trauma center's experience with those injuries over the past 25 years.

Methods: All patients who presented to a level I pediatric trauma center with injuries from lawnmowers between 1994 and 2019 were reviewed. Date of birth, gender, date of injury, mechanism of injury, type of lawnmower, and type of injury (including whether an open fracture, soft tissue defect, and/or amputation were present) were recorded.

Results: A total of 142 pediatric patients were treated over the study period. The average age was 7.5 years. The three most common mechanisms of injury were being hit by a riding lawnmower moving forward, falling off a riding lawnmower, and being hit by a riding lawnmower moving backward. Of all patients, 68.3% sustained an open fracture and 38% required an amputation. Riding lawnmowers resulted in more operative procedures, longer hospital stays, and more soft tissue defects that require reconstruction than push mowers. Younger patients were at a higher risk to sustain proximal amputations (wrist/ankle or proximal) than older patients.

Conclusion: Lawnmower injuries are devastating and largely avoidable. There are currently recommendations and regulations in the United States, which if followed, would prevent the vast majority of pediatric lawnmower injuries. Unfortunately, the incidence of these injuries has not decreased despite the current regulations. Broader public education is essential to decrease the incidence of serious lawnmower injuries in children.Level of Evidence: IV.

Keywords: Amputation; Child; Injury; Lawnmower; Push mower; Riding lawnmower; lawnmowers; pediatric.

Figure 1

A) After being run over by a riding lawnmower driven backwards, a 3-year-old male sustained a degloving injury of his left medial foot and ankle, without joint penetration or fractures. B) The patient underwent four operative debridements and negative pressure wound therapy, followed by the application of bilayer dermal regeneration template. C) After complete vascularization and granulation of the dermal regeneration template, split-thickness skin grafting was performed. D) and E) The patient healed uneventfully and underwent a period of physical therapy to address ankle stiffness.

Figure 2

A) A 5-year-old male sustained a traumatic amputation through the talocrural joint, after falling off a moving riding lawn mower that he was sitting on with a family friend. Significant soft tissue injury was evident in the muscles and tendons of the calf. The wound was heavily contaminated. B) The patient underwent five operative debridements and negative pressure wound therapy. The patient did not have adequate soft tissue coverage over the distal stump (shown). C) A tibialis anterior myocutaneous flap was elevated and advanced to cover the distal stump with well-padded soft tissue. The flap was myodesed to the bone through drill holes. D) After flap coverage of the distal stump, the residual calf defect is covered with a split-thickness skin graft E) and F) The patient's leg healed fully, and he is able to walk and run with a custom prosthesis