Lawnmower injuries (Dr. Frush)

Question 1

Epidemiology of lawn mower injuries

Answer 1

• 74,000 ER visits for lawnmower injuries per year
• foot fx and toe amputation the most common cause of hospitalization
• men are 5.3 times more likely to be hospitalized
• more injuries from riding lawn mowers

Question 2

Zone I

Answer 2

Digits to heads of metatarsals.

• 53%
• Primary Closure.

Question 3

Zone II

Answer 3

Dorsal surface of foot.

• 19%
• Primary Closure.
• Flaps and grafts may be necessary.

Question 4

Zone III

Answer 4

Lateral aspect and plantar surface of foot.

• 2%
• May need flap coverage, if involved.

Question 5

Zone IV

Answer 5

Heel up to Achilles.

• 9%
• Tendon and bone injuries need surgical repair.
• Greater complication rate due to soft tissue breakdown.
• Splint at 90 degrees to prevent contracture.

Question 6

Zone V

Answer 6

Ankle.

• 17%
• Splint at 90 degrees to prevent contracture.
• Surgical reduction may be necessary.

Question 7

Gustilo and Anderson Type I

Answer 7

• puncture wounds <1cm with minimal contamination and muscle damage
• lowest rate of infection

Question 8

Gustilo and Anderson Type II

Answer 8

• laceration >1cm with mod soft tissue injury
• bone coverage adequate, comminution minimal
• middle rate of infection

Question 9

Gustilo and Anderson Type IIIa

Answer 9

• heavily contaminated wounds with severe comminution
• extensive soft tissue damage with adequate soft tissue coverage
• **Highest rate of infection

Question 10

Gustilo and Anderson Type IIIb

Answer 10

periosteal stripping and expose bone

Question 11

Gustilo and Anderson Type IIIc

Answer 11

extensive arterial injury

Question 12

What is essential when treating lawnmower injuries?

Answer 12

• early antibiotic therapy
• adequate irrigation
• adequate debridement
• These will prevent further infections

Question 13

Antibiotic therapy

Answer 13

• administer ASAP
• combo therapy: 1st general cephalosporin and aminoglycoside
• farm injuries or anaerobic infections suspected: ampicillin, penicillin, or clindamycin should be included

Question 14

Wound Managment

Answer 14

• Irrigation with at least 1 liter of saline.
• Debridement of nonviable contaminated soft tissue.
• Removal of free cortical bone fragments with no soft tissue attachments.
• If wounds aren’t irrigated and debrided within 6-8 hrs wait for closure.

Question 15

Charalampos et al Recommend

Answer 15

• Waiting 3 - 7 days for closure on all open fx.(unless exposed tendon, nerve or bone)
• Monitor wound for infection and drainage.
• Wait for soft tissue flaps and grafts.
• Ex fixation preferred over internal fixation.

Question 16

How does the use of Plavix potentially complicate treatment?

Answer 16

may impair coagulation due to platelet impairment