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Wringer washing machine injuries: criteria for obtaining radiological studies
Abstract:
While the number of wringer washing machine injuries is declining due to the increasing use of automatic washing machines, these injuries still occur. Historically, children with wringer injuries received routine radiographs to diagnose fractures, in spite of the low fracture rate in wringer injuries. Review of the records at Milwaukee Children's Hospital between the years 1973 and 1983 revealed that of the 99 wringer injuries seen, 80 of 99 patients were radiographed and only five fractures were diagnosed. Of these fractures only two were attributable to the wringer device and these two required therapy. Criteria are developed to identify which patients should undergo radiologic studies. Using the criteria of localized pain or tenderness, crepitation, obvious deformity, or abnormal movement in the extremity, the two serious fractures would have been identified, and these two patients would have been radiographed. The other 78 patients would not have been radiographed.
Insights
Wringer washing machine injuries in children are declining but still occur. Routine X-rays are often unnecessary; specific criteria can identify children needing radiologic evaluation for fractures.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Public Health
Background:
- Wringer washing machine injuries in children, though decreasing, still present a clinical challenge.
- Historically, routine radiography was employed for diagnosing fractures in these injuries, despite a low incidence.
- This practice led to unnecessary radiation exposure for many young patients.
Purpose of the Study:
- To evaluate the necessity of routine radiography for pediatric wringer injuries.
- To develop evidence-based criteria for identifying wringer injury patients who require radiologic assessment.
- To reduce unnecessary radiographic procedures in children with wringer washing machine injuries.
Main Methods:
- Retrospective review of pediatric wringer injury cases treated at Milwaukee Children's Hospital from 1973 to 1983.
- Analysis of radiographic findings and fracture diagnoses in relation to injury mechanism.
- Development and application of clinical criteria to assess the need for radiography.
Main Results:
- Out of 99 wringer injuries, 80 patients underwent radiography, revealing only five fractures.
- Only two fractures were directly attributable to the wringer mechanism and required therapeutic intervention.
- Proposed clinical criteria (localized pain, crepitation, deformity, abnormal movement) would have identified these two fractures while sparing 78 patients from radiography.
Conclusions:
- Routine radiography for pediatric wringer injuries is often not indicated.
- Clinical assessment using specific criteria can effectively identify patients with significant fractures requiring radiologic evaluation.
- Implementing these criteria can reduce unnecessary radiation exposure and healthcare costs associated with pediatric wringer injuries.