Surgical Firework Injury of the Thumb: Injury Pattern and Treatment Algorithm

Area of Science:

• Trauma surgery
• Orthopedic surgery
• Hand surgery

Background:

• Firework blast trauma commonly causes severe hand injuries, with a high incidence of thumb and first web space involvement.
• Injuries range from minor burns to extensive damage requiring surgical intervention.

Purpose of the Study:

• To review surgical management of upper-extremity firework injuries, focusing on thumb and first web space damage.
• To propose a treatment algorithm based on injury patterns for these specific injuries.

Main Methods:

• Retrospective chart review of patients surgically treated for firework-related hand injuries at a level-1 trauma center (January 2009 - December 2023).
• Analysis of demography, injury patterns, and surgical treatments, including a case series of two thumb/first web space injuries.
• Descriptive statistical analysis of collected data.

Main Results:

• Seventy-four patients with severe firework blast injuries were reviewed; 80% had thumb injuries, and 88% of those involved the first web space.
• Amputation was the most frequent treatment (60%), followed by skin grafting (36%) and primary closure (32%).
• Local and free flaps were utilized in 35% of cases.

Conclusions:

• The thumb and first web space are most commonly affected by surgical firework hand injuries.
• Preserving thumb length, sensation, and mobility, along with a functional first web space, is critical.
• A treatment algorithm is proposed to guide management of these complex blast injuries.