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Epidemiology, management and outcomes of paediatric upper limb friction injuries: A systematic review
Alexander J Baldwin1, Galini Mavromatidou1, Claire Coleman2
1Department of Burns & Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK.
Insights
Friction burns in children, especially from treadmills, are often treated with dressings, leading to good functional recovery. Deeper burns may require surgery and increase scarring risk.
Area of Science:
- Pediatric surgery
- Wound healing
- Dermatology
Background:
- Friction burns are common pediatric injuries with potential for long-term disability.
- Management and outcomes of these injuries require thorough evaluation.
Purpose of the Study:
- To systematically review the management and outcomes of pediatric upper limb friction injuries.
- To identify factors influencing healing time, functional results, and complications.
Main Methods:
- Systematic review of studies on pediatric upper limb friction injuries.
- Searched MEDLINE, EMBASE, CENTRAL, CINAHL, and trial registries.
- Primary outcomes: healing time, functional outcomes, surgical intervention; Secondary outcomes: scarring, cost.
Main Results:
- 22 studies included 842 pediatric patients; 95% of injuries were treadmill-related.
- 58.7% of injuries were deep partial-thickness to full-thickness.
- Conservative management (70.4%) showed good functional outcomes, while surgery (29.6%) involved skin grafting.
Conclusions:
- Conservative management is typical for pediatric upper limb friction injuries with good functional outcomes.
- Deeper injuries and delayed healing correlate with increased risk of problematic scarring and revision surgery.
- Standardized treatment protocols are needed to minimize long-term complications.
Aim:
Friction burns are a common paediatric injury that can result in significant morbidity and long-term disability. This systematic review aimed to evaluate the management and outcomes of these injuries.
Methods:
A protocol was developed a priori and registered on the PROSPERO database (CRD42022376782). A comprehensive search of MEDLINE, EMBASE, CENTRAL, CINAHL and trial registries was conducted to identify studies evaluating the management and outcomes of paediatric upper limb friction injuries. Primary outcome measures were healing time, functional outcomes, and the need for surgical intervention. Secondary outcomes included complications such as problematic scarring and cost.
Results:
Twenty-two studies met the inclusion criteria, encompassing 842 paediatric patients with upper limb friction injuries, predominantly treadmill-related (95 %). Most injuries (58.7 %) were deep partial-thickness to full-thickness. Conservative management with dressings was the primary treatment in 70.4 % of cases, while 29.6 % underwent acute surgery, predominately full-thickness skin grafting followed by split-thickness skin grafting. Mean healing times ranged from 19.4 to 31.5 days. Problematic scarring affected 20.5 % of patients, with 38.3 % of this group undergoing further scar revision surgery. Functional outcomes were generally positive, with minimal long-term disability reported.
Conclusion:
Paediatric upper limb friction injuries, particularly those caused by treadmills, have typically been managed conservatively, with good functional outcomes. However, deeper injuries and delayed healing increase the risk of problematic scarring and need for scar revision surgery. Further research is needed to standardise treatment protocols and minimise long-term complications.
