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Angle grinder injuries
Injury, Int. J. Care Injured 31 (2000) 475±476
www.elsevier.com/locate/injury
Case report
Angle grinder injuries D.L. Back a,*, M. Espag a, A. Hilton b, T. Peckham a a
Basildon & Thurrock Hospital, Nether Mayne, Basildon, Essex, UK b Royal National Orthopaedic Hospital, Stanmore, UK Accepted 2 March 2000
1. Introduction Angle grinders consist of a high speed revolving disc that can cut paving stone, metal and concrete. They are increasingly used in the home, as the craze for DoIt-Yourself (DIY) continues to grow [1,2]. Well printed instructions, advise on types of disc to use and when to change it. However, as with all machines, instructions are not always adhered to and injuries result. In a 6 month period, we encountered simple lacerations, as well as open fractures, chest injuries and scrotal lacerations. Five varied cases of angle grinder associated injuries are presented.
2. Case 1 This patient was cutting stone with an angle grinder, when the grinder shattered into multiple high velocity fragments. Multiple lacerations to the left forearm and a open distal ulnar fracture resulted. Exploration and debridement revealed a severed ¯exor carpi ulnaris tendon, the ulna fracture was held with Kirschner wires. Six months later he still lacks 20 degrees of supination.
3. Case 2 This man was cutting paving stone, with the wrong type of disc, when his hand slipped. The disc penetrated a thick protective glove. A laceration on the * Corresponding author: 2 Shrawley Road, Fernhill Heath, Worcester, WR3 7UQ, UK. E-mail address: [email protected] (D.L. Back).
dorsum of the middle phalanx of the left ring ®nger and a partially severed extensor digitorum profundus tendon were repaired. A full recovery resulted.
4. Case 3 Once again the disc exploded sending multiple high velocity pieces radiating out from the grinder. His injuries included: 1. A V-shaped laceration on the antero-lateral aspect of his distal left forearm and a deep bony defect in the radius. Exploration resulted in repair of extensor pollicis brevis, adductor pollicis longus, brachioradialis and extensor carpi radialis longus and an external ®xator to the radius. 2. The distal right forearm had a super®cial laceration requiring sutures. 3. Lacerations to the dartos muscle of the scrotum and glans penis required sutures. Interestingly, he was unaware of the latter two injuries until a full examination was performed. He has residual weakness of his left thumb.
5. Case 4 The disc shattered into three high velocity missiles. Two missiles embedded in the ceiling, the third passed through a thick work coat and penetrated the left upper chest under the medial aspect of the clavicle. This caused a skin laceration, a comminuted fracture of the shaft of the clavicle and a complex laceration of the subclavian vein. A defect in the clavicle remained;
0020-1383/00/$ - see front matter 7 2000 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 0 ) 0 0 0 2 5 - 5
476
D.L. Back et al. / Injury, Int. J. Care Injured 31 (2000) 475±476
the vein was repaired by direct suture. Post-operatively, some weakness of shoulder abduction remains. 6. Case 5 An undisplaced lateral malleolar fracture was treated in a cast. In his desperation to work, he used his angle grinder to cut the cast o, sustaining multiple small lacerations over his calf groin, forearms and stomach. He was left with residual super®cial scars. He did not recommend this method of cast removal. 7. Discussion DIY injuries are notoriously common in Accident & Emergency Departments worldwide [1±3]. Stanley knives, drills, saws, ladders, hammers etc. all present the untrained and enthusiastic with numerous ways to injure themselves in the pursuit of home improvement [2]. There is almost no information in the Medline literature on this subject. The mechanism of injury has been clearly de®ned and the problems with angle grinder injuries are indicated [3]. It is easy in these circumstances to concentrate on the obvious injury and not listen to the mechanism. The history of multiple missiles must be taken seriously and more distant injuries should be looked for. A poll of 25 workmen, showed awareness of these injuries. Every workman polled knew of the common injuries and the reasons behind them. A number of el-
ementary mistakes, by D-I-Yers and professionals, should be taken into consideration when examining these patients. Firstly, there are two types of disc, one for stone cutting and the other for metal. The shop owners surveyed said that the wrong type of disc was frequently used, increasing the likelihood of the disc shattering. Secondly, the protective guard is frequently taken o, despite the manufacturers guidelines stating clearly not to [4]. Finally, shattering of the disc can occur when the disc gets a chip in it, and has been incorrectly ®tted. The discs rotate between 10,000±15,000 rev/min, giving sucient momentum to travel far and penetrate deeply. Once again it is a salutary reminder to listen to the history that the patient gives, the mechanism of the injury and in the case of angle grinders that shatter, to fully examine the patient. In our increasingly litiginous society, we would undoubtedly ®nd a claim heading our way if we had missed the scrotal lacerations, because we had been too focused on the obvious upper limb injuries.
References [1] Hayward G. Fatal home accidents Ð a database. Accid Anal Prevent 1988;20(5):399±410. [2] Owen P, Keightley SJ, Elkington AH. The hazards of hammers. Injury 1987;18(1):61±2. [3] Thurner W, Pollak S. Morphologic aspects of angle grinder injury. Beitr Gerichtl Med 1989;47:641±7. [4] Black and Decker Angle Grinder Manual. Instructions and Safety Guidelines. 1997.
www.elsevier.com/locate/injury
Case report
Angle grinder injuries D.L. Back a,*, M. Espag a, A. Hilton b, T. Peckham a a
Basildon & Thurrock Hospital, Nether Mayne, Basildon, Essex, UK b Royal National Orthopaedic Hospital, Stanmore, UK Accepted 2 March 2000
1. Introduction Angle grinders consist of a high speed revolving disc that can cut paving stone, metal and concrete. They are increasingly used in the home, as the craze for DoIt-Yourself (DIY) continues to grow [1,2]. Well printed instructions, advise on types of disc to use and when to change it. However, as with all machines, instructions are not always adhered to and injuries result. In a 6 month period, we encountered simple lacerations, as well as open fractures, chest injuries and scrotal lacerations. Five varied cases of angle grinder associated injuries are presented.
2. Case 1 This patient was cutting stone with an angle grinder, when the grinder shattered into multiple high velocity fragments. Multiple lacerations to the left forearm and a open distal ulnar fracture resulted. Exploration and debridement revealed a severed ¯exor carpi ulnaris tendon, the ulna fracture was held with Kirschner wires. Six months later he still lacks 20 degrees of supination.
3. Case 2 This man was cutting paving stone, with the wrong type of disc, when his hand slipped. The disc penetrated a thick protective glove. A laceration on the * Corresponding author: 2 Shrawley Road, Fernhill Heath, Worcester, WR3 7UQ, UK. E-mail address: [email protected] (D.L. Back).
dorsum of the middle phalanx of the left ring ®nger and a partially severed extensor digitorum profundus tendon were repaired. A full recovery resulted.
4. Case 3 Once again the disc exploded sending multiple high velocity pieces radiating out from the grinder. His injuries included: 1. A V-shaped laceration on the antero-lateral aspect of his distal left forearm and a deep bony defect in the radius. Exploration resulted in repair of extensor pollicis brevis, adductor pollicis longus, brachioradialis and extensor carpi radialis longus and an external ®xator to the radius. 2. The distal right forearm had a super®cial laceration requiring sutures. 3. Lacerations to the dartos muscle of the scrotum and glans penis required sutures. Interestingly, he was unaware of the latter two injuries until a full examination was performed. He has residual weakness of his left thumb.
5. Case 4 The disc shattered into three high velocity missiles. Two missiles embedded in the ceiling, the third passed through a thick work coat and penetrated the left upper chest under the medial aspect of the clavicle. This caused a skin laceration, a comminuted fracture of the shaft of the clavicle and a complex laceration of the subclavian vein. A defect in the clavicle remained;
0020-1383/00/$ - see front matter 7 2000 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 0 ) 0 0 0 2 5 - 5
476
D.L. Back et al. / Injury, Int. J. Care Injured 31 (2000) 475±476
the vein was repaired by direct suture. Post-operatively, some weakness of shoulder abduction remains. 6. Case 5 An undisplaced lateral malleolar fracture was treated in a cast. In his desperation to work, he used his angle grinder to cut the cast o, sustaining multiple small lacerations over his calf groin, forearms and stomach. He was left with residual super®cial scars. He did not recommend this method of cast removal. 7. Discussion DIY injuries are notoriously common in Accident & Emergency Departments worldwide [1±3]. Stanley knives, drills, saws, ladders, hammers etc. all present the untrained and enthusiastic with numerous ways to injure themselves in the pursuit of home improvement [2]. There is almost no information in the Medline literature on this subject. The mechanism of injury has been clearly de®ned and the problems with angle grinder injuries are indicated [3]. It is easy in these circumstances to concentrate on the obvious injury and not listen to the mechanism. The history of multiple missiles must be taken seriously and more distant injuries should be looked for. A poll of 25 workmen, showed awareness of these injuries. Every workman polled knew of the common injuries and the reasons behind them. A number of el-
ementary mistakes, by D-I-Yers and professionals, should be taken into consideration when examining these patients. Firstly, there are two types of disc, one for stone cutting and the other for metal. The shop owners surveyed said that the wrong type of disc was frequently used, increasing the likelihood of the disc shattering. Secondly, the protective guard is frequently taken o, despite the manufacturers guidelines stating clearly not to [4]. Finally, shattering of the disc can occur when the disc gets a chip in it, and has been incorrectly ®tted. The discs rotate between 10,000±15,000 rev/min, giving sucient momentum to travel far and penetrate deeply. Once again it is a salutary reminder to listen to the history that the patient gives, the mechanism of the injury and in the case of angle grinders that shatter, to fully examine the patient. In our increasingly litiginous society, we would undoubtedly ®nd a claim heading our way if we had missed the scrotal lacerations, because we had been too focused on the obvious upper limb injuries.
References [1] Hayward G. Fatal home accidents Ð a database. Accid Anal Prevent 1988;20(5):399±410. [2] Owen P, Keightley SJ, Elkington AH. The hazards of hammers. Injury 1987;18(1):61±2. [3] Thurner W, Pollak S. Morphologic aspects of angle grinder injury. Beitr Gerichtl Med 1989;47:641±7. [4] Black and Decker Angle Grinder Manual. Instructions and Safety Guidelines. 1997.