Auger injuries

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Auger injuries* B. J. S. Grogono DeDartment of Swuerv Uiiversity, Halifax,N&

(OrthoDaedics), ’ Sco&at

Summary

Attention is drawn to accidents caused by the auger used on the farm and in industry. The worst machine is the portable grain auger which produces severe, mutilating injuries of the forearm., hand or lower limb. There are large numbers of these portable conveyors in the Prairies, and probably 5000 or more in Manitoba alone. It is likely that some 120 amputations occur each year on the farm, and many of these are due to augers.

Look after the accidents and the injuries look after themselves. HEINRICH THE serious

problem of farm accidents in Canada has been emphasized by reviews from Saskatchewan (Huston and Smith, 1969), Manitoba, and Ontario. The large number of fatalities from tractor injuries and the common occurrence of amputation owing to farm machinery make it extremely important that measures should be taken to prevent these accidents. The object of this paper is to bring attention to auger injuries, which cause serious mutilation of limbs, sometimes ending in amputation and occasionally in death. TYPES OF AUGER Augers began as simple machines. Archimedes solved the problem of moving water up a hill by using a screw conveyor inside a cylinder. Modern augers and screw conveyors are widely used to transport wood, grain, meat, and other materials on the farm and in industry. They are often used in conjunction with other types of conveyor or compressed air systems. * Presented in part at the Annual Meeting of the Canadian Orthopaedic Association, Jasper, Alberta, June, 1971. Illustrations by F. C. Gill (Halifax). t This study was undertaken while the author was Tutor in Orthopaedics at the University of Manitoba, Winnipeg, Man.

Halifax Infirmary, and Dalhousie

Grain augers These are common on the Prairies. The portable form is usually powered by a gas motor or power take-off, and is from 20 to 100 feet long. The diameter varies from 4 to 8 inches. There are five to six thousand of these distributed in the West. Fig. 1 shows a typical construction of a portable auger with a central screw inside a cylinder. The open end draws the grain up and discharges it through a spout at the upper end (Fig. 2). At the lower end, there are different types of mechanisms -some feeding from a hopper, some from an open flighting which revolves around a bin and drains into the auger, and some from a simple opening (Fig. 3). The lower end is placed in the grain and may well be hidden so that a child, enticed by the sight of moving grain, may not realize the danger. Fig. 4 illustrates how a hand can be placed in the machine. These augers depend upon grain flowing freely. They are not easily stalled, so that when a limb gets jammed in one it may go on being mutilated until the motor is turned off. Children’s limbs go in further than adults’. Elevator augers These work on a similar principle, but have a much larger diameter and are used to convey grain for storage. There is little reason for any human contact with this machine, but occasionally an inexperienced person is sent to clean a machine while it is still on. Harvester augers A variety of screw conveyors are used in large Some of these are open, and limbs can combines. get mutilated if an attempt is made to clear them while the machine is in motion. Industrial augers These are found in saw mills, where they are used in association with positive air-pressure to convey

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Fig. 1.-Archimedes’

Fig. 2.-Typical

portable grain auger. Lz

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idea of an auger to raise water.

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: Auger

sawdust to the hopper. They are also found in abattoirs and for conveying waste from work areas. Wherever there is an unguarded auger an accident is possible.

CASE

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Injuries

REPORTS

Patients treated in Winnipeg hospitals from 1963 to 1969 were reviewed, and fell into three groups, being injured by:1. Grain augers. a. Portable. b. Harvester. 2. Elevator augers. 3. Industrial augers.

Grain augers Children The following case records are of 6 children, three with leg injuries, and three with hand injuries. Case 7 A girl of 5 was helping to elevate grain into a barn when her arm disappeared up the spiral flighting until the engine stalled. Her arm was extracted with difficulty. When admitted to hospital, she had severe spiral laceration of the whole right forearm (Fig. 5). Radiography showed an open dislocation of the elbow with soft-tissue injury. Above-elbow amputation was carried out. Case 2 A girl of 7 put her hand into a grain auger and sustained laceration of all the flexor tendons and metacarpals, with skin-loss. After multiple operations including primary tendon suture, bone reconstruction, and a skin flap, the arm was saved, but it was severely scarred (Fig. 6).

Fig. 3.-Shows

Fig. 4.-How

open lower end of grain auger.

hand can be caught in open flighting.

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Case 3

Case 5

A little boy put his arm in a grain auger and sustained laceration of the soft tissues from the metacarpals to the acromion. After thorough toilet of the wounds and removal of grain the tendons were repaired. One year later the arm had recovered well.

A boy of 2 caught his right foot in a grain auger, sustaining severe laceration of the foot with marked blackening of the skin where the auger had been churning. He sustained an open fracture of the tibia and fibula. Toilet of the wound was followed by open reduction of the fracture. The wounds healed, but non-union of the tibia necessitated a bone-graft (Fig. 8).

Case 4 A girl of 2: stepped into a grain auger, sustaining severe injury of all the extensor tendons in the tarsometatarsal region, with considerable loss of soft tissue, metatarsals, and skin. The wound was cleaned and excised. After multiple operations, including skin-grafts, the wound healed with some deformity of the foot (Fig. 7).

Case 6 This boy caught his foot in an auger, resulting in severe laceration without bony injury. The wound healed after operation.

Adults Case 7 A man of 18 put his left hand in an auger, where it was caught until the engine stalled. There was severe

Fig.-5

Case 1.

Fig. 6.-Case

A,

Clinical appearance;

B, Radiograph.

2. A, Original injury; B, After final healing.

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injury of the left forearm, affecting the median and ulnar nerves and the flexor tendons and causing of the metacarpophalangeal joints. dislocation Following repair of the tendons, nerves, and skin some recovery occurred in the median and ulnar nerve distribution, although intrinsic paralysis remained (Fig. 9).

Case 8

A man of 34 caught his left hand in an auger, resulting in a mutilating injury of the left hand and wrist. There was an open fracture of the ulna with injury of muscles and tendons. An attempt to save the skin was anaerobic infection occurred and unsuccessful, amputation followed (Fig. 10). Case 9

This middle-aged man caught his foot in a flexor hopper which was feeding into an auger. To prevent his foot from entering the shaft, he placed his other foot in the machine and braced himself with his hands until the machine was turned off. Both feet were so badly mangled that Syme’s amputations had to be performed. Case 10

A man of 33 caught sustained laceration overlying skin. He wound and of the tarsals. Amputation to the metatarsals.

his left foot in a grain auger and of the metatarsals, tendons, and was admitted for excision of the second, third, and fourth metawas later carried out proximal

These adult cases show that the experienced farmer as well as the ignorant child can sustain mutilating injuries from farm augers.

Harvester Fig. 7.-Case

4. A, Initial injury; B, 2 years following in,jury, after bone-graft. (Courtesy of Dr. Porritt.)

A Fig. 8.-Case 5. A, Following of Dr. Bigelow.)

auger

Auger conveyors are used as part of combine harvesters. Injuries usually occur as a result of

C wound excision; B, After screwing; C, Final result after bone-graft.

(Courtesy

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care1lessness or attempts to free grain which has beco Ime blocked in the auger. There were 4 cases in thiis series. Case

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Case 12 A man of 34 suffered accidental amputation of the right arm, and was subsequently fitted with a belowelbow prosthesis.

17

Am; m of 51 caught his left hand in a harvester auger, susta .ining laceration which necessitated below-elbow amp1.ttation.

Case 13 A boy of 10 caught his right hand in a harvester auger, and lost the index, middle, and ring fingers. It was possible to repair the remaining fingers to provide some usefulness. Case

14

A man of 40 was greasing his combine when his hand caught in the auger, which amputated all his fingers. This group was largely the result of interfering with the harvest machines while they were still moving. The screw makes it impossible for the victim to remove his limb before it is almost completely amputated. Miscellaneous augers on the farm In addition to portable augers and harvest augers, a number of other machines on the farm may produce similar injuries. These are used for conveying dirt, manure, and other materials. Table I gives a list of some other accidents which occurred in this group. Elevator augers The elevator is common in the Prairies and are used to convey grain to various parts elevator. Accidents occur at the open end, the auger is hidden in the grain, or by ference while it is still functioning.

augers of the where inter-

of metacarpal% median and ulnar nerve lesions; B, After excision 7. A, Open fracture-dislocation and fixation; C, Appearance of hand 6 months later. (Courtesy of Dr. Bigdow.)

Fig. 9.-Case

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Case 15 A man of 50 was cleaning an auger when it was inadvertently turned on. This resulted in traumatic amputation of the hand at the wrist, leaving a mangled carpus with damaged muscles and tendons (Fig. 11). Amputation at the wrist was carried out and he returned to work with a below-elbow prosthesis. Industrial augers (screw conveyor) These are used for a wide variety of purposes. Sawdust or coal may be blown by compressed air into a large hopper, where it collects before it is taken away by a screw conveyor at the base. When the hopper is full it is usually somebody’s job to ensure that the auger is unplugged. Safety regulations are not always followed. Case 16 A 21-year-old man was employed in a milling plant. The grain was delivered into the open end of the elevator auger, 160 feet long. It was surrounded by plywood except at the unguarded opening into which he slipped and caught his foot. Other workmen heard his screams but he suffered a severe laceration of his foot before the machine was switched off. Case 17 A man of 54 was employed in an abattoir. The auger conveyor was incompletely guarded, the man’s foot got trapped in the auger, and was severely lacerated. Case 78 A man was employed by a wood-processing firm to clear the hopper. In this factory, wood previously cut into chips was transported by compressed air to the top of a defibrator bin, and thus fed into the

Fig. lo.-Case

8. A, Radiograph;

0, Appearance

hopper. Subsequently, it was transported by auger screw into the paper mill. For the man to ensure smooth flow of the chips, he regularly had to inspect the hopper and get inside it. While doing this dangerous job, he was supposed to wear a safety harness, and had in fact done the job for 9 years. One day he was missing, and despite an extensive search, the body was not found until the auger was dismantled the next day (Fig. 12). Examination of the body showed the feet and part of a leg had been lacerated, and death was due to asphyxia. Case 79 A similar tragedy occurred to a man who got caught in a hopper bin. He was 74 years old, and had to push the shavings and sawdust, and collect them in the overhead hopper. He had to enter the bin through a side door, and poke at the chips with a stick. His body was later discovered where he had been trapped in the hopper and asphyxiated. DISCUSSION Although auger injuries account for only a small proportion of the total number of accidents on the farm, they are frequent enough in Canada to demand serious attention. Farming is almost as dangerous as building and mining. Small farms are more liable to accidents than large farms. Disabling injuries occur at a higher rate than in any other industry, as emphasized by Bartlett (1961) in his review of farm accidents in Manitoba. The Ontario Farm Accident Survey (1960) described 20 auger injuries among hundreds of accidents occurring on the farm.

at operation.

(Courtesy of Dr. Mackinnon.)

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Saskatchewan Farm Review: Huston and Smith (1969) emphasized the danger of young children playing near farm machinery. They reported 10 amputations from the grain augers alone, and 19 amputations in children from all types of farm accidents. They urged preventive

Tab/e /.-Accidents Case no.

measures by combined action of engineers, farmers, and public health authorities. Jn this series, the importance of the portable grain auger, as well as the auger in the harvester, elevator, or industrial machine has been emphasized.

due to misuse of augers

Type of auger

Sex

Age

Treatment

Injury

Outcome

1

Grain

F.

5

Open fracture of radius and ulna ; spiral laceration of tendons, nerves, muscles, and skin

Amputation below elbow

Prosthesis

2

Grain

F.

7

Laceration of forearm and hand, nerve and tendons, and skin of toes; fractured metacarpals

Multiple operations including grafting ; tendon repair and reconstruction

Arm functions well but is severely scarred

3

Grain

M.

4

Laceration of outer arm, extending up to acromion and involving brachioradialis

Wound excision and repair of tendons

Little deformity

4

Grain

F.

2;

Severe laceration of foot; open fractures of tarsal and metatarsal bones

Multiple skinand bonegrafts

Foot is deformed

5

Grain

M.

2

Laceration of foot and leg ; open fracture of tibia and fibula

Multiple operations including insertion of screw, and bone-grafting

Limb bowed but functional

6

Grain

M.

4

Laceration of foot; exposed extensor tendons

Primary repair

Foot healed without deformity

7

Grain

M.

18

Open fracture-dislocation of metacarpophalangeal joints; median and ulnar nerves divided

Repair of nerves ; skin and bonegrafts

Attempt to repair thwarted by anaerobic infection

8

Grain

M.

34

Ragged lacerations of all structures of hand

9

Grain

M.

40

Ragged lacerations feet

-

Fair degree of sensation and movement Amputation through wrist; prosthesis

of both

Bilateral Syme’s amputation prosthesis

;

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Compensation

insurance is also usually taken out by the farmer. Compensation is usually totally inadequate for the amount of disability. This inadequacy of compensation may be an important contribution to the lack of proper supervision of farm machinery, the inadequate maintenance of machines,

In Manitoba, the farmer is usually not covered by the Workmen’s Compensation Board. He takes out separate insurance from the grain company, which pays compensation in proportion to the amount of grain he has been producing. Private Table l-continued Case no.

Type of auger

Sex

Age

Injury

Treatment

Outcome

10

Grain

M.

33

Ragged laceration of left foot, involving skin, tendons, and metatarsals

Excision of three metatarsals unsatisfactory

Amputation proximal to metatarsals; prosthesis

11

Harvester

M.

51

Laceration of forearm

Amputation below elbow

Prosthesis

12

Harvester

M.

34

Laceration of forearm

Amputation forearm

Prosthesis

13

Harvester

M.

10

Laceration ; traumatic amputation of fingers

Amputation index, middle and ring fingers

14

Harvester

M.

40

Traumatic amputation of all fingers, right hand

15

Miscellaneous farm

M.

15

Disarticulation shoulder

16

Miscellaneous farm

M.

15

Mid-forearm

17

Miscellaneous farm

M.

15

Above-elbow

18

Miscellaneous farm

M.

15

Below-knee

19

Miscellaneous farm

M.

15

Amputation hand

20

Elevator

M.

50

21

Industrial (milling plant)

M.

22

Abbatoir

23

24

of

of right

Completion of amputation

Prosthesis

amputation

Completion of amputation

Prosthesis

Completion of amputation

Prosthesis

amputation

Completion of amputation

Prosthesis

of finger, right

Completion of amputation

Prosthesis

Ragged laceration of hand, involving all structures

Amputation proximal to wrist

Prosthesis

21

Severe laceration of foot

Debridement

Healed

M.

54

Laceration of foot

Debridement

Healed

Milling plant

M.

44

Fell into hopper; foot trapped by auger

Death from asphyxia

Milling plant

M.

68

Trapped in hopper bin

Death from asphyxia

amputation

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Injury: the British Journal of Accident

and the failure equipment.

to improve

the

design

of the

Prevention of farm accidents Principles for preventing farm accidents are the same as those for prevention of accidents elsewhere. Heinrich (1950) has established fundamental principles and pointed out that an unsafe person is much more common than an unsafe machine. In his analysis of agricultural accidents King has pointed out that certain accidents occur more frequently at certain ages (King, 1955). Falls from a height, or being hit by moving objects being more frequent with increasing age,

Fig. 1 I.-Case

15. Grain elevator auger injury.

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whereas injuries of the limbs from unskilled use of farm machinery are less common in healthy, agile adults. No doubt a skilled farmer takes risks but learns by certain tricks how to save time and escape injury by dexterity. In this series of auger injuries some victims were small children who should have been kept away from moving machinery. In other instances, accidents occurred because of inadequate attention to safety precautions. Occasionally an auger is in a bad state of repair, or the covering has been left off the machine. Design of the auger Portable augers can be made safer by fitting a small guard. This may slow down the flow of grain, but experiments should be undertaken so that a free flow of grain can be obtained. Industrial and elevator augers need safety controls and locks, and strict rules enforced for their operation. A foolproof design is necessary when an auger is used in conjunction with a hopper, especially while it is being cleaned (Fig. 13). RECOMMENDED REQUIREMENTS 1. Federal and provincial measures to prevent farm accidents. 2. Recording of farm accidents, including auger injuries on the farm and in industry.

ry

Chip pipe=

I

Chip

bin

Fig. 12.-A,

I

Plan of hopper where man fell ar id was trapped by auger. B, Hole made to extract body.

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Injuries

efforts to educate the farmer and 3. Persistent his family, especially children, about the danger of the open-ended auger. 4. Discussion with industrialists to demonstrate the dangers of the unguarded auger, and to design it satisfactorily.

Acknowledgements I would like to thank the following orthopaedic surgeons for the courtesy in allowing me to publish their cases: Dr. W. B. MacKinnon, Dr. D. Bigelow, and Dr. P. Porritt. I acknowledge the help of the Safety Division of the Workmen’s Compensation Board, the Versatile Co., the Federal Grain Ltd., and the Editorial Service of Dalhousie University.

REFERENCES

BARTLETT,L. C.

(1961),

‘Farm injuries ‘, Manitoba

med. Rev., 41, 174.

COOPER,D. K. C. (1969), ‘ Agricultural accidents: a study of 132 patients seen at Addenbrooke’s Hospital, Cambridge, in 12 months ‘, Br. med. J., 4, 193.

Fig. 13.-Protective

DONALDSON,G. F. (1968), ‘ Farm machinery safety. Physical welfare effects of the man-machine interaction on farms ‘, Royal Commission on Farm Machinery. Ottawa: Queen’s Printer. HEINRICH, fi. W. (1950), Industrial Accident Prevention: a Scientijk Approach, 3rd ed. New York and London: McGraw-Hill. HUSTON,A. F., and SMITH,C. (1969), ‘ Farm accidents in Saskatchewan ‘. Can. med. Ass. J., 100,764. KING, H. F. (1955); ‘ An age analysis of some agricultural accidents ‘, Occup. Psychol., 29,245. MUCKALA. K. A. (1967). ‘ Farm accidents and their preventibn. An kpide&ological approach ‘, Minn.

cage designed for grain auger.

5. Adequate compensation for the victims of these accidents. 6. Support for the National Safety Council, the Workmen’s Compensation Safety Division, in their efforts to prevent further accidents. Requests for reprints should be addressed to:-B. Nova Scotia, Canada.

.I. S. Grogono,

Med., Ontario

SO,1477,

March 1, 1959Farm Accident Survey, February 29, 1960. Toronto: Ontario Department of Agriculture. WILSON,G. S. (1969), ’ Safety, health, and welfare in agriculture’, Ann. Occup. Hyg., 12, 129.

Esq., Department of

Surgery, Halifax Infirmary, Halifax,