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Deck-chairs: putting a finger on the problem, rather than in it
635
Deck-chairs: putting a finger on the problem, rather than in it C. McGuiness, Accident
D. Potts and S. J. Booth
and Emergency
Department,
Westminster
Hospital,
Although offen portrayed as something of a joke, injuries sustained in the setting-up and use of deck-chairs can have fairly serious consequences. Six patients who sustained finger injuries in some of London’s Royal Parks during the Summer are presented fogether with data from the Department of Trade and Industry suggesting that, taken throughout the county as a whole, large numbers of injuries may be occurring. Notably, four of our patients were foreign tourists who may be less familiar with the traditional wooden folding deck-chair. Surprisingly no British Standards Institute (BSllguidelines exist relating to deck-chair safety. These finger injuries can have marked morbidity if they involve victims who depend upon manual dexterity in their work or hobbies.
Injury, 1994, Vol. 25, 635-636,
December
Introduction Six patients who sustained a crush type injury by trapping their fingers in deck-chairs during the months JuneSeptember were treated in the Westminster Hospital Accident and Emergency department. The Department of Trade and Industry (DTI), Home and Leisure Accident Research body collected details of 124 patients with deck-chair-related injuries over a period of 2 years from 200 000 visits to selected Accident and Emergency departments.
Table I. Injuries to patients seen at the Westminster Case
Sex
Age
M
25
M
43
M
20
M
25
M
20
M
35
Ltd
UK
Results All injuries were in fit young adults aged 24-43 years (children are not seen in the Westminster Hospital Accident and Emergency department). Table1 lists the six patients seen at the Westminster hospital. Sixty-four injuries from the DTI figures involved the fingers and were sustained during setting up or moving deck-chairs, or by them collapsing while being sat on. Eighty per cent of the DTI patients required more than one visit for their treatment.
Discussion Finger tip injuries are well recognized in certain activities. ‘Ampoule snappers thumb’ (Carruthers, 1976), ‘wellie thrower’s finger’ (D’A Feam, 1986) and ‘letter box finger’ (Menzies, 1988) have all been previously reported, but we could find no reference to deck-chair-related finger injuries. These injuries can be serious, requiring treatment varying from simple dressings to surgical procedures. The associated morbidity may be prolonged; even fairly minor finger tip injuries due to crushing taking an average of 28 days to heal with non-operative treatment (Lamon et al., 1983). In children such injuries can heal well leaving no long-lasting deformity or loss of function (Illingworth, 1974). Surprisingly there are no obvious public warning notices in the Royal Parks regarding the potential hazards
Hospital
Finger
Injury
Treatment
Follow-up
Right middle Left middle Left ring and middle Left middle Left ring Left middle middle Right middle
Fracture, distal phalanx, nail avulsion Loss of tip
Minor op., antibiotics
Review Xl’ Review x6 Fracture clinic Nil’
‘Patient returned to own country for follow-up. 0 1994 Butterworth-Heinemann 0020-1383/94/100635-02
London,
Open fracture both distal phalanges Laceration, sub-ungual haematoma Open fracture distal phalanx Fracture distal phalanx Open fracture distal phalanx
‘V-Y plasty, antibiotics Strapping, antibiotics Dressing Dressing antibiotics Minor op, suture, strapping, antibiotics
Review xl‘ Review Xl’
636
Injury: InternationalJournalof the Care of the Injured (1994) Vol. 25/No. 10
of deck-chairs while they are being moved or set up, although there are disclaimers to the effect that injuries sustained by the patrons moving the deck-chairs themselves are not the responsibility of the owners. Even more surprising is the fact that there are no British Standards Institute specifications relating to deck-chairs. Hence the Parks Authorities have no guidance on which types of deck-chairs may be preferable. It is notable that four of our patients were foreign visitors who may not be familiar with this type of deck-chair. We suggest that standards relating to deck-chairs should be introduced and that this would allow an informed choice about which type to use. The traditional folding wooden deck-chair allows victims’ hands to become trapped in the hinge if they attempt to move it while sitting on it, the user’s weight making extraction of the digit difficult. The Royal Parks have attempted to decrease the number of injuries during the past 2 years by using deck-chairs of an improved design, although they are still a problem. Members of the public using such chairs should be made aware of the risks of sustaining injuries that may involve both hands and result in loss of amenity or time from work and even long-term disability depending upon the patient’s occupation.
Acknowledgement We thank the Department of Trade and Industry, 1080 Victoria Street, London SWlH ONN, for supplying ‘1988 & 1989 Sport and Leisure Accident Surveillance Figures.’
References Carruthers R. (1976) Arnpoule snapper’s thumb. Lancer i, 141.2. DA Feam C. B. (1986) Wellie thrower’s finger. Br. Med. J. 293, 1645. Illingworth C. M. (1974) Trapped fingers and amputated fingertips in children. ]. puediafr. Surg. 9, 853. Lamon R. P., Cicero J. J., Frascone R. J. et al. (1983) Open treatment of fingertip amputations. Ann. Emerg. Swg. 12,358. Menzies D. (1988) Letterbox finger. Br. Med. J. 296, 1161. Paper accepted
9 June 1994.
Correspondence should be addressed to: Mr D. Potts PRCS, Senior Registrar in Accident and Emergency, Accident & Emergency Department, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Deck-chairs: putting a finger on the problem, rather than in it C. McGuiness, Accident
D. Potts and S. J. Booth
and Emergency
Department,
Westminster
Hospital,
Although offen portrayed as something of a joke, injuries sustained in the setting-up and use of deck-chairs can have fairly serious consequences. Six patients who sustained finger injuries in some of London’s Royal Parks during the Summer are presented fogether with data from the Department of Trade and Industry suggesting that, taken throughout the county as a whole, large numbers of injuries may be occurring. Notably, four of our patients were foreign tourists who may be less familiar with the traditional wooden folding deck-chair. Surprisingly no British Standards Institute (BSllguidelines exist relating to deck-chair safety. These finger injuries can have marked morbidity if they involve victims who depend upon manual dexterity in their work or hobbies.
Injury, 1994, Vol. 25, 635-636,
December
Introduction Six patients who sustained a crush type injury by trapping their fingers in deck-chairs during the months JuneSeptember were treated in the Westminster Hospital Accident and Emergency department. The Department of Trade and Industry (DTI), Home and Leisure Accident Research body collected details of 124 patients with deck-chair-related injuries over a period of 2 years from 200 000 visits to selected Accident and Emergency departments.
Table I. Injuries to patients seen at the Westminster Case
Sex
Age
M
25
M
43
M
20
M
25
M
20
M
35
Ltd
UK
Results All injuries were in fit young adults aged 24-43 years (children are not seen in the Westminster Hospital Accident and Emergency department). Table1 lists the six patients seen at the Westminster hospital. Sixty-four injuries from the DTI figures involved the fingers and were sustained during setting up or moving deck-chairs, or by them collapsing while being sat on. Eighty per cent of the DTI patients required more than one visit for their treatment.
Discussion Finger tip injuries are well recognized in certain activities. ‘Ampoule snappers thumb’ (Carruthers, 1976), ‘wellie thrower’s finger’ (D’A Feam, 1986) and ‘letter box finger’ (Menzies, 1988) have all been previously reported, but we could find no reference to deck-chair-related finger injuries. These injuries can be serious, requiring treatment varying from simple dressings to surgical procedures. The associated morbidity may be prolonged; even fairly minor finger tip injuries due to crushing taking an average of 28 days to heal with non-operative treatment (Lamon et al., 1983). In children such injuries can heal well leaving no long-lasting deformity or loss of function (Illingworth, 1974). Surprisingly there are no obvious public warning notices in the Royal Parks regarding the potential hazards
Hospital
Finger
Injury
Treatment
Follow-up
Right middle Left middle Left ring and middle Left middle Left ring Left middle middle Right middle
Fracture, distal phalanx, nail avulsion Loss of tip
Minor op., antibiotics
Review Xl’ Review x6 Fracture clinic Nil’
‘Patient returned to own country for follow-up. 0 1994 Butterworth-Heinemann 0020-1383/94/100635-02
London,
Open fracture both distal phalanges Laceration, sub-ungual haematoma Open fracture distal phalanx Fracture distal phalanx Open fracture distal phalanx
‘V-Y plasty, antibiotics Strapping, antibiotics Dressing Dressing antibiotics Minor op, suture, strapping, antibiotics
Review xl‘ Review Xl’
636
Injury: InternationalJournalof the Care of the Injured (1994) Vol. 25/No. 10
of deck-chairs while they are being moved or set up, although there are disclaimers to the effect that injuries sustained by the patrons moving the deck-chairs themselves are not the responsibility of the owners. Even more surprising is the fact that there are no British Standards Institute specifications relating to deck-chairs. Hence the Parks Authorities have no guidance on which types of deck-chairs may be preferable. It is notable that four of our patients were foreign visitors who may not be familiar with this type of deck-chair. We suggest that standards relating to deck-chairs should be introduced and that this would allow an informed choice about which type to use. The traditional folding wooden deck-chair allows victims’ hands to become trapped in the hinge if they attempt to move it while sitting on it, the user’s weight making extraction of the digit difficult. The Royal Parks have attempted to decrease the number of injuries during the past 2 years by using deck-chairs of an improved design, although they are still a problem. Members of the public using such chairs should be made aware of the risks of sustaining injuries that may involve both hands and result in loss of amenity or time from work and even long-term disability depending upon the patient’s occupation.
Acknowledgement We thank the Department of Trade and Industry, 1080 Victoria Street, London SWlH ONN, for supplying ‘1988 & 1989 Sport and Leisure Accident Surveillance Figures.’
References Carruthers R. (1976) Arnpoule snapper’s thumb. Lancer i, 141.2. DA Feam C. B. (1986) Wellie thrower’s finger. Br. Med. J. 293, 1645. Illingworth C. M. (1974) Trapped fingers and amputated fingertips in children. ]. puediafr. Surg. 9, 853. Lamon R. P., Cicero J. J., Frascone R. J. et al. (1983) Open treatment of fingertip amputations. Ann. Emerg. Swg. 12,358. Menzies D. (1988) Letterbox finger. Br. Med. J. 296, 1161. Paper accepted
9 June 1994.
Correspondence should be addressed to: Mr D. Potts PRCS, Senior Registrar in Accident and Emergency, Accident & Emergency Department, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.