FEATURE
FIREWORK INJURIES of the Hand
Amitava Gupta, MD
I
n many countries around the world, major
festivals and holidays are celebrated with
firework displays 1,2,3 . Although some of
these displays are professionally conduct-
ed, there is a great number of festivities
where individuals who use and handle fire-
works end up with injuries to the hand, face,
ear and eyes 4,5 .
EPIDEMIOLOGY
In the United States, nearly 70 percent of firework injuries happen
in connection with the 4 th of July, although some occur at New
Year’s Eve.
In a study of American ER visits for firework injuries from
2006-2010, about a quarter of the injuries were to the hand and
fingers out of 25,691 incidents. Half were patients under age 20
and 76 percent were male. Seventy-eight percent were from the
South or the Midwest. The most common injuries were burns of
the wrist, hand and fingers (26.7 percent) followed by contusion
or superficial injuries to the eye (10.3), open wounds of the wrist,
hand and fingers (6.5) and burns of the eye 1 .
24
LOUISVILLE MEDICINE
PREVENTION
Fortunately, from all the long-term epidemiological studies, it is
becoming clear that the prevalence of firework injury has dropped
by 30 percent since 2000 in the US and is also decreasing in the
rest of the world 1,2,3 .
It is also fortunate that most firework injuries to the hand are
minor and leave no long-term loss of hand function, but devastating
injuries do happen.
A study from a major trauma center in the US 4 outlines the
devastation of these life-altering blast injuries at a young age. The
hand is injured in four ways: 1. Misuse of the firework: holding
the firework while it explodes; 2. Device malfunction; 3. Failure to
withdraw quickly from the blast and 4. Being injured as an innocent
bystander.
In a retrospective cohort study of a large trauma center in the US
between 2005 and 2015, a total of 105 patients sustaining operative
hand injuries due to fireworks were found. Of these, 84 percent
sustained some first web space injuries, and 25 percent of the hands
required some revision amputation. The types of fireworks that
caused hand and wrist injuries included sparklers, rockets, firecrack-