7 Year Old Puts Arm in Concrete Mixer

SavageGlow · #1 ● 09-30-2024, 07:10 PM

A 7-year-old male patient was admitted to our pediatric facility following a traumatic crush injury sustained while playing. The incident occurred when the patient inadvertently inserted his upper limb into a concrete mixer, resulting in entrapment and subsequent crush injury to his upper limb. Upon arrival at our institution, the patient presented with extensive soft tissue trauma involving the entire anterior aspect of his arm and forearm, with exposed tendons and nerves (Fig. 1).

Clinical examination revealed signs of vascular compromise, including absent pulses and coldness in the affected fingers. Radiographic imaging of the forearm revealed no evidence of bony injury, while Doppler ultrasound failed to detect vascular flow in the wrist and forearm.

Emergency surgical intervention was promptly initiated to address the severe soft tissue trauma and vascular compromise. Meticulous exploration and debridement of the crushed tissues were undertaken, revealing significant damage to a segment of the brachial artery measuring 15 cm (Fig. 2).

Urgent repair of the vascular injury was performed, along with management of multiple nerve lacerations identified during the procedure. Vascular reconstruction was achieved using a harvested greater saphenous vein graft (from his right leg) measuring 17 cm, followed by meticulous vascular anastomosis to restore blood flow to the affected limb (Fig. 3). The donor site was managed with appropriate care to prevent complications, and no significant issues were reported.

Due to the extent of soft tissue trauma and compromised vascular supply, amputation of the thumb and distal phalanx of the middle finger was deemed necessary to optimize functional outcomes and wound healing. Following surgical intervention, the patient underwent multiple debridement procedures and was managed with negative pressure wound therapy (VAC) to promote wound granulation and tissue healing (Fig. 4).

Subsequent skin grafting (Fig. 5) was performed to facilitate wound closure, and the patient was discharged home with appropriate postoperative care instructions.

Three months post-injury, the patient underwent a pollicization using the middle finger to optimize hand function (Fig. 6). The middle finger was chosen because its distal phalanx was amputated, making it a suitable candidate for this procedure. Despite some residual functional limitations, including reduced grip strength and joint stiffness, the patient demonstrated acceptable upper limb function.

Long-term follow-up and rehabilitation will be essential to monitor the patient’s progress and optimize his overall recovery and quality of life. This case highlights the challenges associated with severe crush injuries in pediatric patients and underscores the importance of prompt intervention and comprehensive management to achieve favorable outcomes.