Motor cycle spoke wheel injuries in children: A preventable accident.

BACKGROUND: The incidence of motorcycle-induced spoke wheel injury is on the rise in our set up. These injuries range from minor soft tissue laceration to extensive crush injuries. This study aimed to evaluate the mechanism, characteristics, incidence and management of wheel spoke injuries. METHODS: Data of all children admitted to Pediatric Surgery Emergency from January 2014 to December 2017, presenting with wheel spoke injuries were analyzed. Incidence, mechanism and characteristics of injury, along with management plan, were noted. The outcomes were assessed by evaluating patients in follow up. RESULTS: Total study patients were 120, with an incidence of 21.7%. Mean age was 8.03±2.28 years. There were 101male patients and nine female patients. All patients were passengers and were sitting astride. Most of the patients were wearing shoes, and hindfoot area of the right foot was mainly involved. Grade 2 injury was seen in 55 (45.8%) and Grade 3 in 55 (45.8%) patients. Flap was needed in 27(22.5%) patients. All patients were mobile at the time of the follow-up. CONCLUSION: We noted the rising incidence of entrapment injuries; however, we had a satisfactory outcome in our patients using different management techniques. We recommend the implementation of safety protocols to avoid such catastrophic injuries.

Measurement of rotation of the first metacarpal during opposition using computed tomography.

PURPOSE: Opposition is an important movement of the hand and rotation of the first metacarpal is the essential component. There is no agreement on the exact magnitude of rotation of the first metacarpal during opposition. This study used computed tomography to describe rotation measurement of the first metacarpal in the hands of a group of healthy individuals. METHODS: The rotation of the first metacarpal was measured with reference to the fixed unit of the hand. Computed tomographic images were taken of the hands of 10 healthy individuals with the thumb in retroposition, resting position, and opposition to the index, middle, ring, and small fingers. On each image a tangential line was drawn along the dorsal margin of the second and third metacarpals. A second line was drawn through the head of the first metacarpal at the level of the sesamoids. The angle between the 2 lines was measured as the angle of rotation of the first metacarpal in different thumb positions. RESULTS: The mean angle of rotation of the first metacarpal in retroposition was 54 degrees+/-10 degrees with reference to the fixed unit of the hand. In the resting position the angle of rotation of the first metacarpal changed to 74 degrees+/-10 degrees. In the position of opposition to the index, middle, ring, and small fingers the angle of rotation of the first metacarpal increased to 100 degrees+/-7 degrees , 103 degrees+/-6 degrees, 105 degrees+/-6 degrees, and 110 degrees+/-7 degrees, respectively. CONCLUSIONS: The first metacarpal rotates 56 degrees when it moves from retroposition to the position of opposition to the small finger.