Case Report: 2-Year-Old Boy with Grade 4 Avulsion Injury of the Hand Caused by a Conveyor Belt System.

In the western world, mutilating hand injuries such as amputations and severe avulsions are more common in the working population than in children (Pomares G et al. Orthop Traumatol Surg Res 2018; 104: 273–276). An epidemiologic retrospective study from France identified 1715 traumatic upper-limb amputations over a 10-years period with the majority of cases involving middle-aged men (Pomares G et al. Orthop Traumatol Surg Res 2018; 104: 273–276). Systematic literature search using Pubmed on conveyor belt system injuries found few articles. A recent study analyses occupational traumatic injuries in offshore seafood processors in Alaska. Processing equipment and machinery were among the leading causes of injuries, accounting for 28% of traumata (Syron et al. J Safety Res 2018; 66: 169–178). Tiwari et al. describe a collective of six children who sustained motorized machine belt entrapment injuries (Tiwari P et al. Indian Pediatr 2020; 57: 66–68). Overall mortality and paraplegia rate were 33.3% each. Those accidents mainly occured in rural areas in India. The children were caught in the belt by their clothes while their parents were working nearby. Five patients were pulled through their torso, those with involved head were dead at the time of arrival. Only one had only his limbs involved. If a conveyor belt involves the hand, severe avulsion or crush injuries result. The outcome of reconstructive surgery in hand avulsion injuries depends mainly on the initial degree of injury (Kay et al. J Hand Surg 1989; 14: 204–213). Finger avulsion injuries are classified according to Kay’s classification. In class I injuries, tissue perfusion is still normal. Kay II injuries already show inadequate blood flow but no fracture is present. In class III injuries, perfusion is restricted and there is either an associated fracture or a joint injury. Kay IV injuries cover complete digital deglovings or amputations (Kay et al. J Hand Surg 1989; 14: 204–213). Generally, replantations for sharp injuries show higher success rates than for avulsion or crush injuries (Goodman et al. J Hand Surg Am 2017;42:456–463). In general, the age of pediatric patients is critical to the feasibility and success rate of finger replantations and reconstructive hand surgery.