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Affiliation
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Dept of Plastic and Reconstructive Surgery, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham, United Kingdom. (christylau8@doctors.org.uk) |
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Abstract
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A 48-year-old foundry worker was referred to our Burns Unit with an unusual work related burn to his right hand. He was splashed with molten aluminium despite standing behind a protective screen and wearing appropriate gauntlet type gloves. Some of the molten metal travelled down the glove and fused with his gold wedding ring. Appropriate first aid was given, however the ring was not cut off until his arrival at the Accident and Emergency Department.
Industrial accidents are extremely common. According to the DWP (Department for Work and Pensions), around 14,000 new accident claims for industrial injuries were made in the United Kingdom in the first three quarters of 2005. Eighty cases of these were related to burn injuries. Employers or individual employees generally do not strictly follow health and safety measures at all times as a result of resources or convenience. Ring avulsion injuries are probably the most common injury caused by wearing of rings. Burn injuries, although less common, can still cause long term disability. In this case although the patient was behind a screen and wearing appropriate gloves, he admitted not wearing a protective jacket which may have prevented travel of the molten metal down the glove.
Circumferential burns to the upper limb and digits, associated with jewellery have previously documented in the literature. Regan et al. and Bozkurt et al. had described uncommon cases of contact burns to digits associated with metal rings and car batteries. Silver and gold have high conductivity as compared to platinum and will cause deeper burns. The common mechanism of injury is localised high temperature whether it is associated with electrical injury or simple conduction, as in our case. We would like to reiterate that early assessment and appropriate escarotomy can be vital in saving the digit. Deep burns with exposed tendon may require the use of local flaps, such as a cross finger flap, however most heal with more conservative management without serious sequelae. Post-operative physiotherapy is important for maximal functional outcome.
This case report further re-enforces the important message of health and safety measures at industrial workplaces. These include the removal of jewellery and utilisation of protective clothing at all times. This can potentially prevents devastating injuries which can lead to permanent disability. |