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Abstract
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Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is the sugarcane juicer, a machine typically operated by sole proprietorship drink stalls within food centres and more importantly, a dangerous cause of workplace accidents. We highlight the severity of sugarcane juicer-related hand injuries that have resulted in permanent disabilities in 3 representative patients. We also review occupational health risks of such technology to understand the contributing factors involved and how they can be prevented.
Three patients, 2 in their 50s and a teenager, were managed for mutilating hand injuries from operating the sugarcane juicer. The teenage girl (patient A) and one of the older women (patient B) injured their dominant right hand while cleaning the machine without switching it off. They sustained extensive degloving injuries and avulsion amputations of all fingers except for the ring and little fingers in patient A's case, and the little finger in patient B's case. Patient C used the juicer without its safety guard so that more sugarcane stems could be fed inside, and sustained a left mangled hand. She suffered comminuted fractures in her index, middle, ring and little fingers; a thumb avulsion amputation and a proximal degloving skin injury. For all 3 patients, initial management involved debridement and amputation of the unsalvageable digits. Eventual resurfacing of their wounds required complex flap reconstruction--an extended lateral arm flap, bi-lobed pedicled groin flap and posterior interosseous artery flap. Patient A had a total of 10 surgeries to regain a basic hand consisting of a toe-to-thumb transfer and 2 digits. Patient B underwent a total of 13 surgeries to restore an opposable thumb and 2 digits involving staged creation of the webspace with a flap, and thumb lengthening. Patient C also underwent digit lengthening and first webspace reconstruction. Nine surgeries were performed to obtain an opposable thumb and a mitten hand appearance.
The resultant percentage of disability in these mutilating hand injuries ranged from 30% for complete thumb loss to 70% when all 5 digits are involved (cases 2 and 3) according to A Guidelines to the Assessment of Traumatic Injuries and Occupational Diseases for Work Injury Compensation published by the Singapore Ministry of Manpower. None of our patients returned to pre-injury level of work activity. ...
Language: en |