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Case report
Firework-related blast injury to the hand and treatment algorithm
  1. Arvind Mohan1,
  2. Grant S Nolan1 and
  3. Abhilash Jain1,2
  1. 1 Department of Plastic and Reconstructive Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Botnar Research Centre Institute of Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
  1. Correspondence to Mr Grant S Nolan; grant.nolan{at}


Firework injuries, which most commonly affect hands, are increasing in frequency and severity. We present a pictorial case of a devastating hand injury following a firework explosion in a young male patient. The blast resulted in splaying of the hand with multiple fractures, neurovascular compromise and soft tissue loss. Reconstruction involved a third-ray amputation, fracture fixation, nerve and soft tissue repair resulting in an adequate hand with near-normal appearance. Firework-related hand injuries pose a significant surgical challenge due to the combination of burn and blast forces that can compromise the function of intact vessels and nerves making salvage and reconstruction particularly difficult. Here, we propose a treatment algorithm based on current literature. Our case demonstrates, what initially appeared to be an unsalvageable injury can be reconstructed to produce a functional hand if appropriate surgical measures are taken.

  • plastic and reconstructive surgery
  • orthopaedic and trauma surgery
  • trauma

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  • Presented at ASiT (Association of Surgeons in Training) International Conference, Belfast, 2019

  • Contributors AM, GSN and AJ were equally involved in planning, writing and revising the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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