II. Epidemiology
- Injuries often occur in children
- Age under 5 years
- Bystander (60%)
- Riding mower passenger (15%)
- Operator of mower (25%)
- Age 8 to 14 years
- Operator of mower
- Age under 5 years
- Lawn Mower Injury associated with significant morbidity
- Average hospitalization stay: 10 to 24 days
- Amputation required in 64% of cases
- Permanent Impairment in U.S.: 2000 children per year
- Most common sites of injury
- Distal upper extremity
- Distal lower extremity
III. Management: General
- Immediate vigorous surgical Debridement
- Pulsed lavage
- Remove particulate debris
- Obtain intraoperative cultures
- Antibiotic prophylaxis as below
-
Tetanus Prophylaxis
-
Tetanus immune globulin
- Indicated for <3 prior doses of Tetanus Toxoid
-
Tetanus Toxoid Indications
- Unknown status
- No Tetanus Toxoid in last 5 years
-
Tetanus immune globulin
- Observe for adequate Wound Healing
- Maximize healthy granulation tissue
- Consider skin grafting if necessary
IV. Management: Secondary Infection
- Common organisms (polymicrobial in many cases)
- Staphylococcus
- Diphtheroids
- Escherichia coli
- Enterococcus faecalis
- Pseudomonas species
- Seratia marcescens
- Anaerobic organisms
- Fungal organisms
-
Antibiotic Prophylaxis (broad spectrum for 5-10 days)
- Cefazolin and
- Aminoglycoside
- Add for severe injury or open Fracture
- Observation for infection
- Consider re-culturing 24 to 72 hours after injury
V. Prevention
- Avoid ride-on lawn mower use under age 14 years
- Train adolescents on mower prior to use
- Young children should remain indoors during mower use