Lawn Mower Injury

Injuries often occur in children
1. Age under 5 years
  1. Bystander (60%)
  2. Riding mower passenger (15%)
  3. Operator of mower (25%)
2. Age 8 to 14 years
  1. Operator of mower
Lawn Mower Injury associated with significant morbidity
1. Average hospitalization stay: 10 to 24 days
2. Amputation required in 64% of cases
3. Permanent Impairment in U.S.: 2000 children per year
Most common sites of injury
1. Distal upper extremity
2. Distal lower extremity

Immediate vigorous surgical Debridement
1. Pulsed lavage
2. Remove particulate debris
Obtain intraoperative cultures
Antibiotic prophylaxis as below
Tetanus Prophylaxis
1. Tetanus immune globulin
  1. Indicated for <3 prior doses of Tetanus Toxoid
2. Tetanus Toxoid Indications
  1. Unknown status
  2. No Tetanus Toxoid in last 5 years
Observe for adequate Wound Healing
1. Maximize healthy granulation tissue
2. Consider skin grafting if necessary

Common organisms (polymicrobial in many cases)
1. Staphylococcus
2. Diphtheroids
3. Escherichia coli
4. Enterococcus faecalis
5. Pseudomonas species
6. Seratia marcescens
7. Anaerobic organisms
8. Fungal organisms
Antibiotic Prophylaxis (broad spectrum for 5-10 days)
1. Cefazolin and
2. Aminoglycoside
  1. Add for severe injury or open Fracture
Observation for infection
1. Consider re-culturing 24 to 72 hours after injury