Use of treadmills at home is increasing, as noted by an increase in reports of injuries related to this device. Estimating the incidence of these kinds of injuries in toddlers and children is difficult because many patients with small injuries do not come to physicians; on the other hand, there is no specific center to record these patients and this makes it even more difficult to estimate the incidence of these kinds of injuries in children. In the US there are about 8700 injuries related to home sports equipment reported annually. Considering the recorded data in the US, there have been 1009 hand injuries related to treadmills in a 4-year period, 300 cases of which occurred in toddlers and children younger than 5 years of age (
1). We should mention here that all studies and data related to this kind of injury have been done on very small groups of patients. At first injuries caused by treadmills did not seem serious to parents and because of this delay, a considerable number of patients refer in the chronic phase of the disease with scar contracture. It must be taken into account that the earlier the treatment begins, the better the treatment outcome will be. The patients who seek medical help with a delay after the injury have a much worse outcome compared to others. Delaying the initiation of treatment has a direct, linear relation to the increased need for surgery so in case of having such injuries immediate treatment is necessary ( 1, 4, 5). For example, in a study done by Marshall et al, 14 patients were studied and 8 of them had came long after their injury, and had developed contraction scars ( 6).
The average age of the patients in our study was 2.6 years. In other studies it was reported in a range of 2.4-3.9 years (
4, 7). Considering the location of the injuries, most of them had been reported in the upper extremity, especially the hands and fingers ( 1- 4, 7- 10). Volar surface of the hand has been the most common site of injury ( 7, 11). In our study the most common site of injury was the volar surface of the fingers in almost all the patients which corresponds to the previous studies. However, in 1 of our patients the injury location was at the dorsal aspect of thumb. Considering the gender, this trauma is more likely to be seen in boys than girls ( 7). In our study group there were 5 boys and 3 girls in a group of 8 patients.
Considering the depth of skin injury, previous studies offer different data and as one can see the ratio of the prevalence of the superficial injuries to deep ones is different. With correct care of the wound and rehabilitation, many of these injuries especially superficial ones can be treated without surgery. In a study which was done by Camran et al. on 12 patients, half of them had undergone surgical operation. (
7) In a study by Wong et al 47% of the patients eventually needed skin grafting ( 3). On the other hand, in a study done by Friedrich which consisted of 13 patients only 3 of them (23%) had undergone a surgical operation in order to release scar contracture ( 9); in a study done by Han the skin graft was used in 64% of the patients ( 4).
In general, the therapeutic method in acute abrasions is like other burn injuries. In case of superficial or semi-superficial injuries daily dressing and early physiotherapy with night splints are used (
8). In chronic cases with deep injuries, it has been recommended to use a skin graft for these patients. The color mismatch of grafted skin, specially the groin skin which becomes brown, and recurrence of contracture led us to seek Z-plasty combined with soft tissue distraction as an alternative method of treatment ( 1, 3, 4, 12).
The parents are very satisfied with this method because we harvested no skin graft and the care of orthosis is accepted readily. The Z-plasty does not generate tissue however, the contracture is released and the soft tissue distraction in addition to relieving the contracture holds the fingers straight until complete healing is observed(
13). Static finger splints prevent the recurrence of contracture.
The newer model treadmill machines have solved the problem of this type of injury by removing the metal rod but still there are old machines available on the market and this injury is still seen and since prevention is far better than treatment the public must be warned of this potential danger to toddlers (
Treadmill injuries are seen in toddlers and young children and the treatment of choice in chronic cases with contracture has been release of contracture and skin graft. But due to discoloration of the graft, we have used Z-plasty with soft tissue distraction without skin graft to overcome this problem with very encouraging results. Z-plasty relieves the contracture but holding the finger in distraction helps the new skin to be generated and especially in this young patients skin heals rapidly and the late results are acceptable. We propose Z-plasty combined with soft tissue distraction as an alternative modality in the treatment of these patients.