Washing Machine Injuries of the Upper Extremity

Abstract

Washing machines are part of every household and there are various reports of upper extremity injuries due to inadequate safety precautions while operating the machine. Most of the injuries occur when an attempt is made to remove the clothes from the machine and the hand gets caught in the spinning machine. The presentation can vary from minor soft tissue injuries to a mangled upper extremity. The chance of neurovascular damage resulting in compartment syndrome is very high. The author reports three cases of washing machine injuries to draw attention to this not so uncommon injury. The relevant literature is also considered.

There have been various reports of washing machine related injuries ever since MacCollum first published on ‘wringer arm’ injuries in 1938. 1, 2 He described the ‘wringer arm’ as an avulsion injury to the arm caused by the wringer washing machines that were popular at that time.1, 2 Most of the washing machine related injuries were not clinically significant as most of the sufferers required only out-patient management, but a few were serious requiring inpatient management for many days. As the design of washing machine has changed in the recent times, most of the reports are of injuries caused by wringer washing machines. In support of this view, according to the United States Consumer Product Safety Commission, 3 there were 19,109 injuries from 1993 till year 2000 due to washing machines. Most of the reported cases of washing machine injuries come from North America and were often due to a design that is now defunct. The present study documents three cases of injuries to the upper extremities caused by washing machines of more modern design. These were caused when the children were trying to unload the contents while the machine was still spinning, with or without their parents’ permission.

CASE 1

A 10 year old girl was admitted to Ibri Hospital, Oman, in September 2004 following injury to her right forearm when she attempted to remove the clothes from a washing machine while the machine was spinning. She sustained a closed fracture of the radial and ulnar bones of the forearm. There was gross oedema of the forearm and she was hospitalized for observation. The position was not acceptable after closed manipulation and hence she was taken for closed intramedullary fixation.

The fracture united in six weeks time and she regained full range of movements and full recovery of function [Figs. 1 & 2].

Figure 1:

(Case 1) Fracture of the humerus

Figure 2:

(Case 1) Post operative X-ray showing intramedullary K wires in situ

CASE 2

A five year old boy presented to the Orthopaedic Department of Ibri Hospital in March 2007 with swelling of the right arm after it had been trapped in a spinning washing machine. He was diagnosed to have a closed comminuted fracture of the shaft of the right humerus which was treated conservatively. There was no neurovascular compromise in the extremity. The arm was immobilized in a back slab. The boy was admitted for three days to observe for compartment syndrome. There was uneventful healing of the fracture with normal elbow and hand function [Figs. 3 & 4].

Figure 3:

(Case 2) Post operative X-ray showing fractured humerus

Figure 4:

(Case 2) X-ray showing united fracture

CASE 3

A 14 year old boy presented in the Accident and Emergency Department of Ibri Hospital in May 2007 with pain of his right middle finger. The injury was sustained while attempting to remove the clothes from the washing machine while the machine was still spinning. He had sustained a closed undisplaced fracture of the proximal phalanx of his middle finger, which was managed conservatively by strapping it to the neighbouring finger. At follow up he had full range of movements without residual deformity [Fig. 5].

Figure 5:

(Case 3) Fracture of proximal phalanx

DISCUSSION

Washing machines have been part of the household ever since the earliest washing machine, ‘the scrub board’, was invented in 1797. Injuries occur when attempts are made to remove clothes from the machine and the hand gets entangled in the spinning laundry, leading to soft tissue injuries and fractures. In the previously reported studies, this occurs most in children. This present study is consonant with this view. It has been speculated that such vulnerability is probably due to parental negligence.

In most machines there is a safety mechanism to stop the drum from spinning once the loading door is opened. There should be two safety features in the machine: one to keep the door shut and locked during the operation and the other to stop the machine from spinning when the door is opened. But usually there is a time delay and the machine continues to spin even when the door is open. To prevent injury, the washing machine lid, which blocks access to the spinning drum, should be locked in the closed position during the wash and spin cycles; however, most machines continue to spin even when the lid is open causing injury to people trying to remove clothes. A time-delay feature in the lid lock using a thermal element4 is a recently patented improved safety feature. Previous wringer machines had ‘instinctive’ release mechanisms which stopped the machine to prevent hand injuries. Usually, when the arm is trapped, an attempt is made to pull out the arm instead of activating the safety release.

The severity of the injury, which occurs due to mechanical and thermal damage, is not obvious initially, but only a few hours later. These children need to be hospitalised and observed for soft tissue injuries and compartment syndromes.1, 5 The vascular status of the extremity has to be periodically assessed and fasciotomy done if required. In rare cases, a child can present with degloving or mangled extremity. Many authors recommend hospitalization for 48 hours since the magnitude of the soft tissue injury is not obvious at presentation, with initial assessment of neurovascular integrity and radiological survey to rule out skeletal injuries.1, 5 Simple elevation compared to compression dressings is found to be effective in preventing vascular compromise. In an animal study by Adams and Fowler,6 they found maximum damage to tissues at 24 hours, although it began at three to five hours. In their study, striated muscle was found to have the maximum injury. Injuries that can occur include: friction injuries; compression causing contusion of skin and muscles; fractures and haematomas, and degloving injuries.5 Deshmukh in 2005, 7 reported a case of irreducible volar subluxation of the proximal interphalangeal joint of the index finger in a woman, sustained when she attempted removal of clothes while the washing machine was slowing down.

Most of the injuries caused now are due to automatic machines as the United States stopped production of wringer machines in 1983.3 The injuries in the present series were due to top loaded machines which are popular in Oman. The injuries occurred during the spin cycle when patients tried to remove clothes while the machine was still running. Front loading machines use 40–60% less water and 30–50 % less energy than top-loaders, but are expensive. Child injury could be due to specific preventable factors and inadequate child supervision. There should be attentive supervision around known hazards that are frequent sites of injury. 5, 8–10

CONCLUSION

Given the risk, there are various measures that would prevent washing machine injuries to children. Parents should be counselled regarding the proper location of the machine; the need to keep it unplugged to prevent injury and better child supervision. Injuries could also be prevented by improved safety features such as a triggering system, sensitive enough to detect even a small opening of the lid. A further improvement would be a list of safety features and measures clearly displayed in Arabic on a visible area of the machine.