Hunting Hazards to Avoid for a Successful Season

‘Tis the peak of hunting season.

Hunters far and wide have successfully exempt themselves from Holiday gatherings to pursue their passion. treestand-1-300x300

Given this feat, we want to ensure optimal success and the best holiday hunting experience possible by helping hunters avoid some of the most common hunting mishaps identified in scientific studies, seen in emergency centers and reported among hunters in the field.

Among the most reported hunting accidents include:

  • Hunting/Tree Stand Accidents
  • Misfire/Shooting Accidents
  • Field Dressing Dangers

According to a recent study, “hunting mishaps most frequently occurred because of overexcitement, unfamiliarity with equipment, or carelessness.” The study, which reviewed the hospital records of 100 male patients between the ages of 10 and 78 showed a wide variety of injuries resulting from hunting activities.  “Almost half of the patients were injured during a 9-day gun deer hunting season.”  The study concluded that while many of the injuries were minor, serious morbidity with potential long-term disability and costs in time and money can occur [1].

Tree Stand Accidents

Tree stands situated 20-30 feet in the air present a hazard potentially as dangerous as the weapons accompanying hunters in the trek up and down.

According to Tree Stand Safety Awareness (TSSA), tree stand accidents are the number one cause of serious injury and death to deer hunters – estimating that more than one-third of hunters who use tree stands will be involved in a fall sometime in their hunting careers [2].

While broken bones are very common following a fall from a stand (arm fractures, hip fractures, as well as injuries to the head, neck and spine), others less frequently discussed involve jewelry/accessories.

A potentially limb and life-threatening injury that is completely avoidable among hunters involves jewelry/accessories – watches and rings in particular.  During a slip or fall from a stand, these objects can catch on parts of the stand, as well as nails and tree branches causing serious damage to the affected limb.  The catch/pull/hanging of the watch or ring during a fall, traumatically impacts the soft tissue of the impacted region.  This can result in a severe wrist fracture for watch wearers and traumatic ring avulsion for ring wearers, which can strip tendons and nerves from the bones of the finger.

The severity of either injury is long lasting – surgery and rehabilitation required in both cases. Additionally, hunters are often located in remote areas, and treatment of such a severe injury is delayed – impacting outcome.

Hunters are urged to ensure tree stand safety by wearing a full body harness and leaving watches and rings at home.  A system of communication with fellow hunters is also encouraged should a mishap occur.

Misfire/Shooting Accidents

Many of the injuries seen during hunting season involve a shooting accident.  These accidents often occur when hunters are overly eager and fail to adhere to a basic safety protocol – proper attire, weapon check and communication.  Shooting accidents also occur when drowsy hunters fall from their stands with weapon in hand.  These accidents can cause self-inflicted injuries as well as injury to nearby hunters.

According to the International Hunter Education Association (IHEA), approximately 1000 people in the US and Canada are accidentally shot by hunters every year – just under a hundred of those accidents are fatalities.  Hunter safety courses are strongly encouraged and required in some cases before hunt participation.

Field Dressing Dangers

Another opportunity for injury occurs during the process of field dressing.  Not only is the rapid cleaning of hunted game essential to prevent bacteria from growing on the surface of the carcass (at initial wound site or while gutting) and contaminating the meat, but also to reduce risk of dangerous infection if cut during the process.

Field dressing must be done as soon as possible to ensure rapid body heat loss. Bacteria grow most rapidly in the range of temperatures between 40°F and 140°F, in some cases doubling in number every 20 minutes. This range of temperature is often called the “temperature danger zone [3].” Hunters in warmer climates should be particularly vigilant.

Too often most of the hunting preparation is focused on the kill and not enough on safely field dressing the game.  Dull knives and dirty prep areas can result in lacerations prone to infection. These types of infected wounds can be difficult to treat.  Additionally, many types of popular game are infected with Brucellosis, an infectious disease caused by bacteria.  Hunters merely handling the blood and organs of an infected animal while field dressing can become infected.  The infection may remain dormant up to a month after exposure and can cause severe illness requiring antibiotics. Symptoms include fever, chills, headache, fatigue, muscle and joint pain [4].

Field dressing preparation should include:

  • Clean, sharp knife
  • Resealable plastic storage bags
  • Whetstone or steel for sharpening
  • Cooler full of ice/snow
  • Rope or nylon cord
  • Disposable plastic gloves
  • Clean wipes or paper towels
  • Clean drinking water

Be safe and Happy Hunting!

References

  1. Huiras CM, Cogbill TH, Strutt PJ. Hunting-related injuries. Wis Med J. 1990 Oct;89(10):573-6.
  2. Bailey C. Here are the Five Most Common Hunting Injuries. Wide Open Spaces. 2017 March 29. http://www.wideopenspaces.com/these-are-the-5-most-common-hunting-injuries/
  3. PennState Extension. Proper Field Dressing and Handling of Wild Game and Fish. 2017. https://extension.psu.edu/proper-field-dressing-and-handling-of-wild-game-and-fish
  4. Centers for Disease Control and Prevention (CDC). Hunters: Protect Yourself from Brucellosis. https://www.cdc.gov/features/huntersbrucellosis/index.html

 Dr. Korsh Jafarnia is a Houston based board-certified, fellowship trained orthopedic surgeon specializing in the hand, wrist and elbow. He is recognized locally and nationally as a “top doctor” in his field and highly sought for his level of expertise in hand and upper extremity orthopedic care.

Staying Healthy Post Hurricane Harvey

As Texans begin to restore and rebuild following one of the most devastating storms in US history, we thought it would be a good time to talk about some of the health concerns that exist in this post flood environment and precautions everyone can take to stay healthy.

Harmful Elements in Flood Waters                                     Healthy Post Hurricane Harvey

Flood waters contain a variety of potentially harmful elements, many of which linger even after water begins to recede.  Aside from sheets of fire ants, snakes and other potential harmful critters, sharp metal bits, nails and glass shards are often prevalent and linger in debris.

In a recent interview with the Washington Post, Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, explained that sewage systems merge with flooding rain, introducing infectious human waste to streets and into flooded homes. What remains as sludge and a dirty film permeates everything it once washed over.  While the waters recede, the infectious elements remain and must be treated with caution (1).

And while it is not easy to predict which microbes will cause the greatest problems, the Centers for Disease Control and Prevention (CDC) reported 30 cases of MRSA, an antibiotic-resistant staphylococcus bacterium, in a group of New Orleans evacuees following Hurricane Katrina in September 2005. “Vibrio” pathogens, also known as “flesh-eating” bacteria, sickened two dozen people and killed six – in addition to reports of heat and infection-related skin rashes and red marks associated with biting mites (2).

Other Post Storm Concerns                                                                                             

The harmful material contained in flood waters and the contaminated and dangerous debris left in its wake are common concerns following a flooding storm (3), but there are also other lesser known concerns and areas of caution.  These include:

Scientific research is increasingly reporting the significant role that stress plays in our overall health – from a weakened immune system predisposing us to a host of illnesses, to increased risk of musculoskeletal injuries and conditions traditionally associated with physical stress only.  The type of stress that can come with the anticipation of such a storm, its duration and damaging aftermath is capable of threatening the health of an individual in ways many may not realize.  Referred to as “psychosocial” factors (frustration, dissatisfaction, depression and despair), the resulting stress has shown to induce physiological responses that can contribute to the development of musculoskeletal disorders (4).

Additionally, food and water quality that is compromised during power outages can challenge the healthiest among us if not approached with caution (5). Upper respiratory disorders associated with the rapidly growing mold following a Texas flood are a big concern.  Exposure to mold spores can prompt a rise in asthma and other respiratory illnesses.  The close proximity of individuals housed in shelters or working shoulder to shoulder in cleanup efforts can perpetuate respiratory illnesses and other communicable diseases.

Cuts and lacerations resulting from and/or exposed to flooded debris are particularly concerning to physicians.  The skin is the largest organ of the human body and should be protected as such.  Any opening creates vulnerability to not only the affected area but the entire body, particularly when exposed to potentially harmful microbes often found in flood water and debris as described earlier.

Reducing Risks and Staying Healthy Post Hurricane Harvey

There are several precautions that flood victims and those helping in their recovery should do to ensure everyone stays healthy post Hurricane Harvey.  These include:

 

  • Tetanus booster shots – Texas health officials urge people post Hurricane Harvey to get a tetanus booster shot to protect themselves against disease potentially entering the body through cuts/lacerations, unless one is current with their tetanus immunization (within 10 years). Even seemingly insignificant damage to a nail bed or cuticle should be treated as any other cut.
  • Proper garments and supplies – Clothing protecting arms and legs from flood sludge and lingering debris is strongly encouraged, along with rugged gloves for debris removal, rubber gloves for cleaning affected areas/items and face masks to minimize inhalation of potentially harmful elements.
  • Proper care of cuts/lacerations/skin rash – It is extremely important when working in flood environments to properly protect existing cuts and quickly clean and care for those occurring during cleanup. Risk of skin rashes resulting from the combination of sewage, chemicals and Houston heat can be reduced with the proper garments.
  • Adequate rest, relaxation – While it is difficult for those working to rebuild their homes and quickly reclaim their lives to contemplate taking time for themselves, it is a critical part of maintaining health and well-being. The rebuilding process for many will be a lengthy one requiring strong, healthy individuals.  Adequate rest, break from exposure to irritants and moments of relaxation/destressing can reduce risk of fatigue-related accidents/injuries, optimize mental outlook and maximize physical endurance.

 

When an injury is sustained or a respiratory or gastrointestinal irritation seems to linger, it is important to see a physician.  Postponing care can in some cases complicate an otherwise simple treatment or solution – and delay all recovery efforts.
Our health is truly one of our greatest assets. Let’s protect it!

 

 

References:

  1. The Health Dangers from Hurricane Harvey’s Floods and Houston’s Chemical Plants. Washington Post, September 1 2017.
  2. Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers after Hurricane Katrina – Multiple States. Centers for Disease Control and Prevention (CDC). August – September, 2005.
  3. Stay Out of Flood Water, Texas Health Officials Urge. NPR – Houston Public Media News. August 28, 2017.
  4. Musculoskeletal Disorders – Psychosocial Factors. Canadian Centre for Occupational Health and Safety (CCOHS). Last updated August 13, 2012.
  5. Food and Water Safety during Power Outages and Floods. U.S. Department of Health and Human Services. FDA U.S. Food and Drug Administration. Last updated August 25, 2017.

 

Other Educational Links

 

 

It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

Ring Avulsion, a Traumatic Finger Injury

Recently talk show host Jimmy Fallon explained to his audience how a seemingly minor fall nearly cost him a finger – shedding light on a rare yet serious finger trauma known as a Ring Avulsion injury.

Ring avulsion results from the mechanism of crushing, shearing and avulsion, inducing severe macroscopic and microscopic damage. This type of injury often occurs when a ring that an individual is wearing is caught on an object, usually during a fall or jump.  It can also occur when caught on fast moving equipment or just simply in a “freak” accident.

Damage from the abrupt and often harsh tug of the caught ring can range from a simple contusion to “degloving” of soft tissue – pulling the skin off circumferentially and stripping away the nerves, tendons and bone. Severe accidents may result in traumatic amputation of the finger.

Ring avulsion can be among one of the most devastating traumatic finger injuries, as often replantation following severe soft tissue damage is not possible – requiring revision amputation.

Fortunately, advances in microsurgery and interposition graft techniques have improved results with ring avulsion replantation.  Patients should see a hand specialist immediately after the injury is identified.

Symptoms of Ring Avulsion

While Fallon knew he had severely injured his finger in his fall, the extent of the damage and seriousness of the injury was not completely revealed until his examination and x-ray.  Prompt attention and surgical care from a specialized hand team fortunately saved his finger.

The severe damage that can occur in a ring avulsion case is not always evident to a patient. Immediate examination and x-ray assessment are necessary.

Symptoms may include:

  • Pain
  • Bleeding
  • Lack of sensation at the tip
  • Disfigurement
  • Finger discoloration or whitening

In severe cases, part of the finger is removed from the bone or completely severed (traumatic amputation).

Diagnosing and Treating Ring Avulsion

When a patient presents with this type of finger trauma, the wound is cleaned and inspected for visible avulsed vessel, nerve, and tendon.  Damaged skin edges are also assessed.  An x-ray may also be indicated before determining the type of avulsion a patient has incurred.  If a portion of the finger is separated, an x-ray is performed on both the amputated part and the remaining digit to fully asses damage and likelihood of replantation.

If there is a separated part, it is wrapped in a saline gauze and placed in a bag with ice water.  The patient is given antibiotics and tetanus prophylaxis.

The injury is then classified using one of several ring avulsion classification systems that exist.  Most commonly used is the Urbaniak Classification system.  The class of ring avulsion (Class 1, 2, or 3) will help determine treatment.

The goal of the hand surgeon is to salvage, maintain function and, if possible, provide an esthetic appearance.

Commonly used classification chart for Ring Avulsion injuries.

Commonly used classification charts for Ring Avulsion injuries.

Avoiding Risk of Ring Avulsion

It is difficult for patients to understand how otherwise inconsequential stumbles or movements can result in the damage or loss of a digit when a ring is involved.  We often forget that the bones and joints of the hand and wrist are small and capable of sustaining just so much force. Skin is the finger’s strongest part.  Once the skin tears, the remaining tissue quickly degloves. Though rare, the potential harm that a ring can pose should be considered – particularly when performing certain extracurricular or sports activities, or when working with machinery. Unfortunately many accidents resulting in a ring avulsion are not anticipated nor could be imagined.  Prompt attention is key to a successful outcome.

References

Flagg SV, Finseth FJ, Krizek TJ. Ring avulsion injury. Plast Reconstr Surg. 1977;59:241–8.

Brooks D, et al. Ring avulsion: injury pattern, treatment, and outcome. Clinics in Plastic Surgery April 2007 ;34(2):187-95, viii.

Fejjal N, Belmir R, Mazouz S El, Gharib NE, et al. Finger avulsion injuries:  A report of four cases.  Indian J Orthop. 2008 Apr-Jun; 42(2): 208–211.

Sears ED, Chung KC.  Replantation of finger avulsion injuries:  A systematic review of survival and functional outcomes.  J Hand Surg Am. 2011;36(4):686-94.