Occupational Medicine Advance Access originally published online on April 2, 2007
Occupational Medicine 2007 57(5):383-385; doi:10.1093/occmed/kqm019
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Case Report |
Band saw injury in a butcher
1 Yale University Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT, USA
2 The Orthopaedic Group, 199 Whitney Avenue, New Haven, CT 06511, USA
Correspondence to: Lee Eric Rubin, Yale University Department of Orthopaedics and Rehabilitation, 800 Howard Avenue, First Floor Yale Physicians Building, PO Box 208071, New Haven, CT 06520-8071, USA. Tel: +1-203-785-2579; fax: +1-203-785-2135; e-mail: lee.rubin{at}yale.edu
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Abstract |
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Background While treating an unusual amputation caused by a meat band saw in a 35-year-old butcher, we sought information from the medical literature that would be useful to other physicians who might encounter similar occupational injuries.
Methods Using the Medline database and relevant search terms, we reviewed the literature concerning occupational saw blade injuries and porcine microbiology as they related to this injury.
Results Among meat workers using powered cutting equipment, hand injuries and distal fingertip amputations appear to be common. The greatest risk for a wound infection after open exposure to raw pork meat appears primarily related to environmental flora rather than enteric-borne porcine pathogens.
Conclusions Decision-making strategy when formulating a treatment plan for debridement or reconstruction of saw blade amputations should rely on a detailed understanding of the injury and occupational environment to achieve an optimal patient outcome. When considering operative and antibiotic treatment for porcine meat-related amputation injury, surgeons should adhere to open fracture-related guidelines, since porcine-borne illnesses are most often caused by ingestion rather than transcutaneous inoculation.
Keywords Band saw; butcher; meatpacking; occupational accident; pork
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Case report |
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A 35-year-old right hand dominant male butcher injured his dominant hand with a meat band saw while butchering a piece of raw pork at a supermarket. He presented to our emergency department within 30 min of the injury along with the amputated portion of his index finger, which contained the radial border of both the index metacarpal and proximal phalanx, connected by an intact radial collateral ligament of the metacarpophalangeal (MCP) joint. Examination of his right hand demonstrated a clean-cut wound on the radial side of the index finger extending from the mid-portion of the first web space to a point just distal to the MCP joint, with minimal active haemorrhage.
Tetanus toxoid booster and intravenous cefazolin were administered in the emergency department, and he was taken urgently to the operating room after written informed consent was obtained. Surgical fixation of the salvaged bony fragments and radial collateral ligament allowed reconstruction of the metacarpophalangeal joint and primary skin closure yielded a cosmetically acceptable result (Figure 1 A–D). After a course of cefalexin and post-operative hand therapy, the patient's MCP joint had full range of active motion from 0 to 90 degrees of flexion, and was stable to varus and valgus stresses throughout the flexion arc. No cultures were taken during debridement and there was no clinical evidence of infection during post-operative follow-up. Based on his functional improvement and adequate bony healing seen on a follow-up radiograph (Figure 2), he returned to his full duties as a butcher 16 weeks following the injury.
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Discussion |
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Since the incidence of occupational injuries among butchers is not well established in the medical literature, a limited analysis of saw blade injuries among woodworkers serves as a useful parallel in establishing the general rates of injuries among individuals using powered saws. A retrospective survey of 1002 woodworkers established that the band saw accounted for 6% of injuries and 2% of 366 amputation incidents in the series; 37% of all injuries were finger amputations and 52% of the injuries involved the pulp or fingertip alone [1]. A separate survey of 283 woodworkers reported that 59% of respondents had been injured by powered saws and equated band saw injuries with a reported incidence of 2.6 per 1000 person-hours [2].
In an online publication, the United States Department of Labor's Occupational Health and Safety Administration (OSHA) stated that the meatpacking industry had the highest injury rate of any industry in the country for five consecutive years (1980–85), with a rate three times that of other manufacturing industries [3]. Statistics for 1985 indicated that of 319 workers injured during their first month of employment in the industry, 29% were cut by knives or machinery and >30% were 25 years of age or younger. That same year, OSHA also reported 1748 cases of injuries to the fingers, including 76 amputations among meatpacking industry workers.
Band saw safety recommendations from OSHA include fostering familiarity with equipment and emergency shut off mechanisms prior to use, earplug use for noise reduction, goggle and/or face shield use during operation, removal of all loose clothing and jewellery, placement of non-slip flooring around the machine and use of self-adjusting blade guards during saw blade use. To help reduce the spread of infectious diseases, OSHA suggests that protective gloves should be worn when workers handle meat and workers who use knives must be provided with metal mesh gloves, aprons and wrist and forearm guards to protect them from lacerations; the use of armoured gloves during band saw use is specifically prohibited [4].
Bacteria such as Salmonella species, Listeria monocytogenes, Escherichia coli and Enterobacteriaceae are commonly encountered on the surface of processed pork meat, and can vary in relative concentration. Typically, these pathogens occur in low numbers, but cross-contamination between carcasses and contact surfaces (e.g. polisher blades, band saws, and butcher's hands) progressively increases during pork processing activity [5].
A study of eight butcher shops in Munich, Germany, found that 12 genotypes (I–XII) of pathogenic Yersinia enterocolitica 4/O:3 was present in six shops. The occurrence of this human pathogen on raw pork products varied from 8% to 25%, and in most (five or six) shops, more than one genotype was found, indicating different contamination sources in the pork processing chain [6]. A separate study of 159 butcher shops in Denmark found Y. enterocolitica O:3 in only 15 of the shops, with the highest contamination rate seen among the small ‘family-type’ shops as opposed to large-scale butchers and supermarkets with a butchery department [7].
Despite the heterogeneous microbial surface environment related to processing variations, packaging techniques, storage temperatures and storage time, the relative concentration of Enterobacteriaceae on packaged pork samples is affected mainly by cross-contamination after carcass evisceration and concentrations <5% can be considered a reflection of acceptable sanitation practice by processing plants [8].
Additionally, pork is known to harbour parasitic organisms, such as Taenia solium and Trichinella spiralis, but the life cycle of these organisms are completed only when viable cysticerci are ingested by humans [9]. The frequency of these infections in the United States, especially with Trichinella, has decreased markedly in recent years, but infection is known to occur after ingestion of raw or undercooked pork, and especially with sausage.
One last important zoonosis is the Brucella species, a group of gram-negative coccobacilli that are facultative intracellular parasites. They are a known occupational hazard for farmers, veterinarians and butchers as transmission can occur across skin or conjunctiva or via ingestion or aerosolization [9]. B. suis has a pork reservoir, but its cousins B. abortus (cattle) and B. melintensis (sheep and goats) are much more common human pathogens. Infections from ingestion of fresh, unpasteurized goat's cheese or untreated milk are the cause of nearly a half-million cases worldwide each year.
Evidence suggests that in the meatpacking industry, occupational exposure to powered saws is closely associated with amputation injuries to the hand and fingers. Education regarding the frequency and potential severity of saw blade injuries may be one portion of a broader safety curriculum directed at reducing saw blade injuries in the meatpacking industry. In considering operative and antibiotic treatment for porcine meat-related amputation injury, surgeons should adhere to open fracture-related guidelines, since porcine-borne illnesses are most often caused by ingestion rather than transcutaneous inoculation. A recent review [10] of treatment modalities for open fractures provides relevant guidance for decision making in the present case; the authors suggest that (i) wound cultures are not recommended either before or after fracture debridement, (ii) antibiotics should be initiated as soon as possible after injury (iii) intravenous cefazolin should be administered every 8 h until 24 h following wound closure, with the addition of gentamicin or ciprofloxacin for ‘high-grade’ or grossly contaminated injuries. Moreover, it appears likely that environmental flora, including nosocomial bacteria, may play the most significant role in post-operative wound infection following open fractures.
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Disclosure |
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None of the authors report financial support from pharmaceutical or industry sources related to this report.
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Conflicts of interest |
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None declared.
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References |
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- Justis EJ, Moore SV, LaVelle DG. Woodworking injuries: an epidemiologic survey of injuries sustained using woodworking machinery and tools. J Hand Surg [Am] (1987) 12A:890–895.[Medline]
- Becker TM, Trinkaus KM, Buckley DI. Tool-related injuries among amateur and professional woodworkers. J Occup Environ Med (1996) 38:1032–1035.[CrossRef][Web of Science][Medline]
- United States Department of Labor, Occupational Health and Safety Administration. Safety and Health Guide for the Meatpacking Industry. http://www.osha.gov/Publications/OSHA3108/osha3108.html (13 January 2007, date last accessed).
- United States Department of Labor, Occupational Health and Safety Administration. Safeguarding Equipment and Protecting Workers from Amputations. http://www.osha.gov/Publications/OSHA3170/osha3170.html (13 January 2007, date last accessed).
- Warriner K, Aldsworth TG, Kaur S, Dodd CEG. Cross-contamination of carcasses and equipment during pork processing. J Appl Microbiol (2002) 93:169–177.[CrossRef][Medline]
- Fredriksson-Ahomaa M, Koch U, Klemm C, Bucher M, Stolle A. Different genotypes of Yersinia enterocolitica 4/O:3 strains widely distributed in butcher shops in the Munich area. Int J Food Microbiol (2004) 95:89–94.[CrossRef][Web of Science][Medline]
- Christensen SG. Co-ordination of nation-wide survey on the presence of Yersinia Enterocolitica O:3 in the environment of butcher's shops. Contrib Microbiol Immunol (1987) 9:26–29.[Medline]
- Holley RA, Peirson MD, Lam J, Tan KB. Microbial profiles of commercial, vacuum packaged, fresh pork of normal or short storage life. Int J Food Microbiol (2004) 97:53–62.[CrossRef][Web of Science][Medline]
- Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious Diseases (2004) 3rd ed. Philadelphia: Lippincott Williams & Wilkins. 1504, 1717, 2387.
- Okike K, Bhattacharyya T. Trends in the management of open fractures: a critical analysis. J Bone Joint Surg Am (2006) 88-A:2739–2748.
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