Hand injuries are a frequent cause of presentation to emergency departments. Several studies show only a small percentage require specialist treatment. In our experience, all paediatric hand injuries are referred automatically to plastic surgery for review. Palisade railings are available in standard heights as low as 1.2 metres and the spikes are easily accessible to young children. Signs telling children not to climb may not be legible, or obeyed even if the warning is understood. Only one other series of injuries caused by such fences has been reported (Rasheed et al, 1999) when no legislation was in place in Northern Ireland.
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