Introduction: There is a high incidence of patient presentation at our hospital following train accidents. The literature describing the pattern of injuries and management following these accidents is sparse. In addition, the literature looking specifically at orthopaedic injuries and their management is lacking. The aim of this study was to investigate the demographics of patients sustaining traumatic injuries following train accidents and to specifically analyse injury patterns and management of orthopaedic injuries. Furthermore, the mortality rates and the effectiveness of advanced surgical care have also been evaluated and the outcomes of newer limb salvage techniques compared to amputation, which has been widely used in the past. Methods This is a retrospective observational study of patients presenting to a Level I Trauma Centre in Cape Town, South Africa. Prospectively collected data from January 2013 to July 2019 was reviewed retrospectively. All patients presenting with injury mechanism ‘train casualty' or ‘train-' were included in the study. Data was collected by one individual using a set proforma to ensure consistency. Patient folders were reviewed to ascertain specific details including mechanism of injury, types of injury and surgical intervention. Results Two hundred and twenty-two patients were identified through the trauma registers as presenting as train casualties to the Groote Schuur Hospital (GSH) trauma department; 48 patients were excluded, leaving a total of 174 patients included in the study; 92 of these were orthopaedic referrals. The average age was 32 years and males accounted for 87% of the patients. Fifty-four patients were involved in violence, 38 were accidental falls and 15 had been jumping on or off a train. Eight patients (4.6%) in total died in the trauma unit. Most accidents occurred between the hours of 20:00 h and 05:00 h. Of the orthopaedic referrals, males accounted for 89% of patients and the average age was 33 years. Fortynine percent of patients sustained upper limb injuries and 49% sustained lower limb injuries. Spinal injuries were found in 27% of patients and pelvic injuries in 5%. Revised trauma score was calculable for 65 patients, with a mean score of 7.5. Each orthopaedic patient had on average injuries to 1.74 body parts. Thirty-five patients sustained open fractures (38%). Non- operative management was undertaken in 32% of patients. Operative management took place in 68% of patients. A total of 61 patients had surgery for orthopaedic injuries. Each patient underwent on average 2.38 operations. There were 145 theatre encounters for 172 procedures. There were 19 amputation procedures for 12 patients; 10 of these patients had sustained traumatic amputations. There were 10 postoperative complications in total. Conclusion The findings of this retrospective descriptive study provide an insight into train accident victims and their orthopaedic injuries and management with a large sample size. As could be predicted from previous studies, the victims of these accidents are young males from poor socioeconomic areas. The victims who make it to hospital have a good chance of survival and even limb salvage. However, in this day and age, more needs to be done in terms of controlling and preventing railway violence. Similarly, increased health and safety measures need to be implemented in order to minimise accidental injuries on the railways in Cape Town. Further research into the long-term outcomes of these patients and their surgeries would provide further evidence into the role for limb salvage procedures.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/33732 |
| Date | 12 August 2021 |
| Creators | Kontoghiorghe, Christina Niovi |
| Contributors | Maqungo, Sithombo |
| Publisher | Faculty of Health Sciences, Division of General Surgery |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MSc |
| Format | application/pdf |
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