Train related injuries: A descriptive analysis highlighting orthopaedic injuries and management

Abstract

Introduction: Orthopaedic injuries constitute a major aspect of morbidity and mortality following train accidents. The pattern of orthopaedic/musculoskeletal injuries sustained following these accidents has not been fully characterised. The main aim of this study is to describe the range of orthopaedic injuries reported in a major trauma centre and evaluate their management, as well as reporting mortality and amputation rates. Further aims are to identify the social and demographic background of the patients to suggest treatment and prevention strategies.

Methods: This study is a retrospective observation of all clinical files of patients presented to Level 1 Trauma Centre in Cape Town, South Africa, as "train casualty" from January 2013 to July 2019, which were reviewed and evaluated. A total of 174 patients were included, of which 92 were orthopaedic referrals. The average age was 29 years, and 87% were male.

Results: Tibial fractures were most common (N = 19), 38% of patients sustained open fractures, and 68% of patients (in total) underwent surgery. Wound debridement was the most common operation, followed by open reduction internal fixation (ORIF). Twelve patients (13%) underwent amputation to 14 body parts. Eight patients (4.6%) (in total) died in the trauma unit.

Discussion: This study provides insight into train accident victims and their orthopaedic injuries and management patterns. The victims are largely young males. The majority of orthopaedic injuries require surgical intervention, and those who make it to the hospital have a good chance of survival and limb salvage. It appears that in addition to early hospital access and specialised updated treatments, morbidity and mortality in train accidents could be reduced by improving safety measures and social awareness to reduce railway violence and accidents.

Keywords: Amputation; Limb salvage; Orthopaedic injuries; Train accidents.

Figure 1

Patients included in the study. Two-hundred and twenty-two patients initially identified, 48 excluded; a total of 174 patients were included in the study and 92 of these were referred to the orthopaedic unit.

Figure 2

Orthopaedic injuries. Presentation of data showing the frequency of injuries incurred by body part. The most common fracture was the tibia (N = 19), followed by C-spine (N = 14).

Figure 3

Time of presentation to hospital. Presentation of data showing the percentage (%) number of patients presenting during each time period throughout the day. Most patients presented during the night to early morning (20:00–05:00 h) 32.9%, fewest patients during morning commute 15.6%.

Figure 4

Summary of literature review findings. Salient points are noted, including the year of publication, country/city, whether this is a developed or developing country, authors, number of patients in the study, mean age, percentage male, suicide attempts, mortality rate, amputation rate, intoxication rate, percentage of patients requiring intensive care admission, and the average length of stay (days).