Air Crash Investigation: Pattern of Spinal Injuries, Management During the COVID-19 Pandemic, and Outcomes

Abstract

Background: Spinal injuries following an air crash can be fatal, and recognizing the patients who need immediate attention and early management could save those patients from ending up with lifelong disabilities and other consequences. However, taking appropriate actions in a pandemic situation presents additional challenges. We present our report of air crash victims with spinal injuries, along with their patterns, morphology, management, and outcomes during the COVID-19 pandemic.

Methods: An analysis was performed on the spinal injuries of victims of the Boeing 737 crash landing at the Karipur Airport (Calicut International Airport, Kerala, India) who were treated at a tertiary care referral hospital in August 2020. Details of the initial triage, patterns of injury, morphologies, mechanisms, management principles, and outcomes at 9 months postinjury were recorded and analyzed.

Results: Of the 47 patients received at our center, 44 survivors were triaged and 13 patients (29.5%) were identified to have spinal injuries of varying severities. The majority of the injuries were chance fractures at the lumbar level, followed by burst and compression fractures. A total of 6 patients underwent surgery, following all COVID-19 guidelines based on priority. All survivors had positive outcomes with our management. No complications such as secondary infections, worsening of neurological deficits, or implant failures were recorded.

Conclusion: A high incidence of spinal injuries is seen in air crash victims. Early prioritized surgical management in selected patients provides excellent outcomes. Disaster management during a pandemic situation is a difficult task, where proper planning and execution is necessary to provide optimal results.

Keywords: COVID-19; air crash; disaster management; pandemic; spinal injury.

Figure 1

Scene at the site of the accident showing the crashed aircraft split into pieces.

Figure 2

Seat layout of the flight showing the sections of the aircraft (marked in black lines as first and second break) and seat numbers of passengers who sustained spinal injuries (marked in red, patient ID as given in Table 1).

Figure 3

A 26-year-old woman sustained an uncommon injury (patient ID No. 2) and presented with American Spinal Injury Association (ASIA) grade B injury including bowel and bladder deficits. Computed tomography image/magnetic resonance imaging showed “H”-shaped fracture of the sacrum with sacropelvic dissociation. She underwent spinopelvic fixation with decompression of S2 foramina. She started weight-bearing mobilization at as early as 4 weeks and recovered completely to ASIA grade E, including full recovery of bowel and bladder control.

Figure 4

Case illustration of surgically managed patient (patient ID No. 5): 52-year-old man with L3 burst fracture, American Spinal Injury Association grade C injury. Short segment fixation with intermediate screw was performed with decompression.

Figure 5

Case illustration of conservatively managed patient (patient ID No. 9 in Table 1): 24-year-old woman with multilevel dorsal level compression fractures with injuries of spinous processes, American Spinal Injury Association grade E.