|Year : 2019 | Volume
| Issue : 1 | Page : 11-14
A study - Incidence and pattern of musculoskeletal injuries among patients attending the emergency of tertiary health care center in Central India
Ashish Anand Gupta, Santosh Kumar Mishra, Suresh Uikey, Deepak Maravi
Department of Orthopaedics, Gandhi Medical College, Bhopal, Madhya Pradesh, India
|Date of Web Publication||16-Aug-2019|
Dr. Santosh Kumar Mishra
A44 City Empire Apartment, Kohefiza, Bhopal, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Trauma is the major cause of death and disability in developing country, is responsible for more years of life lost than most human diseases. This study aims to establish the value of a trauma registry by measuring, monitoring, and analyzing etiological factors of common musculoskeletal injuries caused due to several forms of trauma. Materials and Methods: This study has been conducted retrospectively. The patients attending the emergency department in tertiary care hospital were included in this study. Personal data and pattern of injuries sustained were extracted from the casualty admission register of emergency department and trauma unit, case records, and operation records. Results: A total of 6574 injured patients were seen in the emergency department. The most common injury was bony injury (65.38%, n = 4298) and soft-tissue injury 34.62% (n = 2276) and the most common sites were lower limbs in 41.39% of cases, amputation/crush injury in 7.82%, and 32.03% of cases (n = 1377) were of compound fractures. The most common soft-tissue injury was lacerated wound 45.21%. Most commonly associated injury was the head injury in 5.53% of cases. Maximum cases were in the age group of 30-59. Conclusion: Fractures were the most common pattern of injuries frequently associated with other injuries, especially head injuries, particular age group, and time period need special attention, and we need more such institutes near highways.
Keywords: Fracture pattern, musculosketetal injury, retrospective
|How to cite this article:|
Gupta AA, Mishra SK, Uikey S, Maravi D. A study - Incidence and pattern of musculoskeletal injuries among patients attending the emergency of tertiary health care center in Central India. J Orthop Dis Traumatol 2019;2:11-4
|How to cite this URL:|
Gupta AA, Mishra SK, Uikey S, Maravi D. A study - Incidence and pattern of musculoskeletal injuries among patients attending the emergency of tertiary health care center in Central India. J Orthop Dis Traumatol [serial online] 2019 [cited 2022 May 21];2:11-4. Available from: https://www.jodt.org/text.asp?2019/2/1/11/263462
| Introduction|| |
Trauma is the major cause of death and disability in both developing and developed countries.“The usual causes of trauma are road traffic accidents (RTAs), falls from heights, occupational injuries and assault,”Abhilash et al., 2016. Often interchangeably used, trauma and injury symbolizes a major health problem worldwide. Reported projections for 2020 show that 8.4 million deaths per year will be due to injuries., According to the World Health Organization (WHO) 2004, RTA accounts for >1.2 million deaths and over 50 million injuries worldwide annually. In 2001, the WHO estimated that over 6 million will die and 60 million will be injured or disabled, in the next 10 years in developing countries. It was stressed that India will have a large share in this, with an estimated economic loss of around 2% of gross domestic product (GDP).
Registration of trauma cases, especially in areas around Bhopal, Madhya Pradesh is in the nascent stage of development with relatively limited published data. It leads to poor documentation of injuries and difficulty in measuring any further data. In addition, in developing countries like India, Department of Orthopedics and Department of Trauma Center in medical colleges are overworked in trauma management due to RTAs. The aim of this study is to establish the significance of trauma registry; monitoring and recording trauma rates as well as their common injury pattern and incidence providing with insightful data at the right time, at the right place, and to the right person for distribution.
Bhopal is one the growing cities in Central India region and is crossed by several National Highways 12, 16, 18, and 23 bringing in constant traffic into and from the city. It is a big educational hub with several colleges and universities and caters to a population of about 2,371,0611. It is surrounded by few growing industries for laborer and is the topmost referral center for all the adjoining district hospitals of Vidisha, Raisen, Hosangabad, Sagar, Sehore, Raigarh, etc.
| Materials and Methods|| |
This study was conducted retrospectively in the Emergency Department and Trauma unit in Hamidia Group of Hospitals, a tertiary care hospital situated in Bhopal (M. P.). The patients attending the emergency department in the Trauma unit in Hamidia Hospitals from October 2015 to September 2016 were included in this study. Personal data and pattern of injuries sustained were extracted from the case records, casualty admission register of the emergency department as well as trauma unit.
Patients with complete clinical records, with any type of musculoskeletal injury including fractures with all degrees of severity were included. Closed fractures or compound fractures with Gustilo Anderson's Grade I to Grade III type. All age group and polytrauma patients were included in the study.
Patients with pathological fracture, postoperative cases and nontraumatic cases were excluded from the study.
| Results|| |
During the 12 months study (October 2015-September 2016), 6574 injured patients were seen in the emergency department. RTA was the most common cause of injury being responsible for 60.90% (n = 4004) of patient injuries. Other causes were fall in cases 1409 (21.43%), occupational injuries in 394 cases (5.99%), assault in 757 cases (11.51%), and firearm injuries in 10 cases (0.15%).
The study revealed that the most common injury was a bony injury (65.38%, n = 4298) and soft-tissue injury (34.62%, n = 2276).
The study revealed that the most common site of bony injury was lower limbs in 51.36% of cases (n = 1779) with the tibia/fibula being the most common bone to be fractured 41.39% (n = 824), followed by femur 41.47% (n = 738). The next common site was upper limbs (20.27%, n = 871), followed by dislocation (12.05%, n = 518), traumatic amputation/crush injury (7.82%, n = 336) (most common cause being railway track accident), clavicle fractures (8.14%, n = 350), fracture dislocation (6.1%, n = 262) spine fractures (3.02%, n = 130), and pelvic injury (1.2%, n = 52).
The study revealed that second-most common injury was a soft-tissue injury (34.64%, n = 2276) and the most common injury was lacerated wound 45.21%, contusion in 32.72%, tendon injury 15.82%, blood vessels injury in 3.95% and nerve injury 2.28% of cases.
There were 67.97% of cases (n = 2921) of closed fractures and 32.03% cases (n = 1377) of compound fractures, out of this 48.07% was gustilo anderson (GA) Type I, 30.9% was GA Type II, and 21.03% was GA Type III. Single bone fracture was present in 69.75% of cases (n = 2998), two bone fractures were present in 20.2% of cases (n = 868), and multiple fractures were seen in 10.05% of cases (n = 432).
The study revealed that the most commonly associated injury were the head injury in 5.53% cases (n = 364). Thoracic chest injuries in 3.03% of cases (n = 199), pelvis injury in 2.48%, abdominal injuries were present in 2.25% of cases (n = 148). No associated injuries were found in 86.71% of cases.
The study revealed that out of 6574 injured patients were seen in the emergency department. Of these, the maximum were in the age group of 30-59 years. There were 77.84% (n = 5117) males and 22.16% (n = 1457) of females. Of these 14.52% of patients were <18 years, 26.36% were between the age group of 18-29 years, 44.32% were between the age group of 30-59 years, and 14.80% were >60 years of age.
The study revealed that out of all the patients reaching trauma center 64.2% reached within 24 h, 21.7% reached within 24-72 h, and 14.1% of cases reached after 72 h.
The study revealed that the maximum patients coming in an emergency ward are from Bhopal 64.2%, then next common referred area is Raisen 8.8%, followed by Ashoknagar 8.2%, Sagar 6.3%, sehore 5.4%, Sujalpur 3.7%, and others 3.4%.
The study revealed that the right side (57.54%) was involved more than the left side (46.46%).
| Discussion|| |
The present study shows that RTAs are the most common cause of injury in our center. This high prevalence of RTA 60.90% (n = 4004), is noteworthy as it has implications for the provision of adequate facilities for managing road traffic injuries. This high rate is probably because of the location of the study center, situated on National Highway.
In the present study, other modes of injuries were fall in 21.43% of cases (n = 1409), occupational injuries in 394 cases (5.99%), assault in 757 cases (11.51%), and firearm injuries in 10 cases (0.15%). In the present study, injuries due to assault 11.51% (n = 757) was relatively high, which could be due to more crime.
Solagberu et al. have reported 62.3% prevalence of RTA in their trauma series from Nigeria.
A study by Gururaj et al. found that RTA was responsible for 52% of injuries, falls for 13%, occupational injuries constituted 4%, and assault 3% of total injuries.
Thanni and Kehinde found that road traffic accident was most 49 common mode of trauma (90.6%) at Nigerian teaching hospital.
Mishra et al. showed that RTA is one among the top five causes of morbidity and mortality in South-East Asian countries. Its socioeconomic repercussion is a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors.
Huda et al. found that the most common mode of injury was roadside accident seen in 48.13% of cases, followed by fall in 29.5%, assault in 5.4%, occupational injuries 10.5%, sports-related in 4.17%, and firearms in 2.08%.
In the present study, maximum number of patients were between 30 and 59 years of age group (n = 2914, 44.31%). Similar age distribution has been reported in other studies from developing countries.
This is in conformity with other studies from Sharma et al., Ghosh in India, and Wick et al. in abroad.
Ganveer and Tiwari in their cross-sectional study on RTAs in India showed that fractures were the most common injury among the patients of nonfatal RTAs, and the majority of the victims were in the age group of 18-37 years.
Kelkar-Khambete showed that fatalities and morbidities from RTAs mostly affect the economically productive age group and have serious implications for the economic burden in terms of GDP lost.
Majority of those injured in the present study were males, i.e., 77.84% (n = 1999) and 22.16% (n = 569) were female. Similar results were observed in the literature review.
According to Shiva Prakash et al., “Preponderance of males attributed to their greater exposure to traffic and more risky behavior than females.”
In our study, bony injury was the most common type of injury (65.38%) followed by soft-tissue injury (34.62%).
In the present study, fractures were the most frequently seen injuries accounting for 65.38% (n = 4298) of all injuries and the most common site was lower limb in 41.39% of cases (n = 1779) with tibia/fibula being the most common bones to be fractured (46.32%, n = 824), followed by femur 41.47% (n = 738). Next common site was upper limb (20.27%, n = 871) followed by dislocation 18.15% (n = 780), clavicle fractures (8.14%, n = 350), and traumatic amputations/crush injuries ([7.82%, n = 336] [most common cause being railway track accident]).
According to Mehta, there are more cases of lower limb fractures due to the interaction of gravitational force and velocity of the vehicle at the time of accidents.
A study by Clark and Morton reported the highest number of fractures in upper limbs followed by lower limbs and facial bones.
In the study conducted by Gihuchi in Africa, a retrospective analysis of nonfatal road traffic crush victims still showed that the most common injuries were fractures (69.0%) with the tibia/fibula being most fractured bones (30.3%).
Ngaroua et al. showed in their study in Cameroon that the leg and thigh were the most commonly involved limb segments in fractures.
In the hospital-based study by Thomas and Lavanya, a total of 450 cases admitted due to traffic accidents in the common site of fracture was lower limb (48.2%).
In the present study, after bony injury, soft tissue accounted for 34.62% (n = 2276), the most common most injury was lacerated wound 45.21%, followed by contusions 32.72%, tendon injury 15.82%, nerve injury 2.28%, and blood vessels 3.95%.
In the present study, 13.29% of cases were associated with other injuries. The most common associated injury was head injury in 5.53%, followed by thoracic injury in 3.03%, pelvic injury in 2.48%, and abdominal injury in 2.25%.
Wong et al. in their study in Singapore indicated fractures of bones in the face and head as the most common form of injury.
In the study conducted by Qi et al. in China, the data of 2213 patients with traffic trauma showed that fracture of extremities (53.3%) occurred most often, craniocerebral trauma (19.4%) next, the followed, in turn, by thoraco-abdominal visceral injury (6.56%), spine fracture, (5.37%), fracture of ribs (4.88%), and pelvic fracture (4.18%).
In the present study, closed fractures were seen in 67.97% of cases (n = 2921) and compound fractures were present in 32.03% of cases (n = 1377). The most common associated injury was head injury in 5.53% cases (n = 364).
In a study by Malhotra et al., compound fractures were present in 31.6% of cases. In a study by Huda et al., compound fractures were seen in 39.9% of cases, and closed fractures were seen in 66% of cases.
In the present study, single bone fracture were seen in 69.75% (n = 2998), two bone fractures were seen in 20.2% (n = 868), and multiple bone fractures (three or more) were seen in 10.05% (n = 432).
A study by Huda et al. showed that single bone fracture was present in 46.98% of cases (n = 358), two bone fractures were present in 38.9% of cases (n = 297), and multiple fractures were seen in 14.04% (n = 107).
In this study, time interval to reach the center; 64.2% of patients (n = 4220) reached within 24 h form the time of injury to trauma center, 21.7% (n = 1426) patients reached within 24-72 h, whereas 14.1% (n = 928) reached 72 h.
The time lag between injury and initiation of treatment is crucial for the outcome of the injury as is transfer of victims to the appropriate level of healthcare facility. It is observed that generally the injured are taken to the nearest health facility without considering the ability of the hospital to deal with the trauma.
Singh and Dattarwal in their study found that median delay between injury and reaching hospital was observed to be 45-60 min in a study of RTA fatalities from Rohtak (n = 450). Only 4% from this series had reached the hospital within 15 min and another 16% between 15 and 30 min of the injury. For a third of the victims, the delay was more than an hour.
In a study conducted at AIIMS Delhi by Upendra et al. stated that more than half (59%, n = 403) patients with thoracolumbar spine trauma reached the hospital within 48 h and these patients showed better neurological recovery compared to those with delayed presentation.
| Conclusion|| |
It can be concluded that people who are in most active and productive age groups become victims of RTAs thus causing economic loss to the community. Fractures were the most common pattern of orthopedic injuries. They were frequently associated with other injuries, especially head injuries. Research into appropriate strategies for prevention of injuries, especially RTA, is required, but this must start with the establishment of institutional and regional trauma registries for complete documentation of relevant study.
Measures against road accidents that include the interaction between road users, vehicle, and road environment are crucial. Hence, a multidimensional approach is the need of the hour. There is no Panacea that will prevent RTAs, what is required is an organized teamwork by people in many disciplines such as education, engineering, medical, and law enforcement agencies for effective prevention of road accidents.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Abhilash KP, Chakraborthy N, Pandian GR, Dhanawade VS, Bhanu TK, Priya K. Profile of trauma patients in the emergency department of a tertiary care hospital in South India. J Family Med Prim Care 2016;5:558-63.
] [Full text]
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997;349:1498-504.
Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health 2000;90:523-6.
World Health Organization. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization; 2004.
WHO South East Asia Regional Office. SCN department, New Delhi - Disability, violence - Injury, prevention and rehabilitation. News Letter 2001;2.
Solagberu BA, Adekanye AO, Ofoegbu CP, Kuranga SA, Udoffa US, Abdur-Rahman LO, et al
. Clinical spectrum of trauma at a university hospital in Nigeria. Eur J Trauma 2002;28:365-9.
Gururaj G, Girish N, Issac NK, Subhakrishna DK. Final Report of the Project“Health Behaviour Surveillance”Submitted to the Ministry of Health and Family Welfare. Government of India; 2004.
Thanni LO, Kehinde OA. Trauma at a Nigerian teaching hospital: Pattern and docu-mentation of presentation. Afr Health Sci 2006;6:104-7.
Mishra B, Sinha Mishra ND, Sukhla S, Sinha A. Epidemiological study of road traffic accident cases from Western Nepal. Indian J Community Med 2010;35:115-21.
] [Full text]
Huda N, Parekh P, Rehman M, Afzal M, Siddiquie HQ. Demographic distribution of fractures at a tertiary care hospital in Western U.P. (India) a retrospective study. J Orthop Traumatol Rehabil 2012;5:1.
Sharma BR, Harish D, Sharma V, Vij K. Road-traffic accidents - A demographic and topographic analysis. Med Sci Law 2001;41:266-74.
Ghosh PK. Epidemiological study of the victims of vehicular accidents in Delhi. J Indian Med Assoc 1992;90:309-12.
Wick M, Müller EJ, Ekkernkamp A, Muhr G. The motorcyclist: Easy rider or easy victim? An analysis of motorcycle accidents in Germany. Am J Emerg Med 1998;16:320-3.
Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: A cross-sectional study in central India. Indian J Med Sci 2005;59:9-12.
] [Full text]
Kelkar-Khambete A. Epidemiology of road traffic accidents in India: A review of literature. Sir Ratan Tata Trust 2011. p.1-75.
Shiva Prakash SS, Amardeep G, Manjappa CN. Pattern of orthopaedic injuries among patients attending the emergency department in a medical college hospital. Int J Orthop Sci 2017;3:93-6.
Mehta SP. An epidemiological study of road traffic accident cases admitted in Safdarjang hospital, New Delhi. Indian J Med Res 1968;56:456-66.
Clark DW, Morton JH. The motorcycle accident: A growing problem. J Trauma 1971;11:230-7.
Gihuchi K. Injury pattern among non-fatal road traffic crash victims. East Afr Orthop J 2007;1:23-5.
Ngaroua D, Neossi NM, Amvene JM, Mefire AC, Eloundou NJ. Epidemiology and pattern of road traffic injuries in Ngaoundéré, Cameroon: A retrospective hospital based study prior to the implementation of a formal trauma registry. Health Sci Dis 2014;15:2.
Thomas V, Lavanya S. Epidemiologic profile of road traffic accident (RCT) cases admitted in a tertiary care hospital - A retrospective study in Hyderabad, Andhra Pradesh. Int J Med Pharm Sci 2013;3:30-6.
Wong TW, Phoon WO, Lee J, Yiu PC, Fung KP, Smith G, et al.
Non-fatal injuries among motorcyclists treated as in-patients in a general hospital. Ann Acad Med Singapore 1989;18:672-4.
Qi X, Yang DL, Qi F, Zhang QH, Wang JP. Statistical analysis on 2213 inpatients with traffic injuries from January 2003 to September 2005 in Ningbo city. Chin J Traumatol 2006;9:228-33.
Malhotra C, Singh MM, Garg S, Malhotra R, Dhaon BK, Mehra M. Pattern and severity of injuries in victims of road traffic crashes attending a tertiary care hospital of Delhi Anil Aggarwal's. Internet J Forensic Med Toxicol 2005;6:2.
Huda N, Gupta P, Pant A, Iqbal A, Julfi M, ZahidK M, et al
. Pattern of orthopaedic injuries among patients attending the emergency department in a tertiary care hospital - An analytical study. Acta Med Int 2014;1:10-4. [Full text]
Fitzgerald M, Dewan Y, O'Reilly G, Mathew J, McKenna C. India and the management of road crashes: Towards a national trauma system. Indian J Surg 2006;68:226-32.
Singh H, Dattarwal SK. Pattern and distribution of injuries in fatal road traffic accidents in Rohtak (Haryana). J Indian Acad Forensic Med 2004;26:20-3.
Upendra B, Mahesh B, Sharma L, Khandwal P, Ahmed A, Chowdhury B, et al
. Correlation of outcome measures with epidemiological factors in thoracolumbar spinal trauma. Indian J Orthop 2007;41:290-4.
] [Full text]