Orthopaedic Injuries in Patients with Polytrauma: The Jos Experience and a Review of Literature

Abstract

Background: Orthopaedic injuries constitute a major part of polytrauma. Treatment trends are evolving. In order to determine what is best for our environment, there is a need to define the magnitude of the problem.
Aims and objectives: To describe the frequency of occurrence and pattern of distribution of orthopaedic injuries those occur in patients with polytrauma as well as carry out a review of relevant literature.
Patients and Methods. This is a one-year prospective study of patients with polytrauma from which an analysis of orthopaedic injuries was performed. Patients were recruited at the point of presentation in the accident and emergency department and followed up to the point of discharge.
Results: One hundred and twenty eight patients were recruited out of which orthopaedic injuries constituted 84 (64.1%). Lower limb injuries predominated in 63 (77%), with tibial fractures being the most common in 40 (49.6%) patients. Head injuries were the most frequent associated injuries in 57 (67.9%). Only three (3.6%) patients had operative treatment and all were delayed procedures. Eighty one (96.7%) were either managed non-operatively, or refused hospital treatment. Complications rate was 11.9%, mainly wound infection in compound fractures. Mortality rate was 7.1%, all had associated severe head injury. 33% of the patients discharged themselves against medical advice and opted for traditional bone setting.
Conclusion: Orthopaedic injuries constitute a major part of polytrauma. Lower limb injuries predominate. Head injuries are the most common associated injuries and account for most of the early mortality. Increased operative management is advocated because of established advantages in literature.

Key words: Orthopaedic injuries, polytrauma, trauma.