Original Article

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

¹ Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
² University College London Hospitals NHS Foundation Trust, NW1 2BU London, UK
³ Institute of Population Health Sciences, University of Liverpool, L69 3BX Liverpool, UK
⁴ Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, L9 7AL Liverpool, UK
⁵ University of Texas Southwestern Medical Center, Dallas, 75390 TX, USA
⁶ Burden of Disease Research Unit, South African Medical Research Council, 7505 Cape Town, South Africa
⁷ School of Public Health and Family Medicine, University of Cape Town, 7925 Cape Town, South Africa
⁸ Division of Global Surgery, University of Cape Town, 7925 Cape Town, South Africa

^* Corresponding author: c_kontoghiorghe@hotmail.com

Received: 6 May 2021
Accepted: 4 July 2021

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.