Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.

BackgroundTo describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica.MethodsA cross-sectional study was conducted among persons presenting to the St Ann’s Bay Regional Hospital in Jamaica (2016–2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ2 tests and logistic regression.ResultsThere were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission.DiscussionLower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account.Level of EvidenceLevel IV.

BackgroundPatients are presented in this study to describe injuries, each of which have not been previously described in the literature, as a result of a specific mechanism of injury on a water slide. Some of these injuries are potentially fatal and are usually the result of a very high energy mechanism of injury. All injuries occurred in a 6-week time span in the summer of 2015.MethodInjuries arising from water slides and their definitive treatment were documented. All of the cases presented to Saint Ann's Bay Hospital in Saint Ann's Bay, Jamaica. The mechanism of injury was analyzed with a view to implement preventative measures.ResultsThree cases had open book pelvic injuries and one of them also had a vaginal tear. All of the open book injuries occurred after the patron's thighs violently abducted despite adhering to the recommended starting position that suggested patrons cross their legs. The fourth case was of a 25-year-old man who sustained a posterior shoulder dislocation as a result of his arms flailing despite attempting to adhere to the rule recommending that the patron place his arms across his chest. The final case was of a 14-year-old boy who was involved in an atypical collision injury, resulting in the boy sustaining a displaced distal femoral fracture.ConclusionsModern water slides will expose patrons to more frequent and severe injuries from atypical mechanisms of injuries. Risk factors for injury must be factored into preventative measures. Improved surveillance strategies to monitor these injuries are suggested.

Large bony defects usually occur following high energy open injuries or post debridement. The tibial shaft is the commonest site of these defects. Historically, the treatment was primary amputation. Limb salvage techniques are the current standard of care and options include: staged procedures inclusive of dead space management, soft tissue coverage and subsequent bone grafting, vascularised bone grafting and distractraction osteogenesis. The simultaneous treatment of bone loss, infection, non-union, deformity and leg length discrepancy makes bone transport an extremely valuable treatment option. Due to prolonged treatment times and various potential complications, proper patient selection is mandatory. While it is not a panacea, it remains the most versatile treatment option for complex soft tissue with large bony defects.

The following case report and literature review will detail the management of a traumatic amputation of the arm in a 12-year-old boy. Compared with lower limbs, upper limb prosthesis usually results in significant suboptimal function by any measure. While the literature lacks high-quality evidence with regard to functional outcomes following proximal amputations of the upper limb, especially in children, it is known that children generally have superior functional outcomes compared with their adult counterparts. The mechanism of injury, transportation of the amputated part, type of ischemia, timing of surgery, surgical techniques/factors and postoperative rehabilitation will be discussed as factors affecting outcome of reimplantation.Level of evidence: V

The Caribbean has one of the higher prevalence rates of HIV in the world. Many HIV patients present to the Orthopaedic surgeon as a trauma victim. Trauma continues to be very prevalent as a result of interpersonal violence and motor vehicle accidents. This continues to drain the health budget, deplete blood banks and cause cancellations on elective lists. Orthopaedic surgeons continue to be at risk because a large percentage of their patients present with trauma. Factors affecting cumulative risk include the HIV prevalence in the practising community, the prevalence of trauma nearby communities, the nature and length of surgery as well as adherence to universal precautions.

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