Analysis of orthopaedic injuries in CT pan scans of polytrauma patients at a quaternary academic hospital

Abstract

BACKGROUND: In South Africa, doctors commonly treat patients suffering major trauma, often with multiple injuries, which necessitates the demand for a rapid diagnostic assessment. Whole body computed tomography (CT pan scan) allows for a rapid multisystem injury diagnosis. There is a scarcity of literature evaluating the extent of orthopaedic injuries in CT pan scan of polytrauma patients. The aim of the study was to evaluate the local epidemiology of orthopaedic injuries in polytrauma patients who underwent a CT pan scan. METHODS: A retrospective, observational analysis, based at an academic hospital, was done of polytrauma patients who underwent a CT pan scan during a two-year period. A database was compiled by accessing the picture archiving and communication system. RESULTS: A total of 296 polytrauma patients had a reported CT pan scan; 85% were male and 15% were female with a median age of 33 years. The most common mechanism of injury was motor vehicle accidents (33.1%). A total of 1 012 injuries were identified; 196 were spinal fractures (mostly cervical), 137 were pelvic/sacral fractures, and 101 were long bone fractures of the upper and lower limbs. The most frequent non-orthopaedic injury sustained was a chest injury. In a pedestrian-vehicle accident, the most common combination of injuries was a chest injury with an associated pelvic/sacral injury. Interpersonal and intentional injuries were significantly associated with a higher risk of thoracic spine fractures (relative risk [RR] 1.8, CI 1.1-2.9), whereas road traffic accidents were significantly associated with a higher risk of scapula/clavicula fractures (RR 2.0, CI 1.2-3.5) and a higher risk of tibia/fibula fractures (RR 3.5, CI 1.2-10.3). CONCLUSION: The majority of polytrauma patients were young males involved in road traffic accidents. A patient involved in a road traffic accident is 3.5 times more likely to sustain a tibia/fibula fracture as opposed to any other fracture. One in four patients who sustained a chest injury had an associated cervical spine injury, and one in three patients had a pelvic/sacral injury, and similarly with head injuries. The findings of this study highlight injury patterns that should be anticipated in polytrauma patients. Level of evidence: Level 3