East and Central African Journal of Surgery Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa ISSN: 1024-297X EISSN: 2073-9990 Vol. 14, Num. 1, 2009, pp. 84-87

East and Central African Journal of Surgery, Vol. 14, No. 1, March-April 2009, pp. 84-87

Major Limb Trauma in Eastern Ethiopia.

Munyazewal Dessie, MD

Department of Orthopaedic Surgery, Dilchora Hospital, Dire Dawa, Eastern Ethiopia. E-mail d_manyazewal@yahoo.com.

Code Number: js09015

Background: Disability following road traffic accident is expected to increase dramatically in developing countries resulting in a decline in the size of the labour force. Adolescents and young adults are at the greatest risk of limb injury resulting from road traffic accidents. The objective of the study was to identify patterns of major limb trauma based on the definition given by the WHO scientific group.
Methods: This audit was conducted by the author who recorded the relevant findings on every patient that was referred to the orthopaedic department between October 1^st 2004 and April 31^st 2007.
Results: The results of a two and a half year audit (2004 -2007) made in the Eastern Ethiopia are reported. During this period a total of 1487 patients were managed in our orthopaedic department, of whom 1248 had suffered major limb trauma. Of these 1012 were males (68%) and 475 females (32%) giving a ratio of approximately 2 to 1. The majority 883 (70%) were between the age of 15 and 54 years. Fractures formed the largest group 1044 (83%), followed by amputation 68 (6%), open wounds 58 (5%), dislocation 52 (4%), crush injuries 10 (0.8%) and neurovascular injuries 16 (1%). There were no cases of burns to the extremities in the study period. The commonest causes of injury were road traffic accident (RTA’s) 533 (43%), a fall in 444 (35%), machine and tools in 246 (20%). Suggestions are made as how best to reduce the size of this problem.

Road traffic accidents are among the top ten causes of mortality and the disease burden. Disability following road traffic accident is expected to increase dramatically in developing countries resulting in a decline in the size of the labour force. Adolescents and young adults are at the greatest risk of limb injury resulting from road traffic accidents^1,3 . The global health burden of injuries in the year 2020 is protected to be equal to that of communicable diseases, and to be even greater in some developing countries. Injury related problems are expected to be higher in Ethiopia sue to recent increase in industrialization, road traffic and the use of unsafe technology and working conditions ^2,3,4 . Out of all musculoskeletal injuries nearly 50% are to the upper limb and 36% of injuries to the lower limb (RR = 1.4)³. Of all injuries upper limb fracture accounts for 12% and lower limb fractures for 10% (RR = 1.2). RTA’s, fall, machine and tool injuries in this decreasing order of frequency are the leading causes of limb injuries^3,4,5 . Trauma caused 222% of major upper limb amputations and 18% of major lower limb amputations (RR = 1.2). RTA’s, fall, machine and tools were respectively the caused of 45%, 11% and 9% of major limb amputations⁶.

Operational definition: The definition of major (severe) limb trauma according to a WHO scientific group includes all fractures, dislocation, crush injuries, open wounds, amputations, burns and neurovascular injuries to the extremities¹. Spine, mandibular, nasal and skull fractures are not included in the definition and are hence excluded from my audit. The objective of the study was to identify patterns of major limb trauma based on the definition given by the WHO scientific group.

Patients and Methods

Dilchora Hospital is the only government health facility providing specialised orthopaedic and trauma management in the Eastern part of Ethiopia which has a population (catchment area) of about 5 million. The hospital has 230 beds, of which 24 are for orthopaedic and trauma patients. There is only one specialist orthopaedic surgeon available, but general surgeons and general practitioners provide some orthopaedic and trauma care. This audit was conducted by the author who recorded the relevant findings on every patient that was referred to the orthopaedic department between October 1^st 2004 and April 31^st 2007.

Results

During the two and half years 1487 (1012 males 68%, 475 females 32%) were managed by the author. This is a sex ratio of 2 to 1. Of this grand total, 1248 (84%) were considered to have suffered major limb trauma (Table 1) and 883 (70%) were between the ages of 15 and 54 years (Table 2). The upper limb was injured in 749 (60%) and the lower limb was injured in 499 (40%). The categories of injuries are summarised in Table 3, and to note there were no burn injuries. The responsible agents of injuries are shown in Table 4 and as seen RTA’s were the leading cause.

Discussion

The results of this audit showed that the majority (70%) of major limb trauma occurred in the 15 and 54 years age group. People of working age are largely affected by major limb trauma and this finding is similar to that reported by a WHO scientific group and by others authors^1,3,4 . Major limb trauma occurred more in the upper limb than the lower limb (RR =1.5). This is consistent with other reports^3,5,6. Fracture, dislocations and traumatic amputations accounted for the majority (93%) of the diagnosis in the identified patterns of major limb injuries. Previous study at TAUH agrees with the finding⁴. RTA, fall accidents, machine and tools in their order of decreasing frequency are the leading causes of major limb trauma in the Eastern part of Ethiopia. Many reports showed similar results^1,3,4,5,6. These are preventable causes seriously affecting the labour forces in our country. Improving roads (design, construction, complete separation of pedestrians from vehicles), traffic education of drivers and the public in general, establishment and enforcement of health and safety measures at work (e.g machine guards, protective gear) are suggested to be implemented to reduce the size o f the problem.

Conclusion and Recommendations

To reduce the economic impacts of major limb trauma I suggest:

1. Appropriate measures on preventable causes must immediately be implemented by all thos involved.
2. A nation wide study should be conducted which should leas to the establishment of an organised health information system on the incidence and cost of trauma and thus allow further development of preventive measures.

Acknowledgement

I would like to express my thanks to Professor Goefrey Walker FRCS for his help in the preparation of this manuscript. The cooperation of Dr. Tezera Chaka, Head -Department of Orthopaedic Surgery, AAU, is appreciated.

References

1. The Burden Of Musculoskeletal Conditions At The Start Of The New Millenium: Report of a WHO scientific group. (2003: Geneva, Switzerland).
2. Module on injury prevention and management, for the Ethiopian Health Centre Team, University of Gondar, 2005, pp 5-11.
3. Lambisso W. Biruk, M.D, Permanent Musculoskeletal disability following injury – 17 years trend, East and Central African Journal of Surgery, Vol. 11 No.1, April 2006, pp41-48.
4. Ahmed Elias, Chaka Tezera, Orthopaedic and Major Limb Trauma at the Tikur Anbessa University Hospital, East and Central African Journal of Surgery, 2005; 10 (2): 43-49.
5. Kim JS, Kim SS, Chang SC, National Survey of injury and poisoning on representative Sample Population of Koreans, 2007; 11 (6): 1-2 [Medline].
6. Manyazewal Dessie, MD, Preventable amputations in Ethiopia, East and Central African Journal of Surgery, 2004; 9 (1): 8-11.

© 2009 East and Central African Journal of Surgery

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