Patterns and management outcomes of extremity injuries secondary to motor cycle-related accidents at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background information: The use of motorcycles as a means of transport in Kenya has increased dramatically over the last five years. This has consequently been accompanied with an increase in motorcycle- related accidents which have significantly increased the trauma burden in hospitals. These accidents are among the leading causes of disability and death among trauma patients. The victims who include the riders, passengers and pedestrians are mostly young in their productive years. There is paucity of published data describing the patterns, management and early outcomes of these types of injuries at Moi Teaching and Referral Hospital (MTRH) and Kenya. Objective: To determine the patterns, management options and early outcomes of extremity injuries following motorcycle-related accidents at MTRH. Methods: A prospective study was conducted among the orthopedic inpatients at MTRH, between November 1st, 2017 and March 31st, 2018. The study population comprised of patients who had extremity injuries secondary to motorcycle- related accidents. Sample size of 175 patients was determined using the modified Fisher’s formula. After obtaining informed consent primary data on demographics, mechanisms and patterns of injury, management and outcomes using a standardized questionnaire administered by the researcher was collected. Secondary data was also retrieved from hospital medical records. Analysis was done using SPSS version 20 at a confidence level of 95%, for the study variables. Results: Median age was 28 years (IQR 25, 34), with a range of 13-69 years, males more affected than females with a ratio of 2.2:1. Most patients (61%) had secondary education and 28% of the patients were unemployed. The commonest mechanism of accidents was collision between motorcycles and motor vehicles (35%). The lower to upper extremity injury ratio was 1.9:1. In the upper extremity the humerus was most affected (51 %); most of the upper limb fractures (56%) were closed, while in lower extremity the femur was most affected with femur to tibia- fibula ratio of 1.4:1, with 61% of all lower limb fractures being open. Majority of patients (80%) had received pre-hospital care at some peripheral facility before reception at MTRH; with 54% arriving within the hour after the accident. Majority of patients (79%) had operative management, with 48% on external fixators. At time of discharge, 167 (95%) had adequately reduced fractures, while 8 had amputations. They were discharged for follow-up at outpatient clinics-orthopedics, physiotherapy and occupational therapy. Conclusion: Majority of patients with extremity injuries due to collision between motorcycles and motor vehicles were young males. Most of the patients received operative management. Early outcomes were good. No mortalities were recorded during this period of study. Recommendations: Create awareness and sensitize the group at risk on safety measures. Ensure affordable implants are readily available to maximize patient management and hence improve outcomes of these injuries. Further study on long term outcomes of the injuries will help in improving management protocols. The Highway Code modification to accommodate motorcyclists and pedestrians.