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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. |
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