The pattern of radiological findings in limb trauma: a 3-month prospective study at Kenyatta National Hospital

Abstract

Limb trauma is common in Kenya especially in the city of Nairobi. From 1st December 1996 to 28th February 1997 a total of nine hundred and eighty seven patients presented with limb trauma at the Kenyatta National Hospital Casualty Department. The overall male:female ratio was 1.98:1 with an age range of 2 days to 80 years. Most patients were in the 16-40 age group. The commonest cause was road traffic accident comprising 30.09% of the total. Sports and play injuries caused 17.93% ofthe total, assault 9.73%, occupational injuries 6.99% and domestic violence 4.25%. The remainder (31.00%) were due to a variety of causes including birth trauma, fall, twisting the foot while walking etc. Alcohol was a contributing aetiological factor in 28.06% of cases. About 31.31 % of the patients were unemployed and 72.64% lived in low-income areas. Kenyatta National Hospital serves the majority of the people in Nairobi especially those of low socio-economic status. The initial radiological assessment involved used of plain films only. On average each limb was imaged in two views at right angles to each other. The films were read by the Casualty Officer on duty prior to reporting later or the following morning. The right side was involved more frequently than the left (Rt 52.58% Lt 47.42%). The upper limbs were affected more frequently than the lower limbs (upper 78.82, lower 21.17%). About 28.47% of all patients imaged had negative radiological findings. 7 Hand injuries included fractures and dislocations. The male: female ratio was 1.32:1. Most patients were in the 16-40year age group (73.62%). Those over 40yrs and under 10yrs were rarely affected. Wrist injuries included fractures, dislocations and epiphysial separations. The male:female ratio was 1.38:1. Most patients were in the 16-40yrs age group (31.81 %). Epiphysial separations were particularly common in the 10-16yr age group and were mainly related to falls. Forearm injuries included fractures often associated with proximal or distal radio-ulnar dislocation. The male:female ratio was 1.79: 1. Most patients were in the 16-40yrs age group (59.76%). The commonest cause was a direct force related to road traffic accidents or a fall. Elbow injuries included dislocations and fractures. These were generally uncommon forming a mere 3% of the total. The male:female ratio was 1.72:1. Most patients were in the 16-40yr age group. (40.00%). Sport and road traffic accidents were leading causes. Supracondylar fractures were most common in the 5-10yr age group (46.66%). The commonest cause was a fall. Fractures of the rest of the humerus were uncommon (2%) and had a male:female ratio of 1.6:1. Most shoulder dislocations were anterior dislocations. The male:female ratio was 3.33:1 and they were most common in the 16-40yr age group. Sporting injury was the leading cause. Injuries of the foot, ankle and leg included fractures and dislocations. No epiphysial separation was seen. Most patients were in the 16-40yr age group (48.98%) The male:female ratio was 1.76:1. Injury while walking and road traffic accidents were leading causes. 8 Knee injuries included fractures (patellar, tibial and femoral condyles) and dislocations. Patella fractures were usually caused by an anterior force on a seated passenger involved in a road traffic accident. Often posterior hip dislocation was associated with patella fracture. The male:female ratio of knee injuries was 2.71: 1. Most patients were in the 16-40yr age group. Femoral shaft injuries were due to road traffic accidents in adults mainly of 16-40yr age group and birth trauma in newborns. The male:female ratio was 1.36: 1. Femoral neck fractures were exclusively seen in those over 60 years of age with a male:female ratio of 0.29: 1 and hip dislocation had a ratio of 0.83: 1. Osteoporosis was probably a predisposing agent in fractures of the femoral neck in the elderly. A total of eighty seven (87) of the study population (987) had associated injuries in other organs. The chest was mostly affected (4.86%). Fractured clavicle, ribs and lung injury were the commonest findings. The abdomen and pelvis were involved in 1.01% of patients. Fractured pelvis, injuries to the urethra, bladder and uterus were observed. The head was imaged in 23.3% of the patients but only one patient had a skull fracture.