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PubMedDate not supplied

Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture.

Fragility fractures resulting from low trauma events such as a fall from standing height affect up to one half of women and one third of men after age 50 years. These fractures are frequently associated with osteoporosis. History of a fragility fracture is among the strongest risk factors for future fracture. Therefore, optimal care of the patient with a fragility fracture includes not only treatment of the presenting fracture itself but also evaluation and treatment of the underlying cause or causes to prevent future fractures. However, despite the availability of therapeutic agents that reduce fracture risk among osteoporotic patients who have had a fracture, most patients with fragility fractures are not evaluated for osteoporosis or treated adequately to reduce the risk of future fracture. Orthopaedic surgeons are the first and often the only physicians seen by fracture patients. Thus, they have the unique opportunity to serve as primary advocates to ensure that appropriate action is taken to reduce the risk of future fracture.

Age Factors↗

PubMed1990

Evaluation of ten disposable manual resuscitators.

UNLABELLED: We evaluated the performance and safety of 10 disposable resuscitators -- six adult units: SPUR, Code Blue, 1st Response, Hospitak MPR, CPR Bag, and Pulmanex; and four pediatric units: CPR Bag, 1st Response, Hospitak MPR, and LSP Bag Mask. METHOD: We tested the devices against the American Society for Testing and Materials (ASTM) Standard F-920. We tested each resuscitator by using a lung model, the Bio-Tek VT-1 Ventilator Tester. RESULTS: All resuscitators met the ventilation requirements for VT and f (adult: 600 mL x 12/min; child: 300 mL x 20/min and 70 mL x 30/min) and I:E less than 1:1. Standard F-920 specifies a fractional delivered O2 concentration (FDO2) greater than or equal to 0.85 with attachments and greater than or equal to 0.40 without attachments, at oxygen flow of 15 L/min, and VE of 7.2 L (600 mL x 12/min) for adult units and VE of 6 L (300 mL x 20/min) for pediatric units. All 10 resuscitators met standard F-920 for FDO2 with attachments. Nine resuscitators met the FDO2 standard without attachments. The 10 resuscitators passed the test for valve function after contamination with simulated vomitus, at an oxygen flow of 30 L/min, and for backward leakage. Three pediatric resuscitators (1st Response, Hospitak MPR, and LSP Bag Mask) did not pass the pressure-limit requirement of 40 +/- 10 cm H2O. Four resuscitators, Hospitak MPR (adult and pediatric) and CPR Bag (adult and pediatric), were unable to pass the test for mechanical shock (a fall from a height of at least 1 meter). CONCLUSION: We conclude that only Code Blue, 1st response, Pulmanex (with tube-type reservoir), and SPUR meet ASTM Standard F-920 and are acceptable replacements for permanent resuscitators.

Adult↗

PubMedDate not supplied

Decompression and stable internal fixation of femoral neck fractures in children can affect the outcome.

Pediatric femoral neck fracture is rare and known to be associated with a high complication rate. The effect of early decompression and operative fixation is not frequently reported in the literature. This is a retrospective study of 14 patients younger than 16 years with traumatic fractures of the femoral neck and intertrochanteric region over a 10-year period with a follow-up of 2-11 years (mean, 4.6 years). Road traffic accidents and falls from a height were the main causative factors, and the fractures were subclassified into transcervical, 58%; intertrochanteric, 29%; transepiphyseal, 7%; and cervicotrochanteric, 7%. Of all the fractures, 10 (71%) were displaced. Decompression of the hip by aspiration and closed reduction and internal fixation was performed for all the displaced fractures within 24 h after admission. Three cases required open reduction. Complete fracture healing and functional recovery was achieved in 13 patients with only one delayed union. No patient had radiographic evidence of avascular necrosis. When compared with earlier studies, the current aggressive management protocol for displaced fracture significantly minimized the complications of avascular necrosis, non-union, delayed union, and premature physeal closure.

Adolescent↗

PubMed1999

Early versus delayed repair of facial fractures in the multiply injured patient.

The management of facial fractures in the polytrauma patient requires the coordination of multiple surgical disciplines to optimize the functional and cosmetic outcome while minimizing overall morbidity and mortality. Although the plastic surgery literature historically advocates the early repair of facial fractures, the risk of general anesthesia in patients with associated injuries sometimes makes early repair unsafe. We compared early operative repair versus delayed operative repair of facial fractures in multitrauma patients. We specifically examined wound infection, overall complication rate, total length of hospital stay, days in the Intensive Care Unit (ICU), and days on the ventilator in the two groups. A 5-year (1991-1996) retrospective study of multitrauma patients with associated facial fractures was undertaken at an urban community hospital. We had a total of 82 patients, who were divided into three groups. Thirty-three patients did not have operative repair of the facial fractures during the initial admission and were followed by the plastic surgery service on an outpatient basis. These patients will not be discussed further. Seven patients underwent early operative repair, which was defined as repair within 48 hours of admission (group I). Forty-two patients had delayed operative repair, defined as repair more than 48 hours after admission (group II). The reasons for delayed repair included: excessive soft tissue swelling (16), intracranial injuries (12), unstable medical condition (8), and coordination of procedures with other services (6). Of the 49 patients who underwent operative repair, 43 were involved in motor vehicle accidents, 3 were injured by a fall from a height, 2 were involved in auto-pedestrian accidents, and 1 was a victim of assault. Forty-eight of the 49 patients were initially admitted to the ICU. Cumulative associated injuries were as follows: closed head injury (38), extremity fracture (21), blunt chest injuries (11), intra-abdominal injuries (5), vertebral column injuries (7), and ocular injuries (2). The average Injury Severity Score for Group I was 17.3 and for Group II, 18.1. In group I, there were no deaths, there were no wound infections, and the complication rate was 14.3 per cent. The average total number of days spent on the ventilator was 3.0, the average total number of days spent in the ICU was 5.0, and the average total hospital stay was 16.0 days. In group II, there were no deaths, the wound infection rate was 5 per cent, and the overall complication rate was 21 per cent. The average total number of days spent on the ventilator was 3.3, the average total number of days spent in the ICU was 5.8, and the average total days in the hospital was 14.8. Our results indicate that in a similar cohort of multitrauma patients, delayed repair did not increase length of ICU stay or hospital stay. The wound infection rate was negligible, and the complication rate was similar in the two groups. We conclude that a delay in repair of facial fractures in the critically ill patient has an acceptably low complication rate and may be advantageous in decreasing operative risk and minimizing cost by coordinating multiple procedures with various surgical subspecialties.

Adolescent↗

PubMed1999

Causes of death and unintentional injury among schoolchildren in Thailand.

Few prospective studies of mortality among children in developing countries have been published. Here we quantify and describe mortality and injury morbidity among a cohort of schoolchildren in rural Southeast Asia. Deaths among a cohort of 40,119 schoolchildren in Thailand were prospectively monitored over a two year period from January 1991. Additionally, data were collected with a questionnaire from a subset of 6,378 children asking them to recall all injuries over a one-year period. There were 40 deaths for an annual incidence of 50/100,000. Fifty percent of all deaths were due to injury; 25% to infectious diseases. Sixty percent of the injury deaths were due to motor vehicles and 35% to drowning. Sixty-six percent of the children reported one or more accidents. The leading categories of non-fatal injuries, in decreasing order, were: animal bite, puncture wound, burn, near-drowning, fall from a height. Boys experienced more injuries than girls for almost every type of injury. Injuries are replacing infectious diseases as the most important cause of deaths in developing countries. Additional public health initiatives to reduce childhood accidents may be warranted.

Accident Prevention↗

PubMed2001

[Quantification of cerebral contusions using the contusion index].

The submitted results provide evidence that calculation of the contusion index (CI) for objective expression of the extent and depth of cerebral contusion is very suitable for various comparative studies. The authors assessed, using the CI the influence of direction, site of violent action, and age on the extent and depth of cerebral contusion in different types of head injuries. Consistent with the literature, the greatest contusion developed in areas of the frontal and temporal lobes. In case of violence from the back and from the side, in subjects above 50 years of age the CI of contusion par contrecoup was markedly greater than at the site of violence. The highest CI of the whole brain was in case of violence from the side. During falls from major heights or walking during alcohol intoxication the contusion was worse than in casualties during traffic accidents where pedestrians predominated. Fractures of the skull in junior subjects occurred only after an intensity which at the same time led also to the development of more extensive and deeper contusion as compared with older subjects where CI in fractures of the skull and intracranial haemorrhage were markedly smaller.

Adolescent↗

PubMed2000

Thoracoscopic retrieval of metal rods after penetrating chest injury: case report.

Thoracoscopy has been used for both diagnostic and therapeutic purposes. Its use in the trauma field is rapidly increasing. Here, we present a case of chest trauma that was successfully treated using the thoracoscopic approach. A 43-year-old male patient was brought to our emergency room with a severe right chest wall-penetrating metal-rod injury, which had occurred after falling from a height. The chest X-ray showed an upper right lung lobe injury. Video-assisted thoracoscopic surgery (VATS) was performed for diagnosis of any other associated injury and for management of the penetrating injury. The prognosis was good. We believe that minimal thoracoscopic surgery is an alternative way that provides a more rapid diagnosis, and a less-invasive and safe operation for acute chest trauma patients.

Adult↗

PubMed1975

Impact resistance of ophthalmic lenses of various strengths and the influence of frame design.

Protection of the eyes by safety type spectacle, sunglass and goggle lenses has received considerable attention in recent years. Such protection can be enhanced by design of the frame. We report from 476 lenses mounted in 238 frames and subjected to 9,397 impacts. Maximum blows were delivered by a one inch diameter steel ball falling from a height of 122 inches. Results indicated that the force required to fracture lenses in plastic frame mountings was more than twice that required for fracture of identical strength lenses in wire rims. Minus cylindrical lenses were the most frangible. The lowest fracture and posterior dislocation rates were found in industrial plastic frames with a retaining lip. Greater energy attenuation can be induced in a heat tempered glass lens by even edge compression. Good lens and frame design, when properly correlated, should provide impact attenuation distinctly exceeding conventional standards.

Evaluation Studies as Topic↗

PubMed2001

[The evaluation of the suitability of our cases for referral to a level I trauma center].

This study was performed on 200 patients with a prospective method, between July and October 1998. The aim of the study was to analyze the patients who were admitted directly or referred from another hospital, if they were suitable with the transfer criteria to a level I trauma center. One hundred and seven patients (53.5%) were admitted without ambulance and 93 patients (46.5%) by ambulance to our center. 34% of those patients applied directly and 66% of them were sent from other hospitals. Private ambulances consisted 70%, and 30% the belonged to the national health service. Only 26% of the ambulances had doctor as staff. The most common trauma etiologies were: traffic accidents (42.5%), falling from a height (37.5%) and assaults (11.5%). The mean Glasgow coma score (GCS) of the patients was calculated as 13.9 and mean revised trauma score was 11.7. The Glasgow coma score, revised trauma score and appropriateness to the transfer criteria of the American College of Surgeons were statistically analyzed according to the Fischer Exact test. The results revealed that 96% of the patients with RTS, 86% of the patients with GCS and 60% of the patients with ACS were not appropriate to the transfer criteria to a level I trauma center. In conclusion; we believe that GCS will predict better results in the triage of trauma patients with head trauma in our country.

Female↗

PubMed2002

[Preliminary results for treatment of tibial plateau fractures with the Ilizarov technique of ligamentotaxis].

BACKGROUND: The results of the eight patients who admitted to emergency room with tibial plateau fractures and treated with Ilizarov technique, were retrospective evaluated both clinically and radiologically. METHODS: Seven (87%) men and one (13%) woman ranging in age from 23 to 38, were evaluated. All the cases were between type IV to VI according to Hohl classification preoperatively. Closed indirect reduction by ligamentotaxis was attempted in all fractures, no open technique was performed. RESULTS: Three (38%) cases had open fractures (type I according to Gustilo-Andersen Classification) preoperatively. Six (75%) traffic accident and two (25%) falling from a height were detected as etiology. The cases, whose average follow up was 14 (6-28) months, were evaluated according to Iowa knee score scale and seven (87%) cases were good and excellent. Both clinical and radiological solid fusion were obtained in all cases after removing the frame. Although all the cases had minimal to moderate pin tract infection, all were resolved with dressing and oral antibiotherapy without removing the wires. CONCLUSIONS: Closed reduction with Ilizarov technique is appropriate for treatment of plateau tibia fractures with minimal morbidity.

Adult↗

PubMed2002

Effect of nerve growth factor on neuronal apoptosis after spinal cord injury in rats.

OBJECTIVE: To explore the molecular mechanism of the protective effect of nerve growth factor (NGF) on injured spinal cord. METHODS: The posterior T(8) (the 8th thoracic segment) spinal cords of 60 Wistar rats were injured by impacts caused by objects (weighing 10 g) falling from a height of 2.5 cm with Allen's way. Solution with nerve growth factors (NGF) was given to 30 rats (the NGF group) through a microtubule inserted into the subarachnoid cavity immediately, and at 2, 4, 8, 12 and 24 hours after spinal cord injury (SCI) respectively. Normal saline (NS) with same volume was given to the other 30 rats (the NS group) with the same method. And 5 normal rats were taken as the normal controls. The expression of bcl-2 and bax proteins in spinal cord was detected with immunohistochemistry. The apoptotic neurons in spinal cord were measured with terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling of DNA fragments (TUNEL) staining. RESULTS: The positive expression of bcl-2 protein was strong in the normal controls, but decreased in the NS group, and increased significantly in the NGF group as compared with that of the NS group (P<0.01). The positive expression of bax protein was also strong in the normal controls, but increased in the NS group, and decreased significantly in the NGF group as compared with that of the NS group (P<0.01). Apoptotic neurons were found in the NS group, and they decreased significantly in the NGF group as compared with that of the NS group (P<0.01). CONCLUSIONS: NGF can protect the injured nerve tissues through stimulating the expression of bcl-2 protein, inhibiting the expression of bax protein and inhibiting the neuronal apoptosis after SCI.

Animals↗

PubMed2002

[Pediatric temporal bone fractures].

Temporal bone trauma are more common nowadays related to sports. We report 2 cases with temporal bone fractures in patients younger than 14 years. They were two male, 9 and 12-year-old respectively, that presented traumatism after accidental falls from lowe height. The first case had a longitudinal temporal bone fracture without hypoacusia or vertigo, whereas the second one had an oblique fracture involving the otic capsule, provoking permanent neurosensorial hearing loss, as well as vertigo and unsteadiness that resolved later, related to a vestibular hyporreflexia. Neither case had facial paresia or paralysis. CT scanning was essential to determine the importance of the trauma. Despite the otic capsule rupture, hearing loss in the second case was only significant over 2 KHz, suggesting a selective cochlear trauma. We present clinical and imaging findings, as well as correlation of audiological and vestibular alterations, reviewing the clinical presentation of temporal bone trauma in children.

Cerebrospinal Fluid Otorrhea↗

PubMed2002

[Completed suicide and depression in the elderly].

The aim of the study was to present problems of completed suicide and depression in the elderly. Postmortem examinations were conducted in the Institute of Forensic Medicine of the Jagiellonian University. The analysis included cases of completed suicide in adults, from which all the cases of individuals aged over 65 who in the years 1998, 1999, and 2000 committed suicide within the area of Kraków the City were selected for the present study. The examined group consisted of 92 individuals ranging in age from 65 to 89 years, including 34 females and 58 males. The mean age was 72.5 for the entire group. 44.5% of the subjects had resided in a big city (Kraków); the remainder of the group had resided in villages and towns around Kraków. 57.6% of the subjects committed suicide by hanging, 16.3%--by falling from a height, and 13%--by drowning. In the majority of cases (77.2%), the suicide was committed at home. In 17 cases (18.5%), the post mortem revealed the presence of alcohol. As regards somatic diseases in the examined population, the data from the anamnesis (often incomplete) indicate frequent occurrence of cardiovascular diseases. 43.5% of the subjects, who committed suicide, had been treated for mental disorders, mainly for depression, organic brain disorders, and alcohol addiction. 17 of the subjects (18.5%) had previously attempted to commit suicide. The above results indicate that a typical representative of the elderly committing suicide is a septuagenarian residing in the country or in a small town, and most typically committing suicide by hanging at home. The attention must be paid to the high number of mental disorders, especially depression, detected among both male and female subjects. The close relation between suicide and depression in the elderly is an important guideline on suicide prevention programs and therapy of psychogeriatric patients.

Aged↗

PubMed2003

[Treatment of calcaneal fractures using the medial approach for open reduction].

PURPOSE OF THE STUDY: A comprehensive evaluation of the treatment of calcaneal fractures by open reduction is presented. The long-term results are compared with the relevant literature data. MATERIAL: In the period from 1987 to 2000, 60 displaced fractures of the calcaneus were treated in 51 patients. Of these, 49 patients suffered the fracture by falling from a height, which is generally the most common cause. Only two patients were injured during sports activities. Thirty eight injuries were classified as fractures of the joint depression type and 22 as fractures of the tongue type. The patients had surgery on the day they sustained the injury or after edema had subsided, if this was present on admission. The interval between injury and surgery was 4.6 days on the average. The fracture was fixed with Kirschner's wires (Kw) in 53 cases, a Kirshcner's wire and a hook-nail in five cases and a Kirchner's wire and a spongious screw in two patients. In May 2001, 23 patients were available for evaluation after a follow-up period of 6 to 120 months. METHODS: The patients underwent clinical and radiographic examination and filled a questionnaire. The fracture type was defined on the basis of the Essex-Lopresti classification system. Outcomes were scored according to the Creighton-Nebraska Health Foundation rating system that assessed pain, range of motion, edema, a change in shoe size, patient's activity after therapy termination and return to a job. RESULTS: In May 2001, 23 patients, with a follow-up ranging from 6 to 120 months were checked up. Of them, 20 (86.9%) had neither clinical manifestations nor subjective complaints. Three patients retired because of persisting complaints, two with disability pensions and one with an old-age pension. A total of 19 patients were evaluated by the Creighton-Nebraska Health Foundation rating system. The average score was 90.8 points. The results were excellent in 15 patients, good in three and poor in one patient. The complications reported by the patients included superficial infection in two, thromboembolic disease in one, and hypesthesia on the medial side of the leg in two patients. DISCUSSION: The optimal mode of treatment in dislocated intra-articular fractures of the calcaneus still remains open to discussion. Should conservative or surgical therapy be used? In agreement with others, the authors preferred early surgical intervention. This facilitated a better congruence of the dorsal articular surface. The average remaining dislocation of the articular surface was 1.1 mm in surgically treated as against the average of 4.7 mm in conservatively treated patients. It was possible to restore the length, height and width, and the correct axial position of the calcaneus by this surgery from the medial approach. However, in indicated cases, the procedure required an additional intervention from the lateral approach through a mini-incision. As reported in the literature, other authors have achieved comparable, or even better results but on the basis of either the lateral or the plantar approach. The application of primary spongioplasty or primary arthrodesis of the subtalar joint is discussed. The advantages of preoperative examination by computer-assisted tomography are emphasized. CONCLUSIONS: Good outcomes of the treatment of intra-articular, dislocated calcaneal fractures depend on a correct shape and position of the dorsal articular surface of the calcaneus. The open reduction procedure from the medial approach based on the principles of McReynold's technique allowed us to accomplish both these criteria.

Calcaneus↗

PubMedDate not supplied

[Injuries of the urogenital system].

To analyse the results of treatment of isolated and concomitant urogenital injuries, a retrospective analysis was made of 608 case histories for patients treated in 1986-2000. Of them, 530 patients were males, 78 were females, the age ranged from 16 to 70 years, most of the patients were 20 to 50 (71.2%) years of age. Most frequently the injury was inflicted by beating. Fall from the height, transport accidents ranked second among the causes of injury (17 and 14.3%, respectively). Stab and gunshot injuries occurred in 4.4 and 8% cases, respectively. Ultrasound and x-ray methods were employed for examination. An isolated injury was found in 481 patients, the rest had urogenital injury and skeletal (53%), craniocerebral (25%), abdominal (20%) lesions. 29 patients had a severe concomitant wound: urogenital injury combined with abdominal, skeletal, cranial lesions. Surgery was performed in 267 patients. The rest patients received conservative treatment. Most of the operations were made on the kidney and urinary bladder because of rupture. In some patients these interventions were conducted during laparotomy and were combined with abdominal intervention (44 cases). 25 patients with the compound injury underwent 2-stage operations. 552 patients were cured. 56 (9.2%) lethal outcomes were due to progression of traumatic shock. This low percent of lethality may be explained by an optimal choice of treatment policy in the above patients.

Abdominal Injuries↗

PubMed1992

Spontaneous rupture of normal spleen: an enigma recalled.

That a normal spleen can rupture spontaneously has long been a point of debate. A definitive case is reported here in an attempt to resolve the issue in its favour. Spleen involved in tropical diseases like malaria, infectious mononucleosis and typhoid fever is prone to rupture spontaneously as well as in cases follow minor trauma. In contrast, normal spleen ruptures almost always following severe trauma, such as road accidents or fall from significant heights. Though cases of spontaneous rupture of normal spleens have appeared off and on in the past, doubt has always surrounded the very existence of such an entity. We are reporting a definitive case of spontaneous rupture of normal spleen. This is only the second case of its kind since 1958 and the first ever from the Indian subcontinent.

Adult↗

PubMed2003

[100 CT-guided pelvic operations].

PURPOSE OF THE STUDY: The authors present their 10-year experience with the computed tomography (CT) assisted insertion of implants in the sacroiliac (SI) region and acetabular region. Indications for these interventions and their detailed descriptions are reported. MATERIAL: A total of 98 patients, with the average age of 40.7 years and prevalence of men (70%), were treated. The most frequent cause of injury was a car accident, second in rank was fall from a height. Of these patients, 86 were followed up from 2 months to 3 years. METHODS: The surgical procedure was carried out in the CT department, in which conditions were provided to meet the criteria of an operating theatre. Computed tomography was used to plan the exact position of the implant and, during the procedure, to guide its precise insertion. These procedures required close cooperation of the surgeon and radiologist. A total of 73 CT-guided operations were performed on the SI region, using iliosacral screws or sacral rods. The operation was always preceded by surgery on the anterior pelvic segment. Iliosacral screws were also used in six patients operated on for pseudoarthrosis of the sacrum or chronic instability of the SI joint. The screws were also used in 19 patients who underwent surgical intervention in the acetabular region; in 14 cases it was for a fracture of the acetabular rim. All procedures were carried out by this minimal invasive technique. RESULTS: In all cases, correct insertion of the implant was achieved. There was only one serious preoperative complication due to the fact that the guidewire deviated from its planned direction without this being shown by CT scan. A late infectious complication following iliosacral screw application was recorded in one patient and, in another patient, a nut loosened on one side of the sacral rod. These implants, temporally immobilizing the SI joint, were removed at periods of 6 to 9 months after the operation. There was no case of secondary dislocation of the SI joint after the implant was removed. Complete bony healing of the fractures treated, including pseudoarthrosis, was achieved in all our patients. A comprehensive evaluation of the clinical results of CT-guided operations was difficult because of large inter-individual differences in the extent of pelvic injuries. DISCUSSION: CT-guided interventions are currently indicated predominantly for fractures of the sacrum or displacement of the SI joint up to a 15 mm distance. It is necessary to re-evaluate the extent of displacement after an exact reconstruction of the anterior pelvic segment and restoration of the anatomical conditions. The displacement in the posterior segment usually becomes markedly reduced. The simultaneous surgical treatment of both the anterior and posterior pelvic segments results in restoration of pelvic girdle continuity and maintenance of good stability of the pelvis. This permits early rehabilitation and mobilization of the patient. Other conditions indicated for CT-guided surgery include simple fractures of the acetabular rim with a distance between the fracture lines up to 7 to 10 mm, usually following hip dislocation, and simple oblique fractures of the acetabular columns. CONCLUSIONS: The CT-guided surgical procedure allows us to assess both the shape and course of fracture lines or distance between the injured structures. It also enables us to choose the optimal direction, in relation to these structures, for an implant to be inserted and to respect important anatomical structures in the surroundings. It helps us to determine the exact length of implants to be used. During the procedure, repeated CT scans facilitate checking the direction and position of both instruments and implants. In the closing phase of the operation, it is possible to assess closeness of the bones screwed together, the definitive placement of the implants and their reliable fixation. This method also permits to check whether a screw did not penetrate through the opposite cortical bone.

Adolescent↗

PubMed2003

Death and injury on duty--a study of South African police officers.

OBJECTIVES: Sections of contemporary South African society are characterised by high levels of crime and interpersonal conflict. The South African Police Service (SAPS) is in the front line, with many deaths and injuries occuring among serving officers in recent years. The circumstances and nature of the injuries sustained by these officers have received little attention in the medical literature. DESIGN: A retrospective review of all injured SAPS members was undertaken at a single level one trauma centre in Johannesburg between June 1993 and June 2002. The following factors were recorded: demographics, mechanism and anatomical site of injury, mode of transportation to hospital, whether personal protection had been used, mortality, and return to work. RESULTS: One hundred and thirty-four SAPS personnel were admitted over a 9-year period. The majority (95%) were male and the median age was 31 years. One hundred and thirty-two were on duty and two were in transit to a place of duty when injured. Ninety-two (69%) were injured by gunshot, (including 3 attempted suicides and 9 injuries due to negligent discharge), 2 members were stabbed, 31 were involved in motor vehicle accidents, 2 in motorbike accidents, 1 member was struck by a car while directing traffic, 3 officers were injured by falls from a height, 2 members were injured in helicopter crashes, and 1 member required treatment for gas inhalation. Documentation on whether some form of personal protection was worn at the time of injury was only available for 43 of the 92 cases of gunshot wounds (47%); of these, only 15 (35%) were wearing a bulletproof vest. Use or non-use of a seat belt was documented by hospital staff for only 6 of the 31 officers (19%) injured in motor vehicle accidents. None of the 6 officers had been restrained by a seatbelt. Nineteen SAPS personnel (14%) died of their injuries, but the majority of surviving members returned to duty. CONCLUSION: There is an unacceptably high level of violence in South African society today and SAPS members regularly have to deal with dangerous or violent situations. There is a clear need to introduce a reporting system within the SAPS to record the use of personal protection by officers. Education needs to target SAPS members in order to enhance their use of personal protection. There is a further need to design and implement personal protection that will be universally acceptable by SAPS members.

Accidents, Occupational↗