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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 2  |  Page : 460-463

Clinical study of some medico-legal aspects of cases with extremities trauma admitted to Menoufia University Hospital over 1 year (2011)


Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt

Date of Submission18-Apr-2016
Date of Acceptance13-Jun-2016
Date of Web Publication18-Oct-2016

Correspondence Address:
Hebaallah A Mabrok
Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Menoufia University, Farid Nada Street, Kafr El-Sheikh, 33511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.192415

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  Abstract 

Objective:
The aim of this study was to analyze the socio-demographic patterns of extremities trauma in cases admitted to Menoufia University Hospital during 2011, with evaluation of homicidal cases in relation to the instrument used, type of injury, and the associated complications.
Background:
Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice. Extremities injuries were more common in males in the age group 18 to <30 years. Blunt instruments were the causative agents of most assault and self-inflicted injuries.
Materials and methods:
In this study, patients with trauma to the extremities admitted to Menoufia University Hospital during 2011 were included. Clinical data, plain radiography and/or computed tomography, MRI, electromyography, and nerve conduction studies were assessed.
Results:
The total number of patients included was 1020. Most cases of the study were males in the age group 18 to <30 years. Assault was found to be the most common reason followed by accidents. Injuries were found to be more common in upper limbs than lower limbs, and they outnumbered lower limbs in the self-inflicted mode, whereas lower limbs were more common in the assault mode. A significant relationship was found between the causative instrument and circumstances of injury; accident injuries occurred most frequently because of heat. Most of assault and self-inflicted injuries were caused by blunt instruments. A significant relationship was found between the outcome and the circumstances of injury. Most of accident and assault injury patients developed complications, whereas most of the self-inflicted injury patients improved.
Conclusion:
Trauma can affect different parts of the body: head, chest, abdominal region, extremities, face, spinal cord, the genitourinary system, pelvis, and soft tissues. Limb injuries are a common problem among the physically active, and such injuries may result in diminished performance, reduced participation, and in the longer term loss of function, chronic joint disease, and disability. Limb injuries represent the commonest form of injury involved in road traffic accidents.

Keywords: extremities trauma, medico-legal aspects, trauma extremities Menoufia University hospital


How to cite this article:
Badawy SM, Girgis NF, Al-Fiky AK, Mabrok HA. Clinical study of some medico-legal aspects of cases with extremities trauma admitted to Menoufia University Hospital over 1 year (2011). Menoufia Med J 2016;29:460-3

How to cite this URL:
Badawy SM, Girgis NF, Al-Fiky AK, Mabrok HA. Clinical study of some medico-legal aspects of cases with extremities trauma admitted to Menoufia University Hospital over 1 year (2011). Menoufia Med J [serial online] 2016 [cited 2019 Dec 10];29:460-3. Available from: http://www.mmj.eg.net/text.asp?2016/29/2/460/192415


  Introduction Top


In terms of cost and years of potential lives lost, injury arguably remains the most important public health problem facing the world [1]. Violence affects a significant proportion of the population. It threatens the lives as well as physical and mental health of millions of people, overburdens healthcare systems, undermines human capital formation, and slows economic and social development [2]. It is the leading cause of mortality and disability during the first four decades of life [3].

Trauma is the sixth leading cause of death worldwide, resulting in five million or 10% of all deaths. It is the fifth leading cause of significant disability [4]. Injuries caused one out of 14 deaths in the USA in 2004, including three out of four deaths among adolescents and young adults. In 2005, one in nine people in the USA sought medical attention for an injury [5].

In Egypt, injuries are a significant cause of morbidity and mortality. They are the fifth leading cause of death and the leading cause of hospitalization and account for at least one-quarter of all inpatients [6]. All lesions in the body, external or internal, caused by violence are known as injuries or wounds. A wound is defined as the dissolution of natural continuity of any tissue whether external or internal caused by violence or trauma [7].

More than 90% of injury-associated deaths occur in low- and middle-income countries, where preventive efforts are often nonexistent, and healthcare systems are least prepared to meet the challenge [8].


  Materials and Methods Top


  1. In this study, patients admitted to MPCC in the period from 1 January 2011 to 31 December 2011 were included. The total number of patients was 1020
  2. The demographic and clinical data from their medical records were collected.


Site and type of injury and causative instrument were compared with circumstances of injury.

Statistical analysis

  • Descriptive statistics: as percentages, mean (X–), and SD
  • Analytic statistics: as x2-test, with the following levels of significance – P < 0.05 = significant, P < 0.001 = highly significant, and P < 0.05 = nonsignificant.



  Results Top


The total number of patients included was 1020: 471 cases had upper limb injuries, 414 cases had lower limb injuries, and 135 cases had associated injuries.

[Table 1] reveals that according to the circumstances of injury there was a highly significant relationship between mode of exposure and age (P < 0.001), where accidents occurred more commonly in the age group >50 years. Assaults occurred more in the age group 18 to <30 years, and self-inflicted injuries were much higher in the age group 18 to <30 years.
Table 1: Relationship between circumstances of injury and age of the studied cases

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[Table 2] represents the highly significant relationship between sex and circumstances of injury (P < 0.001), where male cases had the highest percent in assault and accidental modes, representing 66.9 and 83.7%, respectively. Females outnumbered males in the self-inflicted mode, representing 80%.
Table 2: Relationship between circumstances of injury and sex of the studied cases

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There was a statistically highly significant relationship between the causative instrument and circumstances of injury (P < 0.001), as shown in [Table 3]. Heat caused most of the accident injuries. Blunt instruments were the causative agents of most assault and self-inflicted injuries.
Table 3: Relationship between circumstances of injury and the causative instrument

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Regarding the outcome of the studied cases, [Table 4] illustrates the relationship between the outcome and circumstances of injury, which was statistically highly significant. Large percentage of assault and accident injury cases developed complications, representing 42.6 and 25.3%, respectively. Regarding self-inflicted injury cases, most of them improved, representing 80%.
Table 4: Relationship between circumstances of injury and outcome

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[Table 5] illustrates the highly significant relationship between age and the outcome of the injury (P < 0.001). The largest percentage of cases developed complications in the age groups <7, 7 to <18, 18 to <30, and 30 to <40 years; however, most of the cases showed improvement in the age groups 40–50 and >50 years.
Table 5: Relationship between age and outcome

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Regarding the period of hospital stay, the majority of cases who were hospitalized for 1, 2–7, and >7 days developed complications (P < 0.001) [Table 6].
Table 6: Relationship between period of hospital stay and outcome

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  Discussion Top


Injuries are one of the leading causes of the global burden of disease. Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice [9].

The present study revealed that males comprised most of the cases, with predominance in the age group 18 to <30 years. The predominance of males could be due to higher exposure to trauma possibly because of their active lifestyles and their relatively aggressive attitudes both in their public and in their private lives. These results coincided with those of Asirdizer et al. [0] and Van Waes et al. [1] who found that the majority of cases who sustained injuries were males.

the correlation between circumstances of injuries and age is significant.

  • In accident injury cases: the present study showed that accidents were significantly higher in the age group >50 and <7 years. This denotes that children are not well supervised by their families. However, in the age group >50 years, cases are usually working personnel with susceptibility to dangerous injuries; this is not in agreement with the study by Kumar et al. [2], who found that the most common age group affected in the study (fatal road traffic accidents) was between 21 and 40 years, as it is the most active phase of life, physically and socially, and thus outnumbers the other road users.
  • In assault and self-inflicted injury cases: we found that these inflicted injuries were significantly higher in the age group 18 to <30 years. This more or less is in agreement with the study by Ngim et al. [3], who studied limb injuries in Calabar (a city in Nigeria) and reported that the majority of patients with limb injuries (62.3%) were between 20 and 39 years of age. This is the active and productive age; there are therefore serious socio-economic consequences.


Regarding the causative instrument, blunt instruments caused most of the assault and self-inflicted injuries. These results are in agreement with Shalabi et al. [14], who stated that the cause of trauma was blunt instruments in 67% of patients and was penetrating instruments in the remaining 33% of patients.

Regarding the outcome, the present study revealed that a large percentage of assault and accident injury cases developed complications, representing 42.6 and 25.3%, respectively, whereas 80% of self-inflicted injury cases showed improvement. These findings differ from the observations of Olawale and Owoaje [5], who stated that 66% of the injury cases fully recovered, and in 19 (32%) cases the injuries led to disability. Two injury-associated fatalities were recorded in the 5-year period preceding the study, one (2%) within the 4-month study period.

Most of the injured cases who developed complications were in the age groups <7, 7 to <18, 18 to <30, and 30 to <40 years; however, in the age groups 40–50 and >50 years, most cases improved. This is in agreement with the study by Saidi and Mutiso [6], who studied injury outcomes in elderly patients admitted at an urban African hospital and found that 47 percent of patients were discharged home fully recovered, whereas 17 (23.7%) were discharged with various degrees of disabilities, and 13.9% deaths occurred within 2 weeks of hospitalization.

Regarding the period of hospital stay, the majority of cases who were hospitalized for 1, 2–7, and >7 days developed complications. Copuroglu et al. [7] have reported that long hospitalization time can be a reason for secondary infections. Höfling et al. [8] have stated that the total number of days in hospital (including days spent in hospital later on because of complications, metal removal, etc.) was 6.2 days, and the average time spent primarily in hospital was 5.4 days. One must keep in mind that not all patients were discharged home, but some patients were transferred to another hospital or healthcare center some days after primary treatment, and therefore the total number will be higher.


  Conclusion Top


Trauma to the extremities represents one of the most common injury patterns seen in emergency medical and surgical practice. The upper limbs are commonly affected than the lower limbs. Extremities injuries were more common among males in the age group 18 to <30 years. Blunt instruments were the causative agents for most assault and self-inflicted injuries. Most of the patients' injuries got complicated (e.g., infection, embolism, and crush injury).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[18]

 
  References Top

1.
Søreide K. Epidemiology of major trauma. Br J Surg 2009; 96:697-698.  Back to cited text no. 1
    
2.
Aldinger C, Noguera J, Reed J. Whyinvest in violence prevention. Geneva, Switzerland and Newton, USA: Violence Prevention, Alliance and World Health Organization; 2011.  Back to cited text no. 2
    
3.
Mann CV, Russell RC. Accidentand emergency warfare injuries. In: Baily and Love's short practice of surgery. 21st ed. London, UK: Hodder Arnold 1991-12-01 Nelson book services; 1991. 14–28.  Back to cited text no. 3
    
4.
Smith J, Greaves L, Porter K. Majortrauma. In: Oxford desk reference. 1st ed. Oxford, MS: Oxford University Press; 2010. p. 608.  Back to cited text no. 4
    
5.
Bergen G, Chen LH, Warner M, Fingerhut LA Injuryin the United States: 2007 chartbook. Washington, DC: D H H S Publication, no 2008-1033; 2008. 1–5.  Back to cited text no. 5
    
6.
Mashaly AY, Graiter PL, Youssef ZM. Injury in Egypt: injuries as a public health problem. Cairo, Egypt: Ministry of Health; 1993.  Back to cited text no. 6
    
7.
Badawy SM. Clinicalforensic medicine and traumatology. In: Wounds. 4th ed. Cairo, Egypt: Shebin-El Kom; 2008. 95–124.  Back to cited text no. 7
    
8.
Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG. Injuries: the neglected burden in developing countries. Bull World Health Organ. 2009; 87:87–246.  Back to cited text no. 8
    
9.
Cannon JW, Rasmussen TE. Severeextremity injury in the adult patient. 2013; Available at: http://www.uptodate.com/contents/severe-extremity-injury-in-the-adult-patient#H151203162. [Last accessed on 2015 Oct 30].  Back to cited text no. 9
    
10.
Asirdizer M, Yavuz MS, Buken E, Daglar S, UzunI Medico-legal evaluation of vessel injuries of limbs in Turkey. J Clin Forensic Med 2004; 11:59–64.  Back to cited text no. 10
    
11.
Van Waes OJ, van Lieshout EM, Hogendoorn W, Halm JA, Vermeulen J. Treatment of penetrating trauma of the extremities: ten years' experience at a Dutch level 1 trauma center. Scand J Trauma Resusc Emerg Med 2013; 21:2.  Back to cited text no. 11
    
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Kumar A, Lalwani S, Agrawal D, Rautji R, Dogra MD. Fatal road traffic accidents and their relationship with head injuries: an epidemiological survey of five years. Indian J Neurotrauma 2008; 5:63–67.  Back to cited text no. 12
    
13.
Ngim N, Udosen A, Ikpeme I, Ngim NE. Prospective study of limb injuries in Calabar. Internet J Ortho Surg 2007; 8:1–9.  Back to cited text no. 13
    
14.
Shalabi R, Amri YA, Khoujah E. Vascular injuries of the upper extremity. J Vasc Br 2006; 5:271–276.  Back to cited text no. 14
    
15.
Olawale OA, Owoaje ET. Incidence and pattern of injuries among residents of a rural area in South-Western Nigeria: a community-based study. BMC Public Health 2007; 7:246.  Back to cited text no. 15
    
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Saidi H, Mutiso B. Injury outcomes in elderly patients admitted at an Urban African Hospital. Surg Sci J 2013; 4:292–297.  Back to cited text no. 16
    
17.
Copuroglu C, Heybeli N, Ozcan M, Yilmaz B, Ciftdemir M, Copuroglu E Major extremity injuries associated with farmyard accidents. ScientificWorldJournal 2012; 2012:314038.  Back to cited text no. 17
    
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Höfling I, Keinänen P, Kröger H. Injuries caused by motorcycle accidents – a 5-year survey of patients treated in Kuopio University Hospital. Finland Orthop Traumatol 2006; 29:243–247.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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