OBJECTIVE: To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims.STUDY DESIGN: Cross-sectional observational study.PLACE AND DURATION OF STUDY: Study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from October 2006 to March 2007.METHODOLOGY: Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chisquare test was applied to find out statistical significance at 95% confidence level. P-value \u3c 0.05 was considered as significant.RESULTS: A total of 137 (39%) patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part (p60 years. Those with less than 15 years accounted for 12% of cases.CONCLUSION: Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents

Ali, Syed Arif

Aslam, Mubashir

Badar, Nasira

Mirza, Waseem Akhtar

Taj, Tahir M

eCommons@AKU

eCommons@AKUCommunity Health Sciences Department of Community Health SciencesOctober 2008Non-Fatal limb injuries in motorbike accidents.Mubashir AslamAga Khan UniversityTahir M TajSyed Arif AliAga Khan UniversityWaseem Akhtar MirzaAga Khan UniversityNasira BadarAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_chs_chsPart of the Critical Care CommonsRecommended CitationAslam, M., Taj, T., Ali, S., Mirza, W., Badar, N. (2008). Non-Fatal limb injuries in motorbike accidents.. Journal of the College ofPhysicians and Surgeons Pakistan, 18(10), 635-8.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_chs_chs/5Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (10): 635-638 635INTRODUCTIONRoad Traffic Accident (RTA) is considered as one of theleading causes of mortality and morbidity all over theworld and is estimated to kill around 3,000 peopleeveryday.1,2 RTA is between second to sixth leadingcauses of death in age groups 15-60 years.3 Although,a number of studies have been conducted andpublished on RTA in the past few decades, theestimation of the burden and the pattern of injuries dueto motorbike accidents is relatively overlooked.Motorbike injuries account for health problem globallybut the hazard in Asian countries is particularlynoteworthy.4 In Malaysia approximately 35-40% of allRTA involved motorcyclists, and 50-60% of deaths dueto motor vehicle accidents involved motorcyclists.5Similarly, statistics are not very different in Singapore.6In Pakistan, RTA is the third most common cause ofmortality among men in large cities (after circulatorydisorder and T.B).7,8Due to the dangerous outcomes, most of the researchstudies have been focused on head injuries associatedwith motorbike accidents, however, high burden ofinjuries and disabilities resulting from lower limb traumais a hidden catastrophe.9 Tibia and fibula are frequentlyinjured in motorbike accidents due to their superfi-ciality.10 Many victims of motorbike accidents also sufferfrom other disabilities principally owing to the lowerlimbs involvement. On literature search from our part ofthe world, it was found that very few studies haveaddressed this particular issue of lower limb injuriesassociated with motorbike accidents.The purpose of this study was, therefore, to determinefrequency and pattern of limb bone injuries attributed tomotorbike accidents.METHODOLOGYThis cross-sectional, observational study wasconducted at Jinnah Postgraduate Medical Centre,Karachi, from October 2006 to March 2007. Sample size was calculated by Epi Info software on thebasis of previous study,9 keeping prevalence (of lowerABSTRACTObjective: To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims.Study Design: Cross-sectional observational study.Place and Duration of Study: Study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, fromOctober 2006 to March 2007.Methodology: Trained data collectors prospectively collected data from the emergency department of JPMC, Karachiusing structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with singleor multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgerydepartment were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chi-square test was applied to find out statistical significance at 95% confidence level. P-value <0.05 was considered assignificant. Results: A total of 137 (39%) patients presented with tibial injury among the study sample of 348 patients, which wassignificantly higher than the bone injuries of the body part (p<0.001). Out of those, in 26% of patients, fibula was alsoinvolved along with tibia fracture. Other bone injuries included femur (16%), radius (9.2%), humerus (8.3%) and others.Radius was the commonest injured bone and in highest proportion among upper limb injuries (p<0.001). Overall, 66% ofthe injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed onSaturdays (31%). Majority of the accident victims were in the age group between 16 and 30 years (41% accident cases),27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accountedfor 12% of cases.Conclusion: Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposedposition while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lowerlimb involvement in motorbike accidents.Key words: Tibial injury.   Motorbike injury.   Road-traffic accidents.   Lower limb injury.1 Department of Community Health Science, The Aga KhanUniversity Hospital, Karachi.2 Department of Orthopedic, Jinnah Postgraduade Medical Centre,Karachi.3 Department of Radiology, The Aga Khan University Hospital,Karachi.Correspondence: Dr. Waseem Akhtar, 3-D, 25/14, Nazimabad,Karachi.E-mail: waseem.mirza@aku.eduReceived  August 28, 2007; accepted  September 8, 2008.Non-Fatal Limb Injuries in Motorbike Accidents Mubashir Aslam,1 Tahir M. Taj,2 Syed Arif Ali,1 Waseem Akhtar Mirza3 and Nasira Badar1ORIGINAL ARTICLElimb injuries in motorbike accident) of 58%, with 5%probability of type I error, 5% bound on the error ofestimation and 80% power. Additional 10% sample wasadded for non-respondents.Data was prospectively collected by house officers andmedical students working in Orthopaedic Department ofJinnah Hospital, Karachi, using data sheets andquestionnaire pre-tested on 35 (10%) patients in thepilot phase. Data was collected within 24-hour ofpatients’ presentation in the Emergency room. Threedays training was provided to all data collectors andpurpose of the study, data collection procedure andmethodology was explained to them. All patients presented to Emergency Department withmotorbike injuries with single or multiple bone injury inthe body extremities, confirmed by radiography, wereincluded in the study by convenient sampling. Large andsmall joints dislocation cases were also included.Head injury patients were excluded who first presentedto neurosurgery department. Motorbike accident victimswith only soft tissue injuries were also excluded from thisstudy (confirmed by clinical examination andradiography).The studied variables were demographics, time of injury,time from injury to hospitalization, cause and nature ofinjury, status of patients on motorbike (driver/passenger)and definitive anatomical injury diagnoses obtained fromradiology reports.Dependent variables included bone injuries in bodyextremities as the primary defined outcome.Independent variables included age of the patients,gender, marital status, time and day of injury and statusof patients on motorbike as driver or passenger werealso analyzed as associated factors.All patients were conscious at the time of presentation inEmergency department with limb injuries due tomotorbike accidents. Informed oral consent was takenfrom all patients after explaining the purpose of thestudy. Study protocol approval and permission wasgranted by Jinnah Postgraduate Medical Centre. Datawas double entered in Epi Info by a computer operatorand then validation of data entry was also done in EpiInfo.11 Statistical analysis was done using SPSS version14.12 Chi-square test was applied on proportions to testthe statistically significant difference for occurrence oftibial injuries in comparison to the proportions of otherbone injuries at 95% level of significance. P-value >0.05was considered as insignificant.RESULTSA total of 137 (39%) patients were presented with tibiabone injury in the study sample of 348 patients, whowere injured in significantly higher proportion ascompared to bone injuries of the other body parts(p<0.001). Out of those, in 91 (26%) patients, fibula wasalso involved along with tibial injury. Other lower limbinjuries included femur in 55 accident cases (16%),metatarsal in 12 cases (3%), pubic bone in 6 cases(2%), medial and lateral meleolus in 6 cases for each(2%), ankle injury in 5 victims (1%), patella in 5 cases(1%) and others (Table I). Overall, 66% of injuries inmotorbike involved lower limb fractures, which wassignificantly higher than upper limb injuries (p<0.001). Inupper limb injuries, radius bone was injured in 32 cases(9.2%) which was in significantly higher proportion ascompared to other upper limb bone injury (p<0.001).Radius along with ulna was fractured in 13 (4%)patients. Other injured bones included humerus (8.3%),clavicle 15 (4%), metacarpal 5 (1%) and others. Highest proportion of motorbike accidents was observedon Saturdays (31%). Of these 348 patients, 236 (68%)were riding motorbike at the time of accident and 112(32%) were passengers sitting on the motorbike. Male tofemale ratio of the injured victims was 9:1. Age between16 and 30 years (41%) was found in the majority ofaccident cases, 27% in the age group of 30-45 years,15% in 45-60 years and 5 % in >60 years. Those of ageunder 15 years accounted for 12% of cases (Table II).The age representation included both motorbike ridersand passengers on motorbike.636 Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (10): 635-638Mubashir Aslam, Tahir M. Taj, Syed Arif Ali, Waseem Akhtar Mirza and Nasira BadarTable I: Pattern and frequency of injuries in body extremities from motorbike accident.Type of bone injured n        (%)Upper Limbs 117 34Radius 32 9.2Ulna 7 2Radius + Ulna 13 3.7Humerus 29 8.3Phalanx 4 1.1Clavicle 15 4.3Elbow dislocation 5 1.4Scapula 1 0.3Metacarpel 5 1.4Acromio clavicular joint 4 1.1Scaphoid 2 0.6(x2 statistic, p-value) (421, <0.001*) -Lower Limbs 231 66Tibia 46 13.2Tibia + Fibula 91 26.1Femur 55 15.5Ankle 5 1.4Pubic bone 6 1.7Patella 5 1.4Femur + Tibia/Fibula 1 0.3Calcanium 1 0.3Medial/lateral meleolus 6 1.7Hip dislocation 3 0.9Metatarsal 12 3.4(x2 statistic, p-value) (108, <0.001*)Total 348 - * Significant p-valueDISCUSSIONMotorbike accidents can give rise to bone injuries of anybody part, however, it has been determined in the studythat lower limbs’ bones are particularly more prone toinjury in motorbike accidents. This is more applicable ontibia, which was significantly more injured in this studypopulation as compared to other bone involvement. Inother studies from developing countries wheremotorbike is an important mean of traveling, tibiafracture has been reported most commonly as a resultof road traffic accidents of motorbike rider.13 Anotherstudy from a developing country also determined 66% oflower limb injuries in motorbike accidents (consistentwith the results of this study) and revealed similarpattern of bone injuries as tibia was fractured in highestproportion of cases followed by femur injuries, thoughstudy had a limitation of small sample size.14 This studyrevealed consistent results with larger study sample. Onthe other hand, one study from a developed countryreported metatarsal as the most frequent injury boneamong lower limbs injuries due to motorbikeaccidents.15 This variation in the pattern of injuriesbetween developing and developed countries may bedue to difference in motorbike structure and vehicle lawsin different countries. Nevertheless, most of the studiesreported greater occupational loss and psychologicaltrauma when lower limb injuries were involved. For theprevention of mortality and morbidity associated withmotorbike injuries, it is noteworthy that head injurieshave reduced significantly where strict helmet laws areimplemented while riding motorbike.16-18 Thus, it can beconsidered that lower limb protectors can also be a cost-effective intervention for the reduction in frequency andseverity of lower limb injuries. Yet, effectiveness of suchintervention needs to be evaluated through evidencebased future studies. A Swedish cohort study pointed out towards the heavyburden of accidents involving young motorbike riders(age 16 to 30 years).19 The same age group is observedto be the most vulnerable for motorbike accidents in ourpart of world20 and this study has also shown the highestnumber of motorbike injuries in the same age group.The major hazard regarding involvement of this agegroup is the economic burden as this age group isconsidered as the foundation of economy of individualhouses as well as of the country. Furthermore,particularly lower limb injuries would put behaviouraland social impact on individuals. In this regard, LowerExtremity Assessment Project (LEAP) in United Stateshas elaborated on the demographic and social effects oflower limb injuries.21 Frequency of accidents decreaseswith the increment in age groups pointing towards thepossibility that with rise in experience of motorbikedriving, chances of accidents decreases. Anotherproblem is that high traffic load is mostly seen onweekends, which are responsible for highest number ofaccidents on Saturdays as the chances of collisionincreases with high traffic load and several studiesrevealed that collision of vehicle is responsible for mostof the road traffic accidents.13,22,23In this study, most of the accident victims weremotorbike drivers and only few of the cases involvedpassengers. This was one of the limitations of the studythat exact number of passengers were not known whowere riding during the accidents. Only those were takeninto account who were injured and fulfilled the inclusioncriteria. This study was conducted in one tertiary carehospital only; larger multi-centric studies can estimatethe exact prevalence of motorbike injuries along withlower limb involvement. Moreover, this was a cross-sectional study, a follow-up studies can also elaboratethe economic and social burden due to motorbikeinjuries and the disabilities developed in the motorbikeaccident victims.CONCLUSIONIn this study, tibia was found to be at greatest risk inmotorbike accidents probably due to its superficialityJournal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (10): 635-638 637Non fatal limb injuries in motorbike accidents Table II: Demographics and associated factors of patients coming tothe emergency department with motorbike accident-related limb injuries (n=348).Characteristic Number of injured Percentage of injured patients (n) patients GenderMale 296 85Female 52 15Marital statusUnmarried 155 45Married 184 53Unknown 9 2Age0 -15 42 1216-30 141 4131-45 95 2746-60 51 1560 + 17 5Day of accidentMonday 6 2Tuesday 94 27Wednesday 15 4Thursday 61 18Saturday 109 31Sunday 63 18Driver/passengerDrivers 236 68Passengers 112 32Time of accident (hours)00.01-06.00 24 706.01-12.00 52 1513.01-18.00 129 3718.01-00.00 111 32Time to reach hospital0-1 hour 141 411-2 hours 109 312-3 hours 34 10> 3 hours 18 5Unknown 46 13 638 Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (10): 635-638Mubashir Aslam, Tahir M. Taj, Syed Arif Ali, Waseem Akhtar Mirza and Nasira Badarand exposed position while riding motorbike. Protectivemeasures need to be taken for the prevention of injuriesand disability associated with lower limb involvement inmotorbike accidents and leg protectors may help in thisregard, however, further studies are warranted.Acknowledgement: We acknowledge the support ofDr. Saeed Minhaas, Associate Professor, Department ofOrthopaedic, Jinnah Postgraduate Medical Centre, Dr.Emaad, Dr. Salman Adil and Dr. Madhan Lal forfacilitating the data collection process.REFERENCES1. Peden M, Toroyan T. Road traffic injuries in South Asia: nationaland organisational policy responses. J Coll Physicians Surg Pak 2004;14:722-5.2. Van As AB, Rode H. Evisceration through multiple abdominalwall defects following blunt abdominal injury. Pediatr Emerg Care2003; 9:353-4.3. World Health Organization. World health report 2001 database.Geneva: WHO; 2002.4. Injury prevention and control in the South-East Asia region:report of an intercountry consultation. SEA-Accident-7, 1-26.New Delhi, World Health Organization, Regional Office forSouth-East Asia, 2002.5. Motorcycles road accident statistics (1994-1998). Royal MalaysianPolice; 1998.6. Wong E, Leong KF, Anantharaman V. Road traffic accidentmortality in Singapore. J Emerg Med 2002; 22:139-46.7. Razzak JA, Luby SP. Estimating deaths and injuries due to roadtraffic accidents in Karachi, Pakistan through the capture-recapture method. Int J Epidemiol 1998; 27: 866-70.8. Marsh DR, Kadir MM, Husein K, Luby SP, Siddiqui R, Khalid SB.Adult mortality in slums of Karachi, Pakistan. J Pak Med Assoc 2000;50:300-06.9. Lateef Fatimah. Riding motorcycles: is it a lower limb hazard?Singapore Med J 2002; 43:566-9.10. Imran Y, Vishvanathan T. Does the right leg require extra-protection? Five-year review of type 3 open fractures of the tibia.Singapore Med J 2004; 45:280-82.11. 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Patterns of roadtraffic injuries in a vulnerable population in Hyderabad, India.Injury prevention. Inj  Preven 2006; 12:183-8.l l l l lOl l l l l

Non-Fatal limb injuries in motorbike accidents.

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Non-Fatal limb injuries in motorbike accidents.

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