Pedestrians injuries in the north east region of Jamaica: a cross sectional study.

To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann's Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.

A delayed and recurrent pneumothorax complicating a fractured clavicle - A novel presentation.

There are very few reports in the literature about clavicular fractures being associated with a pneumothorax. With this combination of injuries, there are also minimal reports of a delayed presentation of a pneumothorax. This is the first report of a delayed pneumothorax followed by a recurrence of a pneumothorax due to the fractured ends of the clavicle. This case report describes a 49-year-old man who sustained a right-sided pneumothorax from a fractured clavicle several hours after a bus accident. His initial chest examination and radiographs showed no evidence of a pneumothorax. The pneumothorax resolved after 5 days of treatment with a thoracostomy tube. After removing the tube, the procedure was repeated later that day as he again developed a pneumothorax. Ten days later, the patient had surgical intervention of the clavicle due to the unresolved pneumothorax. The clavicle is usually managed conservatively in patients sustaining a clavicular fracture and pneumothorax, however, surgical intervention was mandatory based on failed conservative management. At 3 months follow up, the patient had normal shoulder function. Clinicians must be aware that fractured ends of the clavicle may cause repeated pulmonary damage resulting in a delayed and or a recurrent presentation of a pneumothorax.

Helmet use among motorcycle accident victims in the north-east region of Jamaica.

Currently in Jamaica, motorcyclists account for the largest group of fatalities among all road users. Between 2016 and 2018, a cross sectional study was conducted at the Saint Ann's Bay Regional Hospital involving 155 participants. There were 98.7% males, ages ranged from 14-64 years and more than two thirds of the motorcyclists were under 40 years. Only 29.4% wore helmets, and of those motorcyclists, 52.8% indicated they were only riding for a short distance. Increasing age correlated with increased helmet compliance. Persons with motorcycles greater than 150 cubic centimetres were also more likely to wear a helmet. Interventions to promote increased helmet compliance should take these factors into account in conjunction with enhancing law enforcement.

Predictors of hospitalization and surgical intervention among patients with motorcycle injuries.

BACKGROUND: To describe the distribution of injuries, hospitalization rates by body areas injured, and surgery-requiring admissions, and to identify independent predictors of admission to a regional hospital in Jamaica. METHODS: A cross-sectional study was conducted among persons presenting to the St Ann's Bay Regional Hospital in Jamaica (2016-2018) with injuries sustained from motorcycle crashes. A census was done of patients admitted to the surgery ward from the emergency room, as well as those referred to the Orthopaedic Outpatient Department. Trained members of the orthopedic team administered a pretested questionnaire within 24 hours of presenting to the orthopedic service to elicit data on sociodemographic characteristics, motor vehicle collision circumstance and motor bike specifications, physical injuries sustained and medical management, as well as compliance with legal requirements for riding a motorcycle. Associations between variables were examined using χ2 tests and logistic regression. RESULTS: There were 155 participants in the study, and 75.3% of motorcyclists with injuries required admission. The average length of stay was approximately 10 days. Surgery was required for 71.6% of those admitted. Lower limb injuries constituted 55% of all injuries. The independent predictors for admission were alcohol use and total body areas involved. Motorcycle crash victims who used alcohol close to the time of crash were three times more likely to be admitted to hospital than those who did not consume alcohol. As the total body areas involved increased by one, there was a threefold increase in the likelihood of being admitted. Additionally, the greater the number of body areas involved, the greater was the likelihood of admission. DISCUSSION: Lower limb injuries are the most commonly reported injuries among victims of motorcycle crashes. Alcohol and total body areas involved are independent predictors of admission to hospital. In the planning of trauma delivery services, this information should be taken into account. LEVEL OF EVIDENCE: Level IV.

Case report and literature review of the outcome following reimplantation of the arm.

The following case report and literature review will detail the management of a traumatic amputation of the arm in a 12-year-old boy. Compared with lower limbs, upper limb prosthesis usually results in significant suboptimal function by any measure. While the literature lacks high-quality evidence with regard to functional outcomes following proximal amputations of the upper limb, especially in children, it is known that children generally have superior functional outcomes compared with their adult counterparts. The mechanism of injury, transportation of the amputated part, type of ischemia, timing of surgery, surgical techniques/factors and postoperative rehabilitation will be discussed as factors affecting outcome of reimplantation. LEVEL OF EVIDENCE: V.

Water slide injuries in Jamaica.

BACKGROUND: Patients are presented in this study to describe injuries, each of which have not been previously described in the literature, as a result of a specific mechanism of injury on a water slide. Some of these injuries are potentially fatal and are usually the result of a very high energy mechanism of injury. All injuries occurred in a 6-week time span in the summer of 2015. METHOD: Injuries arising from water slides and their definitive treatment were documented. All of the cases presented to Saint Ann's Bay Hospital in Saint Ann's Bay, Jamaica. The mechanism of injury was analyzed with a view to implement preventative measures. RESULTS: Three cases had open book pelvic injuries and one of them also had a vaginal tear. All of the open book injuries occurred after the patron's thighs violently abducted despite adhering to the recommended starting position that suggested patrons cross their legs. The fourth case was of a 25-year-old man who sustained a posterior shoulder dislocation as a result of his arms flailing despite attempting to adhere to the rule recommending that the patron place his arms across his chest. The final case was of a 14-year-old boy who was involved in an atypical collision injury, resulting in the boy sustaining a displaced distal femoral fracture. CONCLUSIONS: Modern water slides will expose patrons to more frequent and severe injuries from atypical mechanisms of injuries. Risk factors for injury must be factored into preventative measures. Improved surveillance strategies to monitor these injuries are suggested.