More men suffer high-energy traumas due to road, workplace accidents

Pelvic and acetabular fractures (PAFs), high-energy injuries that have significant morbidity and mortality, mostly affect young working males, according to a Singapore study. A significant decrease in PAF incidence has also been observed compared to previously published local data.

“The demographics of PAFs have changed, with fewer injuries in females (20.7 percent vs 33.3 percent) [and] a reduction in the proportion of injuries in the Chinese (51.5 percent vs 70.1 percent),” the researchers said, noting that while road accidents remain the most common cause, crush injuries in the workplace are now more prevalent (13.0 percent). [Singapore Med J 2021;doi:10.11622/smedj.2021024]

This retrospective data analysis involved all trauma patients who underwent surgery for PAFs from 2008 to 2016 in a tertiary trauma centre in Singapore. The researchers collected data including patient demographics, mechanism of injury, and associated injuries.

Over the 8-year period, 169 patients were admitted for PAFs, most of whom were male (79.3 percent). The mean age of these patients was 41 years (range, 13–79) and majority were Chinese (51.5 percent).

Road traffic accidents (53.8 percent) were the most common cause of injury, followed by falls (33.1 percent) and crush injuries (13.0 percent). Of the patients, 46.2 percent also sustained acetabular fractures and 44.4 percent pelvic fractures.

PAFs were predominantly associated with upper and lower limb injuries, as well as spinal and thoracic injuries. The average length of stay in the hospital was 24 days (range, 2–375).

“While road traffic accidents involving motorcycles are still the most common cause, there has been a trend in the mechanism of injury towards workplace accidents involving crush injuries or falls from height,” the researchers said. “The level of energy of the fractures has also increased, with a greater proportion of patients with associated injuries.”

In comparison to local data published by Lee and Yeo 30 years ago, the incidence of PAFs decreased from 33.3 percent to 20.7 percent among female patients, while the proportion of males sustaining pelvic fractures increased from 66.7 percent to 79.3 percent. [Singapore Med J 1972;13:291-297]

Of note, most of the patients involved in road traffic accidents were male (82.4 percent). There was also a male predominance (92.9 percent) among patients who also sustained PAFs through work-related injuries (24.9 percent). This could potentially explain the change in gender ratio among patients with PAFs in the study population.

“In the study by Lee and Yeo, the most common (20.1 percent) age group for pelvic fractures was 50–59 years, although a large proportion of patients were within the working age group (20–59 years),” the researchers said. The findings of Ooi and colleagues were similar to the current study, with pelvic fractures being more common in the younger age group (20–49 years). [Singapore Med J 1972;13:291-297; Int J Emerg Med 2010;3:299-304]

The results of the current study also stress the importance of road and workplace safety, with the former being especially relevant as car and motorcycle ownership has increased in Singapore. For over 10 years, the total number of motor vehicles in the country rose by 26.8 percent from 754,992 in 2005 to 957,246 in 2015. During the same period, the number of motorcycles also increased, from 139,434 to 143,900. [https://data.gov.sg/dataset/annual-motor-vehicle-population-by-vehicle-type]

In addition, the researchers highlighted the importance of safety checklists and adequate personal protective equipment, such as safety harnesses, and of ensuring that workers have enough rest to prevent workplace accidents.

“Safer roads and work environments may help lower the risk of accidents causing life-threatening injuries such as pelvic fractures,” they said.