Citation

Donnally Iii CJ, Sheu JI, Roth ES, Allegra PR, Rush Iii AJ, Shin SH, Dodds SD. Iowa Orthop. J. 2019; 39(1): 159-164.

Copyright

(Copyright © 2019, University of Iowa, Department of Orthopaedics)

DOI

unavailable

PMID

31413689

PMCID

PMC6604534

Abstract

BACKGROUND: Elevated Metrorail systems differ from conventional trains by their slower speeds and collisions with pedestrians predominantly occurring at accessible stations or platforms. Here, the orthopedic implications of pedestrians struck by a Metrorail are evaluated, as were the correlations of substance abuse and psychiatric history on injury and death.
METHODS: Retrospective cohort study at a single Level-1 trauma center of patients requiring admission with orthopedic injuries following Metrorail impact from 1/2004-2/2017. Demographics, substance abuse, psychiatric history, intentionality, LOS, follow-up, fracture characteristics, and management were studied.
RESULTS: 33 patients sustained 104 total orthopedic injuries requiring admission; nine sustained 15 traumatic amputations. There were at least 37 open fractures, with some incomplete data in deceased (5) and amputation (9) patients. Suicide attempts were completed at 35.7% and were associated with a documented psychiatric illness and prior psychiatric evaluation. Spine injuries were associated with increased traumatic brain injuries, rib fractures, and open pelvic ring injuries, yet fewer humerus fractures. Open fractures were significantly predictive of death. 14 patients (42.4%) required ICU admission, and 26 (78.8%) patients required orthopaedic surgery (mean 1.3 ± 1.4 operations).
CONCLUSIONS: Metrorail systems are unique sources of orthopaedic injuries requiring high rates of critical care and surgical intervention. Patients sustain multiple injuries, many with amputations. With this mechanism, there is a high rate of open fractures and suicide. Trauma centers should emphasize an extensive evaluation of orthopaedic injuries in this patient setting.Level of Evidence: II.

Language: en

Keywords

Humans; Wounds and Injuries; United States; Adult; Aged; Female; Male; Middle Aged; Automobiles; Cause of Death; Multiple Trauma; Retrospective Studies; Risk Assessment; Young Adult; Accidents, Traffic; Cohort Studies; Injury Severity Score; accident prevention; Survival Analysis; Trauma Centers; Railroads; orthopedics; railway suicide; polytrauma; Amputation, Surgical; Orthopedic Procedures; metrorail; spine trauma; train-pedestrian fatalities; urban injuries