Cynthia Cheung

Introduction: Although machete-related injuries are common in South Africa, there is no comprehensive review of the spectrum and outcome of these patients and their injuries. This study aims to address this deficit by reviewing our institutional experience in managing such injuries over the past 12 years. Materials and Methods: A retrospective study was conducted on all patients with machete-related injuries from January 2013 to December 2024 at a major trauma centre in South Africa. Results: A total of 538 cases were included (91% male, mean age 33 years). The median Injury Severity Score (ISS) was 9 (IQR 5–12). The head, face and upper limb were the most commonly injured regions, with 58% of all patients sustaining injuries to multiple body regions, 19% requiring operative interventions, 10% (51/538) sustaining at least one complication and 4% (21/538) requiring intensive care unit admission. The mean length of hospital stay was three days. The overall mortality rate was 2% (11/538). The mean number of cases per year was 45. Conclusions: Assault with a machete is not infrequent and results in multiple injuries, which are not confined to single body regions. The most frequent body regions injured include the exposed areas of the head, face and upper limbs. Care needs to be coordinated between a variety of subspecialties and must include allied medical professionals to ensure optimal recovery.

Background: The aim of this study was to review the spectrum, pattern and clinical outcome of shotgun injuries managed at a major trauma centre with limited resources. Methods: Patients presenting with shotgun injuries between January 2012 and December 2024 were retrospectively reviewed. This was accomplished using the Hybrid Electronic Medical Registry. Data included demographics, injury pattern, regions affected, diagnostic imaging, operative interventions and clinical outcomes. Results: During the 13-year study period, a total of 148 patients sustained shotgun injuries. The median age was 31 years and 93% (137/148) were male. The median Injury Severity Score was 9. Of the 148 patients, 76% (112/148) had plain films performed in the resuscitation room, and 76% (113/148) underwent computed tomography following initial assessment. Single body injuries were noted in around half (51%) of the patients, with the remaining sustaining injuries in multiple regions. The abdomen was most commonly injured (46%), followed by the chest (38%) and lower limb (34%). Operative intervention was necessary for 88 patients (59%), of whom 33 (38%) required multiple operations. The median total length of hospital stay was 5 days, with an overall mortality rate of 5% (8/148). Conclusion: Shotgun injuries are associated with a range of injuries to multiple body regions. These injuries have a high requirement for operative intervention and pose a significant morbidity and mortality risk. High-quality imaging is essential but must be integrated with clinical assessment to guide management.

Background: Selective conservative management of asymptomatic patients with small pneumothorax (PTX) in the specific setting of thoracic stab wounds (SWs) remains controversial. Methods: A prospective study was conducted over a 15-year period on patients with isolated thoracic SWs with small PTX on chest radiograph (CXR) (< 2 cm) and who were asymptomatic. These patients did not undergo tube thoracostomy (TT) but rather active clinical observation at a major trauma centre in South Africa. Results: Two hundred and eighty-four patients were included (91% male, mean age: 24 yrs). Eight (3%) eventually required TT: three deteriorated clinically and five demonstrated radiological progression of PTX on interval CXR. Of these eight patients who required TT, six (75%) had multiple SWs. All eight patients had uneventful recovery. All other patients who were managed successfully with clinical observation alone were discharged home. No patients represented to the hospital following discharge. There was no morbidity or mortality as a direct result of our selective conservative management approach. Conclusion: Selective conservative management of patients with asymptomatic small PTX < 2 cm following thoracic SWs appeared to be safe. The vast majority of these patients do not require TT. Active clinical observation alone by an experienced clinician is sufficient.

This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), p<0.001). For retained knives in the anterior abdomen, 72% (13/18) of the laparotomies were positive for intra-abdominal organ or visceral injury. For the posterior abdomen, 7 of the 8 (88%) were positive for intra-abdominal organ or visceral injury. There were no differences in the need for intensive care unit admission, length of hospital stay, morbidities or mortalities. Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.

Geriatric injuries comprise a significant burden in the developed world but much less are known in the developing world setting. This study aims to review our experience of geriatric injuries with a focus on interpersonal violence (IPV) managed at a major trauma centre in South Africa. This was a retrospective study on all patients who were aged > 65 years admitted to our trauma centre from January 2013 to December 2020, based in Pietermaritzburg, South Africa. Over the 8-year study period, 323 cases were included (62% male, mean age 72 years). Mechanism of injury: 80% blunt, 16% penetrating and 4% others. The median injury severity score (ISS) was 9. The median Charlson comorbidity index (CCI) for all 323 cases was 3. Diabetes (n = 53) was the most prevalent comorbidity which was followed by pulmonary disease (n = 23), cerebral vascular accidents (n = 16) and myocardial infarction (n = 15). Fifteen patients were on antiretroviral therapy (5%). Twenty-four per cent required surgical intervention. Eight per cent of cases experienced one or more complications. Twenty-five per cent (80/323) were related to IPV, 61% (49/80) of these were penetrating injuries and the remaining 31 cases were blunt injuries. Of the 49 cases of penetrating injuries, 33 were gunshot wounds (GSWs) and 16 were stab wounds (SWs) (1 GSW and 2 SWs were self-inflicted and were not included in IPV). Those cases that resulted from IPV were significantly more likely to require operative intervention, experience complications and longer lengths of hospital stay. Geriatric patients had poorer outcomes than non-geriatric patients and rural geriatric patients had worse outcomes than urban geriatric patients. Although the burden of geriatric trauma in South Africa appears to be relatively low, it is associated with significant morbidity and mortality. Trauma from interpersonal violence is especially common and is associated with significantly worse outcomes than that of non-interpersonal violence-related trauma. Elderly rural trauma victims have worse outcomes than their urban counterparts.