Surya Akash Boppana

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 optimal duration of urinary catheterisation and the necessity of routine follow‐up cystogram prior to catheter removal in non‐iatrogenic bladder injury remain controversial. International guidelines vary, and no local protocol exists. This study reviewed our institutional experience to evaluate the yield of routine cystogram prior to catheter removal. Methods: A retrospective audit was conducted of patients with non‐iatrogenic bladder injuries managed at a Level 1 trauma centre between 2005 and 2024. Patients with partial thickness or complex injuries and those who died within 7 days were excluded. Demographics, injury characteristics, management strategy, catheter duration, use of follow‐up cystogram and complications were analysed. Urinary tract infection was defined as a clinically diagnosed or microbiologically confirmed urinary infection documented during admission requiring antibiotic treatment. Intraperitoneal (IP) and extraperitoneal (EP) injuries were compared using non‐parametric and categorical statistical tests. Follow‐up cystography at our institution was performed using conventional fluoroscopic cystography. Contrast was instilled retrograde through an indwelling urethral catheter using diluted Omnipaque 350 in saline. The bladder was passively filled to approximately 300–350 mL, or until the patient reported fullness or resistance to filling was encountered. Standard anteroposterior and oblique radiographs were obtained. A positive cystogram was defined as any radiologically reported contrast extravasation consistent with a persistent urinary leak. Results: Thirty‐two patients were included (53% male; median age 35 years [IQR 26–53]). All included cases were attributable to blunt trauma. Eighteen (56%) injuries were IP and 14 (44%) EP. Twenty‐two (69%) injuries underwent operative repair. Thirty patients (94%) underwent routine follow‐up cystogram prior to catheter removal; all studies were normal. The median duration of catheterisation was 17 days (IQR 11–25). Urinary tract infection occurred in 38% of patients. Patients who developed urinary tract infection had a longer median duration of catheterisation compared with those who did not develop urinary tract infection (27 days [IQR 12–34] vs. 15 days [IQR 10–22]). There were no urinary leaks identified following catheter removal and no mortality within the available follow‐up documentation. Conclusion: Routine follow‐up cystogram prior to catheter removal demonstrated a very low diagnostic yield in uncomplicated non‐iatrogenic bladder injuries within our cohort. Prolonged catheterisation was common and associated with high rates of urinary tract infection. A selective approach to cystography and earlier catheter removal in uncomplicated injuries, particularly following IP repair, may be appropriate.

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) has been demonstrated to be safe. However, the optimal timing in obtaining interval chest radiograph (CXR) remains unknown. Methods: A prospective study was conducted over a 14-year period on patients with isolated thoracic SWs who were asymptomatic with small PTX on CXR (< 0.5 cm) that underwent active clinical observation at a major trauma centre in South Africa. Results: Fifty patients were included (87% male, mean age: 24 years). 43 (86%) were male and the mean age was 27 years. All 50 were successfully managed without tube thoracostomy (TT), with no adverse outcome. 35 (70%) had their interval CXR obtained at 12 hours, 7 (14%) at 12–16 hours, 4 (8%) at 16–20 hours and 3 (6%) at 20–24 hours. All patients demonstrated complete resolution of PTX at each of the time intervals and remained asymptomatic. Conclusion: In patients with asymptomatic small PTX <0.5 cm, interval CXR at 12 hours invariably demonstrates complete resolution. As all patients remained asymptomatic, this may facilitate earlier patient discharge.