Damage control surgery (DCS) is a widely used approach in trauma. An open abdomen carries complications, increased morbidity and mortality. This study aims to quantify the mortality rate, determine contributory factors and factors influencing the decision to perform DCS and assess morbidity in patients undergoing open abdomen. A retrospective review was conducted on 205 patients in Charlotte Maxeke Johannesburg Academic Hospital Trauma Unit. The mortality rate was evaluated over a 24-hour, 7-day and 28-day period. Data were collected by a data collection sheet from 1 January 2016 to 31 December 2018. Of the 205 patients, 193 were male and the median age was 34.34 years. Penetrating trauma was the most predominant mechanism of injury in 162 (79%), with gunshot injuries seen in the majority (130/162). The mortality rate was 55/205 (26.8%) for open abdomen patients, 19/55 (34.5%) within the first 24 hours, 22/55 (40%) in the 24-hours to 7-days period, and 14/55 (25.4%) in the 8-day to 28-day period. Statistically significant factors contributing to mortality were haemodynamic instability, hypothermia, coagulopathy, massive transfusion, vasopressors, and significant associated injuries. Morbidities were entero-atmospheric fistula (EAF) in 7.3% (Clavien-Dindo grade IIIa), surgical site infection in 45.3% (Clavien-Dindo grade I) and ventral hernia in 10.24% (Clavien-Dindo grade IIIb). Most open abdomens were performed in males, with gunshot injuries being the most common mechanism. The majority of mortalities were within the 24-hours to 7-days period. The most common morbidity associated with an open abdomen was surgical site infection.

Background: Fractured ribs remain a significant cause of morbidity and are associated with severe injuries requiring several healthcare resources and may be associated with prolonged hospital stays that may require an ICU facility. In our facility, we have a high burden of patients sustaining rib fractures, and we aim to compare management options, outcomes, and factors associated with mortality from a single center. Methods: A retrospective review was performed on patients who presented with rib fractures at a Level 1 Trauma facility in Johannesburg, undergoing medical or surgical management. The study included data from 1 July 2011 until 31 December 2020. All patients were identified using the Medibank database. STATA Version 18 software was used for all data analysis. A p-value of ribs. Only 4.6% sustained a flail chest. The median SBP was 126 mmHg (IQR:109–144), and the pulse rate was 91 (IQR: 79–108) beats per minute. The mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 17 (IQR: 10–29) and 22 (IQR: 14–34), respectively. The most common associated injuries were chest trauma in 42%, combined abdominal and pelvic trauma in 35%, and severe extremity trauma in 37%. The mortality rate was 17% (159/940). Most patients required medical and supportive management, with only 8% undergoing rib plating (76/940). The mean length of stay was 14 days (IQR: 6–25). Statistically significant factors associated with mortality were rib fractures 3≥, flail chest, higher ISS, severe head, neck, chest, abdomen and pelvis injuries (p-value 0.001) and severe extremity injury (p-value 0.006). Conclusions: Rib fractures remain a common pathology in the trauma population, and these patients can have significant associated injuries. With an appropriate multidisciplinary approach, our study found an 83% survival rate, and only 8% of patients requiring surgical intervention. Poor outcomes in patients are directly linked to the number of ribs involved, the injury severity score, associated injuries, and advanced age.

Burn injuries are a global health issue affecting millions of people annually, more so in developing countries. Electric burns are severe and uncommon forms of burn injuries which account for approximately less than 5% of all burn injuries, and are associated with high morbidity and mortality. Ocular complications occur in approximately 5% of electric burn cases, and they often present in unique patterns depending on the path of the electrical current. This case report describes a 35-year-old man who sustained high-voltage electric burns following an alleged cable theft incident. He suffered burns to his face, neck, left upper limb, and bilateral lower limbs, with subsequent ocular injuries that included exposure keratopathy, corneal perforation, and eyelid necrosis. His management entailed multiple surgical interventions, moisture chambers, tarsorrhaphy, and an amnion corneal transplant. This case highlights the importance of early ophthalmologic assessment and intervention to prevent severe vision loss. Given the devastating effects of electric burns, public awareness and preventive measures remain crucial.

Motorbike collisions (MBC) pose significant public health challenges in low- to middle-income countries (LMICs), particularly in urban settings. This study examines the injury patterns of patients involved in MBCs at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) trauma unit over a two-year period (May 2022 to April 2024). This was a retrospective review of all patients involved in MBCs. A total of 134 patients were identified, predominantly male (97.1%), with a mean age of 32 years (SD ± 8.8). Most of these incidents were work-related, highlighting the increasing use of motorbikes for commercial purposes, including food delivery. The analysis revealed that head injuries were present in 22.4% of patients, with 9.7% sustaining facial fractures and one patient presenting with a cervical spine injury. Chest injuries were reported in 21.6% of cases, while abdominal and pelvic injuries occurred in 8.2% and 6.7% of patients, respectively. The predominant injuries were long bone fractures, with 58 patients affected. The mean injury severity score (ISS) was 25 (SD plus-minus 2), indicating high levels of trauma. The mortality rate after an MBC was 2.2%. Two patients died in the emergency department due to severe injuries. The findings underscore the complexity of injuries sustained in MBCs, which often involve multiple body regions. This study highlights the urgent need for targeted interventions to enhance the safety of motorbike riders in urban areas, particularly as the prevalence of MBCs rises in association with commercial transport services. Improved trauma care and public health strategies are essential to address the ongoing challenge of motorbike-related injuries in Johannesburg and similar urban contexts.

Background: Renal trauma is a major cause of morbidity and mortality among trauma patients, especially in low- and middle-income countries (LMICs) where penetrating injuries are common. Although international evidence increasingly supports selective non-operative management (SNOM) for haemodynamically stable patients, data from resource-limited settings remain scarce. This study sought to assess the management outcomes of patients with traumatic renal injury at a South African tertiary trauma centre, describing management patterns and outcomes and identifying predictors of in-hospital death. Methods: A retrospective audit was carried out on all consecutive trauma patients presenting with renal injuries at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between July 2021 and June 2024. Patient demographics, injury mechanism and grade, admission physiological parameters, management strategies, complications, and outcomes were documented. Associations with in-hospital mortality were analysed using bivariate methods and Cox proportional hazards regression. Results: Of 161 patients included, 91.3% were male, with a median age of 32 years (interquartile range [IQR] 26–38). Penetrating trauma accounted for 80.1% of cases, predominantly gunshot wounds (GSWs; 49.7%). Most injuries were classified as American Association for the Surgery of Trauma (AAST) grades III–V (74.5%), and 68.3% required surgical intervention, although direct renal procedures were necessary in only 42.7% of operated patients. Nephrectomy accounted for 80.9% of renal-specific surgical interventions (38 of 47 patients who underwent a direct renal procedure). The overall in-hospital mortality rate was 17.4%. On multivariable analysis, admission lactate (hazard ratio [HR] 1.09; 95% confidence interval [CI] 1.00–1.18; p = 0.049), admission creatinine (HR 1.56; 95% CI 1.29–1.89; p < 0.001), and blood product transfusion within 24 h (HR 3.27; 95% CI 1.14–9.41; p = 0.028) were independently associated with mortality in the adjusted model. Conclusions: Admission lactate, creatinine, and early blood transfusion requirements were independently associated with in-hospital mortality in the adjusted model in this high-acuity cohort. These readily available physiological markers may facilitate early identification of high-risk patients in resource-limited settings; however, in the absence of ISS data, these variables may partly reflect the global burden of physiological insult from polytrauma rather than renal-specific predictors of death. A proportion of patients were managed non-operatively; however, given the inherent selection bias in management allocation and the absence of SNOM-specific outcome data stratified by AAST grade, no conclusions regarding the efficacy or safety of non-operative management can be drawn from this descriptive audit.

Background: Penetrating chest trauma is a leading cause of mortality in South Africa. In haemodynamically stable patients with injuries within the cardiac box, occult cardiac injury remains difficult to detect, particularly in resource-limited settings. The diagnostic utility of troponin T in this population is poorly defined. Methods: A retrospective cohort study was conducted on haemodynamically stable patients presenting with penetrating anterior chest injuries to Charlotte Maxeke Johannesburg Academic Hospital between May 2022 and June 2024. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of serum troponin T were calculated against subxiphoid pericardial window, surgical findings, ultrasound and electrocardiography. Results: Among 256 patients (96% male; median age 31 years), 65% sustained stab wounds and 35% gunshot wounds. Serum Troponin T demonstrated high sensitivity (90.5% pooled against definitive modalities) and an NPV of up to 88.8% in concordance analysis with commonly used screening modalities (non-reference comparators); NPV against definitive reference standards ranged from 50.0% to 66.7%, but had low specificity (37.5% pooled). Overall mortality was 3.9% and was significantly associated with haemopericardium (p = 0.020) and pleural injury (p = 0.029). Conclusion: Serum Troponin T offered high sensitivity and NPV for excluding occult cardiac injury in haemodynamically stable patients, supporting its role as an accessible screening adjunct in resource-constrained emergency departments. Contribution: This study represents the largest cohort evaluating serum troponin T in haemodynamically stable penetrating chest trauma, addressing a critical evidence gap. The findings are directly relevant to South African clinical practice and align with the journal’s focus on improving patient care in resource-limited settings.