Background: Penetrating cardiac injuries are rare in South African and international literature. Penetrating cardiac injuries are regarded as one of the most lethal injuries in trauma patients. The mechanism of injury varies across the world. In developing countries, stab wounds cause the majority of penetrating cardiac injuries. These injuries remain clinically challenging and are associated with high mortalities. Aim: To describe our experience with penetrating cardiac injuries and the outcome of their management at a level 1 trauma unit in Johannesburg, South Africa. Materials and methods: We retrospectively reviewed all patients who presented with penetrating cardiac injuries over a period of four years (1 January 2016 to 31 December 2019). The patients were identified using the hospital database. The patient’s demographics, mechanism of injury, injury severity score, vital signs, investigation findings, final diagnosis, type of operation, length of hospital stay, morbidities, and mortalities were recorded. Results: There was a total of 167 patients with penetrating cardiac injuries identified. There were 151 (90.4%) males, with an overall median age of 29 years (IQR 24–34). Stab wounds accounted for 77.8% of the injuries, while gunshot wounds (GSW) accounted for 22.2%. The median injury severity score (ISS) and revised trauma score (RTS) were 25 and 7.1, respectively. The right ventricle was the most injured chamber (34.7%), followed by the left ventricle (29.3%), right auricle (13.2%), right atrium (10.2%), and combined injuries accounted for 7% of injuries. A commonly used incision was a sternotomy (51.5%), left anterior-lateral thoracotomy (26.9%), emergency room thoracotomy (19.2%), and clamshell thoracotomy (2.4%). The overall mortality rate was 40.7%, with a 29.2% mortality in the stab wounds. Twenty-four (14.4%) patients died in the emergency department, sixteen (9.6%) patients died on the table in theatre, and the remaining twenty-eight (16.7%) died in the intensive care unit or wards. Gunshot wounds, other associated injuries, right ventricle injuries, a high ISS, low RTS, and low Glasgow coma scale were all significantly more likely to result in death (p < 0.001). Conclusions: Penetrating cardiac injuries are often fatal, but the mortality can be improved with appropriate resuscitation and a work-up. The injuries to the heart can be safely managed by trauma/general surgeons in our setting. The physiology in presentation and other associated injuries determines outcomes in patients with penetrating cardiac injury.

Introduction: Trauma is a major disease burden in low and middle‐income countries like South Africa. Abdominal trauma is one of the leading reasons for emergency surgery. The standard of care for these patients is a laparotomy. In selected trauma patients, laparoscopy has both diagnostic and therapeutic usage. The trauma burden and the number of cases seen in a busy trauma unit make laparoscopy challenging.Aim: We wanted to describe our journey with laparoscopy in the management of abdominal trauma in a busy urban trauma unit in Johannesburg, South Africa.Methods: We reviewed all trauma patients who underwent diagnostic laparoscopy (DL) or therapeutic laparoscopy (TL) between 01 January 2017 and 31 October 2020 for blunt and penetrating abdominal trauma. The demographic data, indications for laparoscopy, injuries identified, procedures performed, intraoperative laparoscopic complications, conversion to laparotomy, morbidity, and mortality were evaluated.Results: A total of 54 patients who had laparoscopy were included in the study. The median age was 29 years (IQR 25–25). Most injuries were penetrating 85.2% (n = 46/54) and 14.8% blunt trauma. Most patients were males, 94.4% (n = 51/54). Indications for laparoscopy included diaphragm evaluation (40.7%), pneumoperitoneum for evaluation of potential bowel injury (16.7%), free fluid with no evidence of solid organ injury (12.9%) and colostomy (5.5%). There were 8 (14.8%) cases converted to laparotomy. There were no missed injuries or mortality in the study group.Conclusion: Laparoscopy in selected trauma patients is safe even in a busy trauma unit. It is associated with less morbidity and shortened hospital length of stay.

Introduction: Preperitoneal pelvic packing for early pelvic haemorrhage control reduces mortality. Bleeding noted with pelvis fractures is predominantly due to associated venous complex injuries. More studies are advocating for angiography as first‐line therapy for haemodynamic instability in pelvic fractures; however, these facilities are not in abundance in middle‐ and low‐income countries. We hypothesized that PPP improves outcomes under these circumstances.Methods: Retrospective analysis of data from the patients charts over a period of 16 years from 01 January, 2005 to 31 December, 2020. All patients over the age of 18 years who presented with haemodynamic instability from a pelvic fracture and required PPP were included. The demographics, physiological parameter in emergency department, blood products transfused, morbidity and mortality were analysed.Results: There were 110 patients identified in the study period who underwent pelvic preperitoneal packing for refractory shock or ongoing bleeding. The majority (75.5%) of patients were men (n = 83). The median age was 38 years. The most common mechanism of injury was pedestrian vehicle collision (51%), followed by motor vehicle collisions (27.3%). The median ISS and NISS were 35 and 40, respectively. The median RTS in ED was 4.8(3–6.8). None of our patients rebleed after pack removal and no one needed repacking or adjunct angioembolization in our study group. The in‐hospital mortality rate was 43.6% (n = 48) in patients who underwent preperitoneal pelvic packing. The operating room table mortality was 20% (n = 22/110), and the mortality rate of those who survived to ICU transfer was 29.5% (n = 26/88).Conclusions: Pelvic preperitoneal packing has a role in the acute management of haemodynamically abnormal patients with pelvic fractures in our environment. In the absence of immediate angioembolization, preperitoneal packing can be lifesaving.

Background: In the twenty-first century, transportation disasters and subsequent injuries are on the rise, in particular air travel, and, thus, contributing significantly to the morbidity and mortality. Aviation injuries are not common in South Africa, injuries and outcomes of patients involved in aircraft crashes are unknown. We aimed to describe the injury patterns, and mortality rate resulting from air crashes presenting at a level 1 trauma centre in Johannesburg, South Africa. Methods: Data was collected between January 2011 and December 2019. The hospital trauma database was used to obtain data related to patients who were involved in aircraft crashes. Their demographics, type of related aircraft, injuries sustained, injury severity score (ISS), new injury severity score (NISS), revised trauma score (RTS) surgical intervention carried out, length of stay in ICU, length of hospital stay, morbidities, 28-day mortality and outcomes (discharge/death). Results: Fifty-two (52) patients (mean age was 44,8 years) were identified. The mean ISS was 9, and NISS was 11. Patients were occupants of civilian, noncommercial, powered aircraft. Fixed wing constituted 63,46%, followed by helicopters 21,15% and 7,69%. Spinal injuries were the most common injury in our patients, followed by soft tissue injuries and rib fractures. The median hospital stay was 10 ? 22 days. The overall in-hospital mortality rate was 7.7 % Conclusion: Majority of patients sustained musculoskeletal injuries. We suggest that these injured patients should be managed at a Level 1 facility in view of combined multiple injuries sustained during the crash.

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.

Background: Damage control surgery (DCS) is a life-saving strategy for critically injured patients in extremis . Identifying predictors of mortality in this population may help guide clinical decision making and resource allocation in low- and middle-income countries. This study aimed to identify independent predictors of in-hospital mortality following DCS. Methods: We conducted a retrospective analysis of 219 consecutive patients who underwent DCS at a trauma centre, over 3 years, between June 2021 and June 2024. Patient demographics, physiological parameters, laboratory values, transfusion requirements, operative details and outcomes were compared between survivors and non-survivors. Multivariable logistic regression analysis was performed to identify independent predictors of mortality. Results: The overall in-hospital mortality rate was 11.0% (n = 24). Patients were predominantly male (93.5%) with penetrating trauma (84.5%). Non-survivors demonstrated significantly lower Glasgow Coma Scale scores (13.0 vs. 15.0, p < 0.001), lower arterial pH (7.07 vs. 7.29, p < 0.001), higher lactate levels (13.4 vs. 6.3 mmol/L, p < 0.001) and greater transfusion requirements (p < 0.001). Multivariable analysis identified three independent predictors of mortality: elevated lactate (OR 4.33 per SD increase), lower Glasgow Coma Scale (OR 0.56 per SD increase) and lower arterial pH (OR 1.34 per SD decrease). The predictive model demonstrated excellent discrimination (AUC 0.912). Conclusions: Lactate, Glasgow Coma Scale and arterial pH are independent predictors of mortality following DCS. These readily available clinical parameters may assist in prognostication and guide resuscitation efforts in this high-risk patient population.