Purpose: The purpose of this study was to evaluate epidemiological and clinically relevant sex-related differences in polytraumatized patients at a Level 1 Trauma Center. Methods: 646 adult patients (210 females and 436 males) who were classified as polytraumatized (at the point of admission) and treated at our Level I Trauma Center were reviewed and included in this study. Demographic data as well as mechanism of injury, injury severity, injury pattern, frequency of preclinical intubation, hemodynamic variables on admission, time of mechanical ventilation and of intensive care unit (ICU) treatment, as well as the incidence of acute respiratory distress syndrome (ARDS), multi organ failure (MOF), and mortality were extracted and analyzed. Results: A total of 210 female and 436 male patients formed the basis of this report. Females showed a higher mean age (44.6 vs. 38.3 years; p < 0.0001) than their male counterparts. Women were more likely to be injured as passengers or by suicidal falls whereas men were more likely to suffer trauma as motorcyclists. Following ICU treatment, female patients resided significantly longer at the casualty ward than men (27.1 days vs. 20.4 days, p = 0.013) although there was no significant difference regarding injury severity, hemodynamic variables on admission, and incidence of MOF, ARDS, and mortality. Conclusion: The positive correlation of higher age and longer in-hospital stay in female trauma victims seems to show women at risk for a prolonged in-hospital rehabilitation time. A better understanding of the impact of major trauma in women (but also men) will be an important component of efforts to improve trauma care and long-term outcome.

Background: High-voltage injuries associated with train surfing are a distinct subset of electrical injuries, yet detailed analyses remain limited. This study retrospectively reviewed train-surfing injuries admitted between 1994 and 2024, comparing their characteristics and outcomes to work-related high-voltage injuries. Methods: Medical records of 102 patients admitted for high-voltage injuries were analyzed, including 32 train-surfing and 70 work-related cases. Demographics, injury patterns, and clinical outcomes were assessed. Results: Train surfers were predominantly young males (median age 19 years), while work-related injuries involved slightly older males (median age 34 years). Train surfers sustained more severe burns (%TBSA: 47.6% vs. 25.4%, p < 0.0001) and higher ABSI scores (6.7 vs. 5.3, p < 0.01). Vertical electrical flow was predominant in train surfing (65.6%), reflecting contact with overhead lines, while work-related injuries showed varied flow patterns, with diagonal flow being most frequent (58.6%). Train surfers had longer ICU stays (38.7 vs. 17.9 days, p < 0.001) and underwent more surgeries per patient (5.3 vs. 2.8, p < 0.01). Fasciotomy rates were significantly higher among train surfers (84.4% vs. 55.7%, p < 0.01), as were amputations (53.1% vs. 25.7%, p < 0.001). Mortality rates were similar in both groups (25%). Conclusions: Train-surfing injuries represent a distinct and highly severe subgroup of high-voltage trauma, marked by greater burn extent, predominantly vertical electrical flow due to contact with overhead lines, and significantly higher surgical complexity—including increased rates of fasciotomies and amputations. Despite comparable mortality, the clinical burden for train-surfing victims is substantially higher, reflected in longer ICU stays and more operations per patient. These findings underscore the urgent need for targeted prevention strategies addressing youth engagement in train surfing. Public health campaigns, railway infrastructure modifications (e.g., deterrent systems or physical barriers), and early educational interventions could play a critical role in reducing these preventable injuries. Furthermore, trauma centers should be prepared for the specific reconstructive and critical care demands posed by this high-risk group, emphasizing the importance of specialized multidisciplinary management protocols.

Background: Surgical care in conflict regions like Tigray, Ethiopia, faces severe challenges due to limited resources, infrastructural deficiencies, and high trauma burden. From 2019 to 2023, a multidisciplinary team conducted five humanitarian missions focusing on orthoplastic reconstruction of extremity and mandibular injuries from high-energy gunshot trauma. Methods: A retrospective analysis was performed on 98 patients who underwent free or pedicled flap reconstruction. Data included demographics, flap type, technique, complications, follow-up, and early clinical outcomes score as well as mobility scores. Flaps were harvested using loupes anastomosis performed using microscopes, depending on availability. Results: Among 98 patients (25.5% female, 74.5% male), 69 free flaps and 38 pedicled flaps were performed. Free fibula flaps (n = 54) included 33 mandibular and 21 extremity reconstructions. Additional flaps included ALT, gracilis, and LD flaps. Pedicled flaps included 18 fibula and 20 ALT/LD flaps. Mean age was 35.5 years; mean operative time was 429.5 min, with mandibular fibula transfers being longest. Microsurgical techniques were used in 34% of cases. Median follow-up was 10 months. Microsurgical complications occurred in 18.4%, mainly in fibula transfers (25.9%). Non-microsurgical issues included wound infections (n = 15), graft loss (n = 3), and bleeding (n = 5). Flap loss occurred in 16.3% overall. Early clinical outcome results were good (30.6%), acceptable (28.6%), and moderate (24.5%). Conclusions: Orthoplastic reconstruction using both free and pedicled flaps is feasible in low-resource, conflict settings. Despite infrastructural challenges, functional outcomes were achievable, supporting the value of adaptable microsurgical strategies in humanitarian surgery.