With a substantial portion of the U.S. population living near water, it would seem natural to look into orthopedic injuries occurring from watercraft-related accidents.
Watercraft Orthopedic Injuries: 16% Amputation Rate! Why?
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A team of researchers from Florida has done just that. Their work, “Orthopaedic Watercraft Injuries: Characterization of Mechanisms, Fractures, and Complications in 216 Injuries,” appears in the April 2018 edition of the Journal of Orthopaedic Trauma.
Hassan Mir, M.D., M.B.A., with the Orthopaedic Trauma Service at the Florida Orthopaedic Institute in Tampa and co-author on this retrospective case series told OTW, “We treat a high number of these injuries in Tampa given the popularity of watercraft use in both saltwater and freshwater in our area. This is the largest reported series of orthopedic injuries from watercraft.”
The authors wrote, “…data were collected from January 1, 1998 to December 31, 2015, for patients including demographics, watercraft type, mechanism of injury, fracture pattern, infection, organisms, union, and amputation….”
“There were 130 closed fracture (60%) and 86 open fractures (40%). There were 146 lower extremity injuries, 49 (23%) upper extremity injuries, and 21 (10%) pelvic injuries. The overall postoperative infection rate was 9% (20/216) and was commonly polymicrobial in nature. The postoperative infection rate in closed fractures was 4% (5/130) and the postoperative infection rate in open fractures was 17% (15/86)….”
Dr. Mir told OTW, “These injuries can be devastating in nature and difficult to manage, particularly when they are open (40%). There is a high rate of postoperative infection (17%), nonunion (8%), and amputation (16%) associated with open orthopedic watercraft fractures.”
“People need to follow proper safety precautions in the water. In addition, patients and their families should be counseled on the high risk of complications when they sustain open fractures in the water.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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