|Year : 2015 | Volume
| Issue : 1 | Page : 36-40
Radiological imaging of motorcycle-related injuries in a developing country: Experience in a tertiary health facility in the South-Western Nigeria
Olufunso Simisola Aduayi, Olusola Comfort Famurewa, Victor Adebayo Adetiloye
Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
|Date of Submission||19-Jul-2015|
|Date of Acceptance||09-Oct-2015|
|Date of Web Publication||9-Nov-2015|
Olufunso Simisola Aduayi
Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State
Source of Support: None, Conflict of Interest: None
Background: Trauma is one of the major clinical indications for radiological investigation, and this often comes to the fore during hospital care of patients involved in motorcycle crashes. The aim of this study is to highlight the pattern of medical imaging utilization and spectrum of radiological findings among adults presenting with motorcycle-related injuries (MCRI) in a tertiary health facility in the South-Western Nigeria.
Patients and Methods: A cross-sectional descriptive study was carried out prospectively between August 2011 and July 2012. The study population included adult patients referred for investigations at the radiology department following involvement in motorcycle crashes. Appropriate radiological investigations were done, and imaging findings were reported by radiologists. The data was entered into a spreadsheet and analyzed using SPSS version 16.0 for windows, Chicago, USA Inc.
Results: A total of 150 patients were recruited into the study out of which 119 (79.3%) were males and 31 (20.7%) were females. There were 74 (49.3%) motorcycle riders, 55 (36.7%) pillion passengers, and 21 (14%) pedestrians. The limbs (n = 92, 61.3%) were the most imaged site in the body followed by the head (n = 78, 52.0%). Plain radiography (n = 113, 75.0%) was the most utilized radiological investigation among the study population, followed by computed tomography (n = 65, 43.3%), ultrasonography (n = 11, 7.3%), and magnetic resonance imaging (n = 1, 0.6%).
Conclusion: This study highlights the burden of MCRI in our environment from a radiological perspective. The need for continuous advocacy on prevention of MCRI in a developing nation cannot be overemphasized.
Keywords: Computed tomography, magnetic resonance imaging, motorcycle, radiographs, trauma, ultrasonography
|How to cite this article:|
Aduayi OS, Famurewa OC, Adetiloye VA. Radiological imaging of motorcycle-related injuries in a developing country: Experience in a tertiary health facility in the South-Western Nigeria. J Curr Res Sci Med 2015;1:36-40
|How to cite this URL:|
Aduayi OS, Famurewa OC, Adetiloye VA. Radiological imaging of motorcycle-related injuries in a developing country: Experience in a tertiary health facility in the South-Western Nigeria. J Curr Res Sci Med [serial online] 2015 [cited 2020 Feb 23];1:36-40. Available from: http://www.jcrsmed.org/text.asp?2015/1/1/36/168916
| Introduction|| |
The burden of road traffic injuries (RTI) is of global significance hence the role of prompt and accurate radiodiagnosis in the delivery of optimal care for trauma victims cannot be overemphasized. According to the World Health Organization; about 1.2 million people die, 50 million are injured yearly, and a disproportionate burden of this injury is currently and will continue to be borne by low- and middle-income countries., Motorcycles have become a popular means of transportation for both personal and commercial purposes in Nigeria , with a resultant rise in motorcycle crashes contributing to overall morbidity and mortality from RTI.,
Trauma is one of the key clinical indications for radiological investigations; imaging findings influence the choice of medical intervention and prognosis determination. This study highlights the pattern of radiological imaging utilization and spectrum of radiological findings among adults presenting with motorcycle-related injuries (MCRI) in a tertiary healthcare facility in the South-Western Nigeria.
| Patients and Methods|| |
A cross-sectional descriptive study was carried out prospectively between August 2011 and July 2012 in a tertiary health facility in the South-Western Nigeria.
Approval for the study protocol was obtained from the Hospital Ethics and Research Committee. MCRI was defined as an injury that occurs during a motorcycle crash in which the victim was either on a motorcycle as a rider or pillion passenger or was a pedestrian knocked down by a motorcycle. The study population included 150 adult patients presenting with MCRI, who had radiological investigations done at the radiology department. Victims of RTI from nonmotorcycle-related causes were excluded from the study. The imaging modalities utilized include plain radiography, computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI). The images were reviewed by Radiologists and findings were documented. Statistical Package for Social Sciences (SPSS) for windows version 16.0 (Chicago, USA SPSS Inc.,) was used to analyze the data.
| Results|| |
Of the 150 patients recruited into the study, 119 (79.3%) were males while 31 (20.7%) were females. The age range of the study population was 18–93 years with a mean age of 41.22 ± 36.10 years. Motorcycle riders were 74 (49.3%), passengers 55 (36.7%), and pedestrians 21 (14%). Multiple injuries were found in 52 (34.7%) patients while the remaining 98 (65.3%) patients had injuries localized to a particular region of the body.
The limbs were the most imaged site in the body. Plain radiography was the most utilized radiological investigation while MRI was the least utilized [Table 1].
|Table 1: Imaged body sites and radiological investigations utilized by study population|
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Plain radiography was used for imaging of patients with suspected limb fractures, chest injuries, head and maxillofacial injuries, and pelvic and spinal injuries. Some patients with moderate to severe head injuries also had cervical spine radiographs taken as part of the routine trauma imaging series. Findings on the skull, cervical spine, and chest radiographs are summarized in [Table 2].
Comparing extremity injuries seen on plain radiographs, the lower limb [Figure 1] was the most commonly injured and the tibia (n = 39, 39.8%) was the most commonly fractured bone. Other lower limb bones involved include fibula (n = 28, 28.6%), femur (n = 27, 27.6%), tarsals/metatarsals (n = 3, 3.0%), and patella (n = 1, 1.0%). The right lower limb was more commonly injured among the motorcyclists and pedestrians while the left lower limb was more commonly injured among the passengers. Upper limb injuries were seen only among the riders and pillion passengers, and the left upper limb was more commonly involved. The radius (n = 8, 36.4%) was the most commonly fractured upper limb bone. Other upper limb bones involved include ulna (n = 7, 31.8%), humerus (n = 5, 22.7%), carpals (n = 1, 4.5%), and clavicle (n = 1, 4.5%). Findings on limb and pelvic radiographs are summarized in [Table 3].
|Figure 1: Antero-posterior and Lateral plain radiograph views of the left leg showing comminuted mid shaft fracture of the tibia and a fractured fibula in a patient involved in a motorcycle crash|
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Ultrasonography [Figure 2] was done for a total of 11 patients. This was made up of 10 abdominopelvic ultrasound scans and a scrotal ultrasound scan. Five of the abdominopelvic scans were done for pregnant women involved in motorcycle crashes. The distribution of the abdominopelvic ultrasound findings is shown in [Table 4]. The scrotal ultrasound scan was done for a male pillion passenger who sustained scrotal injury. It showed bilateral scrotal hematoma seen as echogenic collections within the scrotal sac surrounding the testes.
|Figure 2: Abdominal ultrasonography showing intra-peritoneal free fluid in the lower abdomen of a motorcycle crash victim with blunt abdominal injury|
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Cranial CT scans [Figure 3] and [Figure 4] performed in cases of head injury showed positive findings in all, except for a patient with mild head injury, who had essentially normal features [Table 5]. Comparing the findings among the riders, passengers, and pedestrians, the patterns of injury were similar. A passenger with blunt abdominal trauma had an abdominal CT scan is done with significant findings of the perihepatic hyperdense collection (representing blood), hypodense areas within the liver parenchyma (representing contusions), and hemoperitoneum. Spinal CT scan was also done for a rider who sustained spinal injuries, and the significant findings were comminuted fractures of the body of the eighth and ninth thoracic vertebral bodies (T8 and T9).
|Figure 3: Bone window of an axial cranial computed tomography scan image showing depressed and comminuted fractures of the right temporoparietal bone in a motorcycle crash victim with head injury|
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|Figure 4: Soft tissue window of the axial cranial computed tomography scan image in Figure 3 showing acute intra-cerebral hemorrhage in the right parietal lobe with perilesional edema and compression of the body of the ipsilateral lateral ventricle|
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MRI of the cervical spine was done for one passenger, and it showed spondylolisthesis of C6 on C7 vertebra [Figure 5].
|Figure 5: Sagittal view of a T1-weighted magnetic resonance imaging image showing spondylolisthesis at C6–C7 level of the cervical spine in a pillion passenger involved in a motorcycle crash|
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| Discussion|| |
In many developing countries, optimal utilization of medical imaging for trauma is often hampered by a lack of appropriate equipment and expertise. On the other hand, sophisticated equipment such as CT and MRI scans are used for routine emergency room evaluation of trauma cases in the developed nations.
Research has shown that limb injuries are the most common form of injuries sustained following involvement in motorcycle crashes,,,,,, and this is followed by head injury. Other parts of the body ,,,,, such as the eyes, teeth, spine, chest, abdomen, pelvis, and the genitourinary organs are less commonly involved in MCRI; injuries at these sites may occur in isolation or with limb and/or head injuries in a multiply injured patient. In this study, evaluation of limb injuries was the most common indications for radiological imaging, followed by head injury. This also reflected in the pattern of utilization of radiodiagnostic imaging with plain radiography taking the lead, followed by CT scans.
In Nigeria, X-ray machines are available in most urban areas. It is less expensive to acquire and maintain than other imaging equipment such as CT and MRI scans. Moreover, plain radiographs readily provide necessary information on the bones, and this is why it is often utilized for baseline radiological evaluation of trauma patients with suspected musculoskeletal injury. The plain radiograph findings in this study are similar to findings in a study conducted by Eze et al. in Lagos, Nigeria and Chalya et al. in Tanzania. Comparing the limb injury patterns among motorcycle riders, passengers, and pedestrians in our study, it was interesting to discover that it was only among the pedestrians that upper limb injuries were not sustained. Chest, spinal, and pelvic injuries were also not common among pedestrians. This may be due to the fact that the lower limbs are usually in closer proximity to the motorcycle and likely to be more involved in MCRI after motorcyclists run into and/or knock down a pedestrian.
In this study, CT scans were mainly utilized for cranial imaging in patients with moderate and severe head injuries while only one abdominal CT and one thoracic spine CT was done. This buttresses the fact that head injury constitutes a significant proportion of MCRI requiring radiological imaging with CT in our environment. Ogbeide and Isara  in a study on cranial CT scans among the head injured in Benin city, Nigeria also observed that motorcyclists constituted the highest number of severely head injured patients presenting for cranial CT scans compared to vehicle occupants and pedestrians. This is not unconnected with noncompliance of the majority of motorcycle users in Nigeria with the use of helmets.,, Cranial CT is useful for assessment of the skull, facial bones and brain parenchyma to detect intra-cranial hemorrhages which may be extra-axial or intra-cerebral. The complications such as raised intra-cranial pressure needing an urgent decision to surgically decompress or institute anti-edema measures are also readily identified. The injury patterns that were demonstrated on CT scan in this study were in keeping with findings in moderate and severe traumatic head injury in other studies.,,
There is a scarcity of literature regarding the use of MRI for imaging MCRIs in Nigeria at the moment. Functioning MRI is available only in a few government owned tertiary health facilities and private diagnostic centers. However, the high cost of investigation and long image acquisition times for the Tesla strength of machines currently available in most of these centers contribute to its low use for routine acute trauma imaging. The presence of metallic implants which may not be MRI compatible can also hinder its use for some patients. In our study, MRI was done for only one patient.
Ultrasound scanning was used for patients with blunt abdominal injuries and pregnant women to ascertain the viability of the fetus. It is cheap, fast and can be repeated for serial evaluation as it does not utilize ionizing radiation. It can also be used to evaluate vascular injury. Research has shown that fewer patients tend to sustain motorcycle-related abdominal injuries,,,,, and this was corroborated by our study. However, the occurrence of intra-uterine fetal deaths among pregnant women the following involvement in a motorcycle crash is a call for concern in our environment.
| Conclusion|| |
The burden of MCRIs in a developing nation has been highlighted from an imaging perspective. Advocacy for MCRI preventive strategies must be sustained in order to curb this menace in our society.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]