SPECTRUM AND OUTCOMES OF ORTHOPEDIC CONDITIONS PRESENTING THROUGH EMERGENCY SERVICES DURING NIGHT-TIME HOURS: A RETROSPECTIVE DESCRIPTIVE STUDY
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Keywords
night-time orthopaedic emergencies, road traffic accident, open fractures, nocturnal surgery, emergency department, Lucknow, Uttar Pradesh, India
Abstract
Background:Night-time emergency orthopaedic presentations constitute a significant but undercharacterised proportion of emergency department (ED) workload in tertiary care hospitals in India. Understanding the spectrum, severity, and outcomes of orthopaedic conditions presenting during nocturnal hours is essential for optimising staffing, resource allocation, surgical scheduling, and training protocols in emergency orthopaedic services.
Objectives:To describe the spectrum of orthopaedic conditions, clinical characteristics, severity, management patterns, and in-hospital outcomes of patients presenting to the emergency department through emergency services during night-time hours (8:00 PM to 8:00 AM) at Career Institute of Medical Sciences and Hospital (CIMS&H), Lucknow, Uttar Pradesh, from December 2017 to September 2018.
Methodology:A retrospective descriptive study of all orthopaedic patients presenting via emergency services during night-time hours (8 PM to 8 AM) at CIMS&H between December 2017 and September 2018 was conducted. Medical records were reviewed for demographics, mechanism of injury, diagnosis, anatomical site, injury severity, clinical management (conservative versus operative), operative details, and in-hospital outcomes. Data were entered in Microsoft Excel and analysed using SPSS v21.
Results:A total of 486 night-time orthopaedic emergency presentations were recorded over ten months. The majority were male (72.4%) with a mean age of 36.8 ± 17.6 years. Road traffic accidents (RTAs) were the dominant mechanism of injury (58.2%), followed by fall from height (18.5%), domestic falls (12.1%), assault (5.8%), and sports injuries (3.1%). Lower limb fractures (femur, tibia-fibula, ankle) constituted 44.8% of all injuries; upper limb fractures accounted for 22.6%; open fractures (compound) constituted 19.8% of all presentations. Emergency operative intervention within the same night was required in 21.8% of patients; 54.3% underwent surgery within 24 hours of presentation. Complications during the index admission included surgical site infection (SSI) in 8.6%, compartment syndrome in 3.7%, and vascular injury requiring urgent repair in 2.1%. In-hospital mortality was 3.1% (n=15), with traumatic brain injury (TBI) as the commonest cause of death.
Conclusion:Night-time orthopaedic emergency presentations at CIMS&H, Lucknow, are predominantly male, young, RTA-related, and involve a high proportion of open fractures requiring urgent operative intervention. The high proportion of open fractures, requirement for nocturnal surgery, and associated complications underscore the need for dedicated orthopaedic emergency teams, round-the-clock operation theatre access, and structured protocols for after-hours management of orthopaedic emergencies at tertiary care institutions in Uttar Pradesh.
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Dr. Patel Jwalant Yogeshbhai
Assistant Professor, Department of Orthopaedics, Career Institute of Medical Sciences & Hospital, Ghailla, Lucknow, Uttar Pradesh, India
