Characteristics and treatment of injury caused by an agriculture rototiller

Abstract

Objective To investigate the characteristics and treatment of injury caused by an agri-cultural rototiller. Methods A retrospective study was performed of the 89 patients who had been treated at our department from January 2008 through March 2014 for injury caused by an agricultural rototiller. They were 76 men and 13 women, aged from 21 to 58 years (average, 46 years). According to Gustilo classifi-cation, 2 patients had type I fracture, 8 type Ⅱ, and 79 type Ⅲ (34 cases of type Ⅲa, 20 cases of type Ⅲb, and 25 cases of type Ⅲc). Shock was complicated in 69 patients, pelvic fracture in 12, vertebral fracture in 8, chest injury in 26, abdominal injury in 15, urogenital injury in 9, craniocerebral injury in 2, osteo-fascial compartment syndrome in 5, and gas gangrene in 2. According to the advanced trauma life support system, life-saving was first, followed by limb salvage and wound treatment. Vascular and neural injuries were repaired after early debridement. X-rays and Puno functional scores were used to evaluate the function during the fol-low-ups. Results Seventy-four patients were followed up for 1 to 6 years (average, 3.6 years). Five patients died from hemorrhagic shock, 3 died from severe infection, and 7 were lost to the follow-up. Limb salvage was successful in 50 patients, but limb mutilation to different degrees was inevitable in 24, of whom 22 received prosthesis. The main complications included soft tissue defects in 35 cases, chronic osteomyelitis in 6, stiff joint in 2, and neurologic deficits in 8. At the final follow-up, the mean Puno functional score was 73.0 (range, from 62 to 95). Conclusions Injury caused by an agricultural rototiller is characterized by severe trauma, complexity, and high rates of mutilation and lethality. Early hemorrhage control, management of combined lesions, limb salvage, later control of wound infection, wound healing, improvement of limb function are the keys to treatment of injury caused by an agricultural rototiller. Key words: Wounds and injuries; Clinical protocols; Prognosis; Rototiller; Injury char-acteristics