Surgical management of leg injuries resulting from road accidents admitted to the university clinics of Kisangani: Epidemiological, anatomopathological, therapeutic and evolutionary aspects

Summary: In the Democratic Republic of the Congo (DRC), road accidents (RA) represent a real public health problem and an enormous financial problem, given that this is one of the poorest countries in Africa, with precarious, dilapidated or inoperable reception infrastructures, including wards, basic equipment, almost non-existent basic investigation facilities and financial inaccessibility for the majority of the injured, making access to care theoretical for the majority of the population. On top of this, there are medical teams who have not been retrained to deal with emergencies, particularly traumatic ones, and who are unmotivated for a variety of reasons. The long-term solution lies in improving socio-economic conditions and radically changing attitudes at all levels to ensure that roads are safe and not places for people to die. This module aims to raise the awareness of healthcare staff regarding the management of leg injuries caused by RA, a real scourge in the Congo. Its main objective is to describe the epidemiological, anatomopathological, clinical, therapeutic and evolutionary characteristics of leg injuries caused by RA. Methods: This was a retrospective study of RA leg injuries admitted to the University Clinics of Kisangani (UCK). The sample consisted of 237 documented leg trauma patients. Our data collection technique was a documentary analysis based on patients' medical records. The data were entered using Excel 2013 and then imported into IBM SPSS version 20 for analysis. Results: During our study conducted at the UCK from 1 January 2015 to 31 December 2019, which focused on leg injuries following RA, we collected 567 road traffic accident victims with all RA injuries, including 237 leg injuries, in the traumatology and orthopaedics department. This represents an overall prevalence of 41.80%. With a male predominance (67.71%), i.e. a sex ratio of 2/8 in favour of the male sex. The 19 to 37 age group was the most frequent in 48.95% of cases. The average age of our trauma victims was 31.49 years. Motorbike taximen were in the majority (50.21%). Most of the patients were from the urban commune of Makiso (46.84%). The main mechanism of injury was a motorbike versus motorbike collision (46.84%), admitted between 6 and 24 hours after the trauma (29.96%). For the most part, the trauma victims were haemodynamically stable (66.67%) with open fractures (56.92%), Cauchoix and duparc type III (51.85%). The definitive treatment consisted of surgical trimming followed by continuous trans-calcaneal traction in 56.96% of cases, with delayed consolidation in 14.77% and an average hospital stay of 63.32 days. Conclusion: Subjects exhibiting risky driving behaviour still predominate. Socio-economic status, support for risky driving behaviour and recourse to advice from family and friends are predictive factors that could benefit from downstream road safety education. However, this is virtually impossible in a country with few resources such as ours (the DRC).