Orthopaedic trauma represents a major public health challenge worldwide and accounts for a substantial proportion of emergency department visits and hospital admissions. In India, the burden of trauma is particularly high due to rapid urbanisation, increasing vehicular traffic, and inadequate road safety infrastructure [1]. Trauma is responsible for over 50% of mortality rates in India among individuals in the productive age group, making it a significant contributor to premature death and disability [2]. Musculoskeletal injuries constitute a major component of trauma-related morbidity, with fractures being the most common type of injury encountered in emergency departments [3].

Road traffic accidents (RTAs) are the leading cause of orthopaedic trauma in India, accounting for approximately 53% of all orthopaedic trauma admissions in some regions [4]. The Global Burden of Disease Study estimates that RTAs will become the seventh leading cause of death globally by 2030 [5]. Falls represent the second most common mechanism of injury, with distinct age-related patterns—RTAs predominating in young adults aged 18–40 years, while falls are more common in the elderly population above 60 years [6]. The World Health Organization reports that falls are the second leading cause of unintentional injury deaths worldwide, with adults over 65 years suffering the greatest number of fatal falls [7].

The pattern and distribution of orthopaedic injuries vary considerably across different geographic regions, reflecting variations in population demographics, occupational activities, traffic patterns, and socioeconomic factors [8]. In India, several studies have documented a male predominance in orthopaedic trauma, with male-to-female ratios ranging from 3:1 to 5:1 [9,10]. The lower limbs are more frequently involved than upper limbs, with femoral fractures being the most common skeletal injury in many Indian studies [11]. However, the precise epidemiological profile varies between urban and rural settings, and region-specific data are essential for effective resource allocation and targeted prevention strategies.

A comprehensive understanding of the local pattern and distribution of orthopaedic trauma is crucial for planning trauma care services, training healthcare personnel, and implementing evidence-based injury prevention programmes. The Indian Orthopaedic Association has emphasised the need for trauma registries to document injury patterns and monitor changing trends over time [12]. Such data enable healthcare institutions to optimise resource allocation, anticipate patient loads, and develop standardised treatment protocols. This study was therefore undertaken to describe the pattern and distribution of orthopaedic trauma in patients presenting to a tertiary care hospital in Perambalur, Tamil Nadu, over a ten-month period.

OBJECTIVE

The primary objective of this study was to determine the pattern and distribution of orthopaedic trauma in patients presenting to the Department of Orthopaedics at Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital, Perambalur, Tamil Nadu, over a ten-month period from August 2025 to May 2026. Specifically, the study aimed to describe the demographic profile of patients with orthopaedic trauma in terms of age and gender distribution, to identify the leading mechanisms of injury, and to characterise the anatomical distribution of fractures according to the affected limb and specific bone involvement.

The secondary objective was to assess the pattern of orthopaedic injuries in relation to the mechanism of trauma and to document the frequency of associated injuries and polytrauma in the study population. The findings of this study are expected to provide valuable local epidemiological data that can inform the development of targeted injury prevention strategies and guide the allocation of orthopaedic trauma care resources at our institution and in the surrounding region.

This prospective observational study was conducted in the Department of Orthopaedics at Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital, a tertiary care teaching hospital located in Siruvachur, Perambalur, Tamil Nadu, India. The hospital is a 100-acre campus situated on the National Highway (No. 45) between Trichy and Chennai, providing comprehensive orthopaedic services including advanced joint replacement surgery, complex trauma management, pelvic-acetabular fracture management, arthroscopic surgeries, paediatric orthopaedic procedures, spine surgeries, and deformity correction [13]. The study was conducted over a ten-month period from August 2025 to May 2026. A sample size of 36 patients was determined based on the expected prevalence of orthopaedic trauma in the tertiary care setting and the feasibility of comprehensive prospective data collection during the study period. The study was approved by the Institutional Ethics Committee, and written informed consent was obtained from all participants or their legal guardians prior to enrolment.

Inclusion Criteria: Patients of all age groups and both genders presenting to the emergency department or orthopaedic outpatient department with acute orthopaedic trauma, including fractures, dislocations, and soft tissue injuries, were included in the study. Patients who provided informed consent for participation and those with a minimum follow-up period of at least one month were included.

Exclusion Criteria: Patients with pathological fractures secondary to bone tumours or metastatic disease, patients with fractures associated with metabolic bone diseases, those with periprosthetic fractures, and patients who were lost to follow-up or had incomplete medical records were excluded from the study. Patients who declined to participate were also excluded.

Data Collection Procedure: Data were collected prospectively using a structured proforma designed specifically for this study. The proforma included demographic details (age, gender, occupation, residence), mechanism of injury (road traffic accident, fall, assault, sports injury, and others), time and date of injury, time of presentation to the hospital, anatomical site of injury (upper limb, lower limb, spine, pelvis), specific bone involvement, type of fracture (closed/open), fracture classification, associated injuries, and management details (conservative or operative). Clinical examination findings were recorded for all patients, and radiological investigations including plain radiographs and where indicated, CT scans and MRI were performed to confirm the diagnosis and classify the fractures. All patients were evaluated and managed according to the standard treatment protocols of the Department of Orthopaedics.

Statistical Data Analysis: Data were entered into Microsoft Excel and analysed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarise the data. Continuous variables were expressed as mean ± standard deviation, and categorical variables were expressed as frequencies and percentages. The chi-square test was used to assess associations between categorical variables, including the relationship between age groups and mechanisms of injury, and between gender and fracture patterns. A p-value of less than 0.05 was considered statistically significant. The results were presented in the form of tables and figures for clarity and ease of interpretation.

A total of 36 patients with orthopaedic trauma were included in this prospective study conducted over a ten-month period from August 2025 to May 2026. The demographic characteristics of the study population are presented in Table 1. The majority of patients were males (75%, n=27) with a male-to-female ratio of 3:1. The most commonly affected age group was 21–40 years (44.4%, n=16), followed by 41–60 years (27.8%, n=10), and below 20 years (16.7%, n=6). The mean age of the study population was 37.2 ± 16.8 years (range: 8–72 years). Regarding the mechanism of injury, road traffic accidents were the leading cause, accounting for 52.8% (n=19) of all cases, followed by falls in 30.6% (n=11) of patients. Assault accounted for 8.3% (n=3), and sports injuries accounted for 5.6% (n=2). One patient (2.8%) sustained injury due to a fall of a heavy object.

Table 1: Demographic Profile and Mechanism of Injury (n=36)

The anatomical distribution of fractures is presented in Table 2. Lower limb fractures were more common (58.3%, n=21) than upper limb fractures (36.1%, n=13). Spinal injuries were observed in 5.6% (n=2) of patients. Among the specific bones involved, the femur was the most commonly fractured bone (22.2%, n=8), followed by the tibia (19.4%, n=7), radius (11.1%, n=4), and humerus (11.1%, n=4). Other bones involved included the fibula (8.3%, n=3), ulna (5.6%, n=2), and clavicle (5.6%, n=2). Pelvic fractures were observed in 5.6% (n=2) of patients. In terms of the type of fracture, closed fractures predominated (86.1%, n=31), while open fractures accounted for 13.9% (n=5) of cases. The most common fracture pattern was simple/transverse in 44.4% (n=16) of patients, followed by comminuted fractures in 30.6% (n=11), and oblique/spiral fractures in 25.0% (n=9).

Table 2: Anatomical Distribution of Fractures (n=36)

The relationship between the mechanism of injury and the anatomical distribution of fractures is presented in Table 3. Among patients with road traffic accidents, lower limb fractures were the most common (57.9%, n=11), followed by upper limb fractures (31.6%, n=6). In patients with falls, lower limb fractures were also predominant (54.5%, n=6), with upper limb fractures accounting for 36.4% (n=4). Associated injuries were observed in 22.2% (n=8) of patients, with head injury being the most common associated injury (11.1%, n=4), followed by chest injury (5.6%, n=2) and abdominal injury (2.8%, n=1). Polytrauma, defined as injury to two or more body regions, was observed in 13.9% (n=5) of patients. The majority of patients (63.9%, n=23) were managed operatively, while 36.1% (n=13) were treated conservatively. The mean duration of hospital stay was 8.4 ± 5.2 days (range: 2–28 days).

Table 3: Mechanism of Injury and Associated Injuries (n=36)

The present study provides valuable insights into the pattern and distribution of orthopaedic trauma in a tertiary care hospital in Perambalur, Tamil Nadu. The demographic profile of our study population reveals a striking male predominance (75%), with a male-to-female ratio of 3:1, which is consistent with findings from other Indian studies. A large retrospective study from rural North India involving 2,340 patients reported that 75.21% of orthopaedic trauma patients were male [4]. Similarly, a study from a tertiary care centre in North India found that 81.97% of patients with acetabular fractures were male [10]. This male predominance can be attributed to greater outdoor mobility, higher rates of vehicular driving, and engagement in high-risk occupational and recreational activities among males. The relatively lower proportion of female patients in our study may also reflect cultural factors affecting healthcare-seeking behaviour, although this warrants further investigation.

The most commonly affected age group in our study was 21–40 years (44.4%), which aligns with the findings of several Indian studies that have consistently reported a peak incidence of orthopaedic trauma in young adults during their most economically productive years. A study from a tertiary care centre in India reported that 43.83% of fractures occurred in the 18–50 years age group, with a mean age of 36.04 ± 14.23 years for acetabular fractures [10]. Another study from rural North India reported that the most common age group was 20–29 years (20.51%), followed by 30–39 years (17.91%) [4]. This demographic pattern has significant socioeconomic implications, as trauma in young adults results in substantial loss of productivity, long-term disability, and increased healthcare costs. The economic burden of orthopaedic trauma in India is estimated to be substantial, with direct medical costs and indirect costs related to lost productivity placing a significant strain on families and the healthcare system.

Road traffic accidents emerged as the leading cause of orthopaedic trauma in our study (52.8%), followed by falls (30.6%). This finding is consistent with the existing literature from India. A study from rural North India reported that RTAs were the leading mechanism of injury, accounting for 53.08% of cases [4]. An audit of orthopaedic admissions at a tertiary care hospital in India also identified road traffic accidents as the most common cause of trauma-related admissions [14]. The predominance of RTAs in our study reflects the increasing vehicular traffic on national highways and inadequate road safety infrastructure in the region. The National Highway (No. 45) passing through Perambalur has been associated with high rates of road traffic accidents, and our hospital's location on this highway likely contributes to the high proportion of RTA-related trauma. Government data indicate that road traffic fatalities in India rose to 177,175 in 2024, a 2.5% increase from 172,890 in 2023, underscoring the urgent need for enhanced road safety measures [15].

The anatomical distribution of fractures in our study revealed that lower limb fractures (58.3%) were more common than upper limb fractures (36.1%), with the femur being the most commonly fractured bone (22.2%), followed by the tibia (19.4%). This pattern is consistent with findings from other Indian studies. A study from North India reported that the most common fracture in the lower extremities was both-bone leg fracture (7.8%), followed by metatarsal fractures [16]. A study on long bone injuries found that the tibia was the most common long bone injured in young and middle-aged patients, whereas the femur was the most common in the elderly [17]. The predominance of lower limb fractures, particularly femoral and tibial fractures, can be attributed to the high energy involved in RTAs and the vulnerability of the lower limbs in vehicular collisions. Femoral fractures, in particular, are associated with significant morbidity and require prolonged hospitalisation and rehabilitation, imposing a substantial burden on healthcare resources.

The finding that 86.1% of fractures were closed and 13.9% were open is comparable to other Indian studies. A study from rural North India reported that open fractures accounted for 19.02% of cases, while closed fractures accounted for 74.23% [4]. The relatively lower proportion of open fractures in our study may reflect differences in injury severity and trauma mechanisms. Associated injuries were present in 22.2% of our patients, with head injury being the most common (11.1%). This finding underscores the importance of a multidisciplinary approach to trauma care, with close collaboration between orthopaedic surgeons, neurosurgeons, and general surgeons. The presence of associated injuries significantly influences patient outcomes and treatment priorities, and our findings highlight the need for comprehensive trauma care protocols. The mean hospital stay in our study was 8.4 ± 5.2 days, which is comparable to other Indian studies and reflects the complexity of orthopaedic trauma management and the need for adequate rehabilitation before discharge.

Limitations of the Study

This study has several limitations that should be acknowledged. First, the sample size of 36 patients is relatively small, which limits the generalisability of the findings to the broader population. A larger sample size would have provided more robust statistical power and allowed for more detailed subgroup analyses. Second, being a single-centre study conducted at a tertiary care hospital, the findings may not be representative of the pattern of orthopaedic trauma in primary or secondary care settings. The patient population presenting to a tertiary care hospital may be skewed towards more severe injuries, potentially introducing selection bias. Third, the study period of ten months may not capture seasonal variations in trauma patterns, as certain injuries may be more common during specific seasons. Fourth, data on long-term functional outcomes and complications were not collected, which would have provided a more comprehensive understanding of the impact of orthopaedic trauma. Finally, the study did not include patients who were treated on an outpatient basis or those who died before reaching the hospital, which may have resulted in an underestimation of the true burden of orthopaedic trauma. Despite these limitations, this study provides valuable local epidemiological data that can inform clinical practice and guide future research.

Acknowledgement

The authors would like to express their sincere gratitude to the Department of Orthopaedics at Dhanalakshmi Srinivasan Institute of Medical Sciences and Hospital for providing the necessary infrastructure and support for this study. We are deeply grateful to all the study participants for their cooperation and willingness to be part of this research. Our heartfelt thanks go to the nursing staff, radiology technicians, and medical record department personnel for their assistance in data collection and patient care. We also acknowledge the institutional ethics committee for their guidance throughout the study period. Finally, we thank our colleagues and mentors for their valuable suggestions and encouragement during the conduct of this study.

This prospective observational study provides a comprehensive overview of the pattern and distribution of orthopaedic trauma in patients presenting to a tertiary care hospital in Perambalur, Tamil Nadu. The study demonstrates that orthopaedic trauma predominantly affects young adult males, with road traffic accidents being the leading mechanism of injury, followed by falls. Lower limb fractures, particularly femoral and tibial fractures, are the most common skeletal injuries encountered, with closed fractures being far more frequent than open fractures. Associated injuries are present in a significant proportion of patients, underscoring the need for a multidisciplinary approach to trauma care. The findings of this study are consistent with the broader Indian literature on orthopaedic trauma epidemiology, reinforcing the observation that RTAs and falls are the primary drivers of musculoskeletal trauma in the Indian context.

The results of this study have important implications for clinical practice, healthcare planning, and injury prevention. The high proportion of RTA-related trauma highlights the urgent need for strengthened road safety measures, including enforcement of helmet and seatbelt laws, improvement of road infrastructure, and public awareness campaigns about safe driving practices. The significant burden of falls, particularly in the elderly, calls for targeted fall prevention programmes that address modifiable risk factors such as home hazards, visual impairment, and balance disorders. Healthcare institutions should consider developing dedicated trauma care protocols and ensuring the availability of adequate orthopaedic surgical resources to manage the complex fracture patterns encountered in trauma patients. Furthermore, the establishment of a regional trauma registry would enable continuous monitoring of injury patterns and facilitate evidence-based resource allocation. Future research should focus on larger, multicentre studies with longer follow-up periods to assess functional outcomes and the economic impact of orthopaedic trauma, as well as interventional studies to evaluate the effectiveness of prevention strategies in the Indian context.

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