Train-versus-pedestrian injuries. Orthopaedic management.

Between February 1989 and February 1993, a retrospective review at our facility identified 30 patients who were victims of train-versus-pedestrian accidents. Although some patients suffered head, chest, and abdominal injuries, the majority of injuries sustained were musculoskeletal. The Injury Severity Score ranged from 5 to 54, with an average of 21. Of the 30 patients, 23 (77%) had significant orthopaedic injuries, with an average of 1.7 extremities involved. The foot was the most commonly injured body segment, sustaining amputation, crush, or degloving injury in 12 patients (12/23 = 52%). The most common operative procedure was debridement, which was performed largely on patients with traumatic amputation in an effort to preserve length. Nineteen lower extremity and 2 upper extremity amputations were necessary in 14 patients (an amputation rate of 14/23 = 61%). With the exception of toe and heel avulsion, nearly all crush and avulsion injuries required amputation at a segment higher than the level of injury. Although image of an unstable patient with mangled extremities, many patients survive low-velocity collisions and subsequently require vigorous orthopaedic intervention.