The pattern of fractures in road traffic crashes; findings from the National Trauma Registry in Iran

Abstract Purpose: Fractures constitute a significant concern in low- and middle-income countries, primarily due to road traffic crashes (RTCs), a leading cause of such injuries. This study aimed to analyze fracture patterns resulting from RTCs in Iran. Methods: A registry-based study was conducted using data from the National Trauma Registry of Iran (NTRI) spanning 2016 to 2023. The study included 10,114 trauma patients involved in RTCs, encompassing car and motorcycle crashes with at least one fracture. International Classification of Diseases (ICD-10) codes were used for data analysis, considering both orthopedic and non-orthopedic admissions related to RTCs. Fracture incidence was compared among pedestrians, drivers/riders, and passengers/pillions. Results: Males constituted a significant majority in cars (90.1% drivers, 72.1% pedestrians, 47.0% passengers) and motorcycle crashes (99.6% riders, 77.0% pedestrians, 65.3% pillions) (p < 0.001). Drivers showed the highest frequency of head injuries (26.9%) (p <0.01), while pedestrians had the highest frequency of upper extremity injuries (73.1%) (p<0.001). Drivers also demonstrated a higher frequency of vertebral fractures compared to passengers (C3-C7: 3.2% vs. 1.4%, p < 0.05). Riders (33.5%) displayed a higher frequency of head and face fractures compared to pillions (24.8%) and pedestrians (17.4%) (p < 0.05). Pedestrians (3.7%) demonstrated a higher frequency of peritrochanteric fractures compared to passengers/pillions (1.9%) and drivers/riders (1.7%) (p < 0.01). Fractures of the tibia were significantly more frequent in pedestrians (20.9%) compared to drivers/riders (22.5%) and passengers/pillions (15.4%) (p < 0.01). Conclusion: The study provided valuable information on the fracture patterns associated with RTCs among road user groups.