create the summary of the findings "Material and methods
In this retrospective descriptive-analytic study,
the data of patients (n = 207) with traumatic
spine injures admitted to Emergency Department
of Shahid Mohammadi hospital of Hormozgan
University of Medical Sciences during 2017 year
was collected. The administrative dataset of
Shahid Mohammadi hospital was used in the
current study. Medical records of patients with
spinal trauma were obtained from the Medical
Records Department of the hospital. This hospital
is a referral teaching hospital in Bandar Abbas
city. Bandar Abbas is a city placed in the southern
part of Iran with a population of about 686000
and hence is a crowded city in Iran. This hospital
adopts patients with trauma. A check list was
prepared including age, gender, education,
marital and mechanism of injury. Types of
injuries, ASIA Impairment Scale (AIS) and the
relation between variables were also
investigated. All the patients with traumatic spine
injures registered in Emergency Department of
Shahid Mohammadi Hospital of Hormozgan
University of Medical Sciences that had radiologic
images were sampled. Exclusion criteria included
the death for other reason exception of traumatic
spine injures, faults in documents and lack of
radiologic images.
The data were analyzed by SPSS 22.0 software.
P<0.05 was considered significant. Spearman
correlation was used for investigation the
relation between variables.
Result and discussions
In the current study, 229 patients were studied,
but 22 patients were excluded from the study and
this study was conducted by 207 patients. Mean
of age for subjects was 40.2. The patients were
divided into 3 groups: 18 subjects <18years
(8.6%), 159 patients 18-60 years (76.80%) and
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37 | P a g e
30 patients >60 years (14.4). In the current study,
148 patients (71.50%) were men and 59 patients
(28.50%) were women. 147 patients (71%) were
married and 60 patients (29%) single.
The most trauma was associated with road
accidents (n=124, 59.9%) and 83 cases (40.10%)
were related to falling from height. The data
showed that 10 patients (4.80%) had died due to
trauma and 197 patients (95.20%) survived. In
sum, 319 cases vertebrate fractures were
observed. Compress fracture (n=88, 42.50%),
burst fracture (n=64, 32.40%), fracture
dislocation (n=57, 27.50%) and transverse
process fracture (n=43, 23.80%) accounted for
the whole cases. The most fracture was
associated with L1 vertebrate (n=53, 15.9%), T12
(n=43, 13.40%), L2 (n=36, 11.20%) and C5
(n=16, 5%).
The results for fracture in main parts showed
that highest fractures were observed in cervical
(n=69, 21.63%), thoracic (n=98, 30.72%) and
lumbosacral (n=152, 47.64%) (Figure 1).
C e rv ic a l T h o ra c ic L u m b o s a c ra l 0
2 0
4 0
6 0 %
F r a c tu r e in m a in p a r ts
n=69
n=98
n=152
Figure 1: Types of fracture in main parts
The most fracture with vertebrate fracture was
associated to pelvic fracture (n=32, 42.10%) and
Tibia (n=14, 18.40%) and lowest was associated
with pnemothorax (n=3, 3.9%) (Figure 2).
H a e m o th o ra x P n e m o th o ra x P e lv ic F x H u m e ru s F x T ib ia F x F e m o r F x
0
1 0
2 0
3 0
4 0
5 0 %
Figure 2: Fracture with vertebrate fracture
The results also showed that 178 patients (86%)
did not have neural defect and 7 (3.38%), 7
(3.38%), 9 (4.34%) and 6 (2.89%) cases had
grades of B, C, D and E, respectively. The results
showed that only 1 case had B grade in women
and the rest was associated with men. It means
there is a close relation between males and
neural injuries in trauma (P<0.05) (Table 1).
Table 1: The relation between AIS score and sex
Non B C D E Total
Men 120 6 7 9 6 148
Women 58 1 0 0 0 59
Total 178 7 7 9 6 207
The results for the relation between trauma
mechanism and sex was not significant. 88 men
(42.51%) and 36 women (17.39%) had road
accidents and 60 men (28.98%) and 23 women
(11.11%) were injured from falling (Figure 3).
M e n
W o m e n
0
1 0
2 0
3 0
4 0
5 0
%
A c c id e n t F a llin g
Figure 3: The investigation of relation between
trauma mechanism and sex
The results also showed some patients with
fracture dislocation had burst fracture. However,
66% of the patients had 66% burst fracture and
88% fracture dislocation. The results showed a
significant relation between fractures and neural
defect (P<0.05). A significant relation was
observed between AIS with Odontoid and
Jefferson fractures.
The results in Table 2 showed a significant
relation between radiologic findings. Three
patients with Transverse process fx had Fracture
dislocation (P<0.05). This was not found between
other parameters. The results also showed that
most fractures were observed in throacolumbar
junction.
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38 | P a g e
Table 2: The relation between radiologic findings
Burst Fx Compress Fx
Dislocation
Lamina Fx Spinous Fx
Transverse
Yes No Yes No Yes No Yes No Yes No Yes No
Burst Fx Yes - - 14 53 17 50 3 64 6 61 10 57
No - - 74 66 40 100 5 135 3 137 33 107
Compress Fx Yes - - - - 8 80 2 86 0 88 7 81
No - - - - 49 70 6 113 9 110 36 83
Dislocation Yes - - - - - - 4 53 1 56 3 54
No - - - - - - 4 146 8 142 40 110
Lamina Fx Yes - - - - - - - - 0 8 1 7
No - - - - - - - - 9 190 42 157
Spinous Fx Yes - - - - - - - - - - 3 6
No - - - - - - - - - - 40 158
The results showed that mean age for subjects
was 40.2 years and most patients were 18-60
years. Similarly, other studies in Iran reported a
mean age of 34.7 years [20] and 21-40 years [19].
Different values were reported in different
countries. The mean age for spinal cord injury in
developed countries was in a range of 14.6 [13]
to 67.6 years [14]. It was reported a range of 29.5
[15] to 46.0 years [16] in non-developed
countries. It was reported that the age of spinal
cord injury patients trends to be bimodal
distribution in ranges of 15-29 and over 65 years
[21].
In the current study, 148 patients (71.50%) and
59 patients (28.50%) were men and women,
respectively. Fakharian et al. (2019) [20] also
reported that most patients were men in Iran. It
was also reported that the incidence of traumatic
spine fracture was higher in males compared
with females in Iran [22]. It was reported a
male:female ratio from 1.10:1 [10] to 6.69:1 [8] in
developed countries, but it was in a range of
1.00:1 [11] to 7.59:1 [12]. In sum, the number of
male spinal cord injury patients is more than the
number of female patients that could be
attributed to the fact that males are the main
undertaker of family and social work. It is a fact
that most men are involved in dangerous
activities. It was reported that laborers, farmers
and the unemployed were three spinal cord
injury groups with high risk [23].
The most trauma was associated with road
accident (n=124, 59.9%) and 83 cases (40.10%)
were related to falling from height. Fakharian et
al. (2019) [20] reported that traffic accident is as
the most common source of the trauma (35.2%)
followed by the falls (26.95%) motorcycle
accident (17.9%). Falls and motor vehicle
accidents are most common reasons for spinal
injury. Other studies in Iran showed that the most
common reason for spinal injuries were motor
vehicle accidents (52%) and falls (43%) [24].
The data showed that 10 patients (4.80%) were
dead due to trauma. Fakharian et al. (2019) [20]
reported 2% death for trauma injuries that is
attributed to 1.5% and 0.5% for accidents and
falling. Similarly, Heidari et al. (2010) [19]
reported 4% death for patients with spinal
fractures 96%. It was reported that mortalities
are 3.1% to 22.2% in developed countries and
1.4% to 20% in non-developed countries [1]. The
findings showed that mortality is very low in
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39 | P a g e
Bandar Abbas that are parallel to findings
reported for non-developed countries.
Compress fracture, burst fracture, fracture
dislocation and transverse process fracture were
common reasons for fractures [Figures 1 and 2].
Tabesh and Rabiei (2019) [25] reported that the
most common type of fracture was compression
and burst fractures in Iran. Other studies also
reported similar results [19, 26, 27].
The most fractures were observed in cervical,
thoracic and lumbosacral, respectively [Figure 1].
Similar to our findings, Fakharian et al. (2019)
[20] reported that most common area of
traumatic injury was thoracolumbar spine
fracture (46.9%). Yousefzadeh et al. (2015) [24]
reported thoracolumbar spine was common area
for fracture. Haidari et al. (2010) showed that
cervical spine fractures were significantly
frequent in lumbar fractures.
The most fracture with vertebrate fracture was
associated with pelvic fracture (n=32, 42.10%)
and Tibia (n=14, 18.40%) and lowest was found
with pnemothorax. Clayton et al. (2012) [28] in
the United States showed that the pelvic fracture
and head injury may have a greater effect than
the multiplicative interaction that is a high risk
for cervical spine injury. It was also reported that
traumatic injuries cause injuries, including head
injuries, ribs fractures, limb or pelvic fractures
and injuries of the rest of body [1].
The relation between trauma mechanism and sex
was found insignificant. It means that men and
women could equally be threatened. The results
showed a significant relation between fractures
and neural defect. Neural defects can be created
due to the effects of fractures on bone and
injuried neural system. The most fractures were
observed in throacolumbar junction that must be
considered.
Conclusion
This study was conducted to investigate the
epidemiology and radiologic findings of patients
with traumatic spine injures in Iran. Our results
showed that the most common causes of spinal
injury in Bandar Abbas are accidents that must be
reduced by observing traffic rules and
guarantying transport safety. It could be advised
a National Registry for spinal cord injuries be
established by the national Ministry of Health, so
that the etiological pattern of spinal cord injuries
in the world can be identified. "