Epidemiology of orthopedic injuries among inpatients admitted at a tertiary teaching and referral hospital in Kenya: a retrospective cross-sectional study

Abstract

Background

Orthopedic injuries are serious and continue to be a concern for healthcare systems worldwide. Approximately 90% of the estimated traumatic injuries occur in low- and middle-income countries. In Kenya, there is a dearth of information on orthopedic injury patterns that could be used to prioritize injury prevention measures and to help hospital management teams allocate resources appropriately. The purpose of this study was to determine the epidemiology of orthopedic injuries admitted to Kenyatta National Hospital.

Methods

This was a retrospective cross-sectional study. Overall, 720 charts were reviewed. Data were analyzed using frequency distribution, pearson chi-square test and logistic regression.

Results

Overall, 85% were aged 15–64 years. Approximately 80% were male, married or single. Patients with primary or secondary education composed 72%. Road traffic accidents (59.4%) and falls (24.7%) were the most common mechanisms of injury. A total of 99.9% of the inpatients were Kenyans. Open injuries were 40.1%. Lower limb (67.4%) and upper limb (26.9%) injuries were the most common. Inpatients aged 15–24 years were 74% less likely to have upper limb injuries than those aged 0–14 years (p = 0.023). However, those aged 15–24 years were 19.250 times more likely to have spine injuries than those aged 0–14 years (p = 0.008). Males were 68.6% and 51.2% less likely to have pelvic injury and comorbidities, respectively, than females (p < 0.001). Patients with secondary and tertiary education were 2.016 (p = 0.003) and 2.3 (p < 0.001) times more likely to have upper limb injuries, respectively, than those with no or preschool education. Similarly, those with tertiary education were 2.079 times more likely to have comorbidities than those with no or preschool education (p = 0.017).

Conclusion

Most of the inpatients with orthopedic injuries were young, male involved in Road traffic accidents and therefore Kenya National Transport and Safety Authority needs to enforce road safety measures to reduce road carnage. Those with higher education and children were more likely to have upper limb injuries. Females were more likely to have pelvic injuries and co-morbidities. Lower and upper limb injuries were the most common injuries and this should guide resource allocation in management of orthopedic injuries.

Background

Trauma is a major cause of morbidity and mortality worldwide with the majority being orthopedic injuries [1, 2]. Orthopedic injuries are serious and growing concerns for healthcare systems worldwide [3]. Globally, Road Traffic Accident (RTA) is thought to be the only cause of 1.2 million deaths and 50 million injuries annually [4]. According to the World Health Organization (WHO), injuries account for 5 million deaths per year, representing 9% of all global deaths and a threat to health globally [5,6,7]. It is estimated that Injuries kill over 5 million people annually worldwide with more than 90% of traumatic injuries and deaths occurring in low- and middle-income countries [7, 8], and this represents an important global public health problem both now and in the coming years [6, 9]. Violence and Injuries are responsible for significant number of hospital visits, hospital admissions and disabilities. Injuries are responsible for 6% of all years lived with disability [5].

In developed countries, the burden of injuries has shown a downward trend, while the developing countries, especially within sub-Saharan Africa have shown an upward trend [10]. In developing countries, surges in industrialization and motorization are usually accompanied by increasing numbers of injuries due to road traffic accidents [11].

In Kenya, trauma is one of the top ten [5] leading causes of death [12]. Kenya, as a low-middle income country, is industrializing and modernizing, which has resulted in a considerable increase in vehicles and hence in road traffic accidents. In Kenya, a retrospective review of death certificates from the Department of Civil Registration on fatal injuries in Nairobi in 2014 revealed that injuries are an important cause of fatality in Nairobi, accounting for one in ten [5] deaths with majority of the injuries occurring in age group 25–44 years, accounting for nearly half of all the injuries. About 85% of the injury fatalities were males [13]. A couple of studies have been done in Kenya health tertiary facilities casualty departments and population-based studies that showed majority of injury fatalities were young males [14,15,16].

Trauma caused by other factors, such as accidents at work or at home, falls, and assaults, greatly contributes to overall mortality and morbidity. An increase in morbidity and fatality in developing nations is attributed to several factors, including rapid motorization, inadequate traffic, unsafe and poor road infrastructure, and poor road user behaviors [17].

Kenyatta National Hospital (KNH) was established as a National Referral and Teaching Hospital to provide training and medical research. KNH was established in 1901, became a State Corporation in 1987 and sits at the peak of the health referral system in Kenya [18]. According to the KNH Board order of 1987 contained in Legal Notice No. 109, the functions of KNH were spelled out as (a) to receive patients on referral for specialized health care; (b) to provide facilities for medical education for the University of Nairobi and other health allied courses; and (c) to contribute to national health planning [18]. This understanding has been reinforced by the Kenya Health Sector Referral Implementation Guidelines, 2014, and the Constitution of Kenya 2010, which tasks the KNH with the responsibility for health policy formulation [19, 20].

Most of the studies in literature focused on injuries as seen in the casualty or in the community and not inpatient admissions. In addition, these were not specifically looking at orthopedic injuries but rather injuries from all body regions. No studies have been done to determine the epidemiology of orthopedic injury admissions in health facilities in Kenya and this is important not only in resource prioritization but also in injury preventions measures.

Prevention of violence and injuries is possible when the burden and risk factors are well known and understood in a country. Unfortunately, orthopedic injury inpatient data remains limited in Sub-Saharan Africa and with Kenya being no exception [21].

There are no studies done on epidemiology of orthopedic injuries admitted in health facilities in Kenya. Knowing the circumstances under which these injuries occur affords policy makers the information to prioritize injury prevention measures. It also affords the healthcare managers vital information in allocation of scarce resources appropriately for care of orthopedic injuries, and at a university teaching facility, this understanding is critical in planning quality training. Therefore, the aim of this study was to determine the epidemiology of inpatient orthopedic injuries in KNH.

Methods

Aim of the study

The aim of this study was to determine the epidemiology of inpatient orthopedic injuries admitted in KNH, a tertiary teaching and referral health facility in Kenya.

Research question

What is the epidemiology of inpatient orthopedic injuries admission at KNH?

Study design

This was a retrospective cross-sectional study. This study was done in KNH, Kenya.

Study setting

The KNH is the largest teaching and referral hospital in East and Central Africa. KNH Orthopedic Wards were used as the study area. The KNH is based in Upperhill, Nairobi - the capital city of Kenya. It is located approximately 5 km from the city center. KNH has a bed capacity of 1,800, over 6,000 staff members, 50 wards, 22 outpatient clinics, 24 theaters and an accident and emergency department [18]. Of the 1800 bed capacity, 96 beds are allocated to orthopedic wards. KNH is a 10-floor storied building complex, and the orthopedic wards are located on the 6th floor; however, orthopedic admissions to private wings occurred on the 9th and 10th floors as well. Orthopedic patients with other comorbidities were also admitted to other wards in the KNH.

Study period

The study period ranged from 1st February 2021 to 31st December 2021.

Study population

Inpatients Orthopedic injuries at the KNH which was 2,546.

Eligibility criteria

All orthopedic trauma admissions at KNH.

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Sample size calculation

This study was nested within the main study [22]. A sample of 720 inpatients with orthopedic injuries was enrolled during the study period.

Recruitment and sampling procedures

Three [3] research assistants (RAs) were recruited to collect and extract patient data from patient charts. The RAs were health care workers with a diploma in Orthopedic Trauma and with some experience in research data collection. The Principal Investigator (PI) was the research coordinator. Orthopedic injury admissions were identified from the (a) admission desk of the Health Information System at the KNH Accident and Emergency Unit (A&E), (b) KNH Orthopedic Outpatient Clinic Records (OC), and (c) KNH Corporate Outpatient Care (COC). The data were subsequently entered in a logbook. This logbook served as a master register for all patients admitted and therefore the sampling frame for the study. The proportional population-to-size (PPS) was subsequently used to determine the number of patients sampled per month from each of these three [3] service points (Table 1).

Table 1 Orthopedic injury patients admitted to KNH stratified by point of admission, 2021

The RAs were trained for two [2] days by the PI on the research protocol, data collection tools, and data collection procedures; pilot testing of the data collection tools was also performed before the actual data abstraction.

Variables

The variables extracted were admission month, age, sex, marital status, religion,

Occupation, education level (primary, secondary or tertiary), mechanism of injury, typeof health facility (government or private), Referring health facility tier (primary, secondary or tertiary tier), nature of admission (facility referrals, walk-ins), alcohol intake status, smoking status, type of Orthopedic injury and comorbidity status.

Data collection procedures

The data were collected through a data abstraction form from the patient charts. This process was carried out from 1st January 2022 to 31st March 2022.

Data abstraction form – The three [3] RAs used pilot tested data abstraction form. The PI reviewed daily all the completed abstraction forms for completeness and accuracy and provided regular feedback to the RAs in a timely manner to ensure data quality and compliance with the study protocol. All the completed and verified data abstraction forms were then collected and filed by the PI at the end of every week in a locked cabinet.

Data management, analysis

The data abstraction tool was designed to collect both quantitative and qualitative data. For anonymity and confidentiality purposes, the data abstraction tools were marked only with the participant study numbers, and no names were used. The data were entered into a password-protected Redcap database (version 7.2.2; Vanderbilt, Nashville, TN, USA) maintained by the KNH Medical Research Department. The data were analyzed using SPSS version 27.0 (version 25.0; IBM, Ltd., North Carolina, USA). Descriptive statistics such as frequencies were calculated, while inferential statistics namely Pearson’s chi-square test and logistic regression were used. The calculations were performed at the 95% confidence level.

Results

Socio-demographic profile of the sample population

Overall, 720 charts were extracted from orthopedic inpatients.

Among the sampled population, 85% were aged 15–64 years, with children and elderly individuals older than 65 years comprising minority inpatient orthopedic injuries. Approximately 80% of the total inpatients were males, married or single. Casual laborers represented approximately 50%. Patients with primary or secondary education comprised 72% (Table 2).

A total of 59% of the inpatients were admitted through health facility referrals, while 41% were self-referrals. Government health facilities comprised 62.6% of the facility referrals, while private health facilities comprised 37.4%. Secondary health care facilities, which represent sub-county and county referral hospitals and a few high-volume private health facilities, referred 87.1% of all orthopedic injury inpatients in KNH (Table 2).

Road traffic accidents comprised 59.4% while falls comprised 24.7% of inpatients orthopedic admissions (Table 2).

Almost all the inpatients were Kenyan (99.9%), with more than 85% of the inpatients coming from Nairobi County and its environs. Nairobi County comprised 62.5% of the inpatient orthopedic injuries (Table 2).

The majority of the inpatients orthopedic injuries admissions was active smokers (74.2%) and consumed alcohol (54.4%) prior to admission at KNH (Table 2).

Table 2 Socio-demographic profile of the sample population in KNH, 2021

Patterns of Orthopedic injuries

Of inpatients orthopedic injuries, 59.9% had closed injuries while 40.1% had open injuries. Among open orthopedic injuries, the majority of the admissions had Gustilo II and IIIc were the most and least common, respectively (Table 3).

Table 3 Classification of orthopedic injuries among inpatients at KNH 2021

The majority of the inpatient orthopedic injuries were lower limb injuries (67.4%), of which femur and tibia-fibula injuries being the most common. The second commonest region was upper limb injuries (26.9%), of which hand, radius-ulnar and humerus injuries were the most common. Pelvic, acetabular and spine injuries were the least common injuries. Among the inpatients, 21.0% and 12.8% were polytrauma and with comorbidities, respectively (Table 4).

Table 4 Frequency distribution of orthopedic injuries among inpatients admitted to KNH 2021

Polytrauma patients were 2.175 times more likely to be assaulted patients than were those due to road traffic accidents (p = 0.001). Similarly, polytrauma patients were 3.401 times more likely to have sustained injured at work or self-inflicted injuries than those who sustained road traffic accidents (p = 0.003) (Table 5).

Table 5 Association between polytrauma incidence, mechanism of injury and health facility tier among inpatients admitted to KNH 2021

Upper limb injuries were 74% less likely to occur among patients aged 15–24 years than were those aged 0–14 years (p = 0.023). However, spine injuries were 19.250 times more likely to occur among patients aged 15–24 years than were those aged 0–14 years (p = 0.008). Spine injuries were twice as likely to occur in patients aged 25–64 years and patients older than 65 years, but these differences were not statistically significant (Table 6). Patients with comorbidities were more likely to be in the older age group than in the 0–14 year age group (p < 0.001) (Table 6).

Compared with females, pelvic injuries and comorbidities were 68.6% and 51.2% less likely to occur in males, respectively (p < 0.001) (Table 6).

Compared to businessmen/women, lower limb injuries and comorbidities were 46.8% (p = 0.04) and 54.2% (p = 0.033) less likely to occur among casuals, respectively. In addition, compared with businessmen/women, upper limb injuries were 2.216 times more likely to occur among employed inpatients (p < 0.001) (Table 6).

Inpatients with polytrauma were 2.386 more likely to have primary education compared to those with no education or a preschool education (p = 0.035). Patients with upper limb injuries were 2.016 times more likely to have secondary education than were those with no education or a preschool education (p = 0.003). In addition, patients with lower limb injuries were 39.3% less likely to have secondary education than those with no education or a preschool education (p = 0.033). Patients with upper limb injuries were 2.3 times more likely to have tertiary education than were those with no or a preschool education (p < 0.001). Similarly, those with comorbidities were 2.079 times more likely to have tertiary education than those with no or a preschool education (p = 0.017) (Table 6).

Compared to self-referrals, inpatients with upper limb injuries were 1.582 (p = 0.030) and 1.919 (p = 0.003) times more likely to have been admitted through government health or private health facilities referrals, respectively. In addition, patients with pelvic and spine injuries were 65.7% and 71.7% less likely to be admitted through private health facility referrals, respectively (Table 6).

Compared to self-referrals, spine injuries were 2.676 times more likely to be health facility referrals (p = 0.002) (Table 6).

Table 6 Association between orthopedic injuries, omorbidities and demographic characteristics, referring health facilities and nature of admissions in KNH, 2021

Discussion

The study findings showed that the majority of admissions were young segment of the population. This parallels studies done in Nigeria, Botswana, South Africa, India, Taiwan, Brazil, the USA, Iran and England that showed the majority of orthopedic injuries were young adults [16, 23,24,25,26,27,28,29,30,31,32,33,34,35]. The study also showed that the majority were males. These findings agrees with those of studies performed in Tanzania, Uganda, Botswana, South Africa, Brazil, Nigeria, India, the USA, England and Iran, which showed that the majority of orthopedic injuries disproportionately affected men [16, 23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Therefore, orthopedic injuries predominantly affect young men who are engaged in productive economic activity that involves frequent travels and risky ventures that are injury prone.

The majority of patients who sustained orthopedic injuries were either married or single. This finding compares with those studies performed on orthopedic trauma admissions among middle-aged and geriatric patients in the USA and Sweden, which revealed that married and single patients composed the majority of admissions due to orthopedic injuries [16, 38, 39]. Whereas the demographic profiles of the individuals in the current study were different from the USA and Sweden, they all showed that orthopedic injuries disproportionately affected married or single patients. This may be because they are either adult engaged in productive economic activities or elderly individuals who are more prone to fragility fractures.

Casual workers accounted for the majority of inpatients. This finding aligns with performed in Kenya, Rwanda, Tanzania and Taiwan that showed orthopedic injuries commonly affect unskilled laborers, farmers and those in low socioeconomic status [13, 14, 28, 40,41,42]. Casual workers are less educated, less likely to afford or adhere to safety measures and more likely to engage in risky economic activities that are injury prone.

The current study also depicted primary or secondary education as the most common level of education for inpatients with orthopedic injuries. This finding was similar to those studies performed in Kenya, Delhi, India and Ethiopia, which showed primary and high school education levels were common among inpatients with orthopedic injuries in tertiary hospitals [14, 23, 43].

The majority of inpatients were health facility referrals, which is in keeping with the fact that the KNH is a national referral health facility. The majority of health facility referrals were from government health facilities across the country, and most of these government facilities were secondary health care facilities representing sub-county hospitals and county referral hospitals. This finding is comparable with that of a study performed in a tertiary health facility in Rwanda, which showed that the majority of orthopedic injury admissions were referrals from government health facilities [40]. This could be because orthopedic injuries are perceived to be serious injuries and predominantly affect those of low socioeconomic status who are likely to visit government hospitals as their first point of contact; these patients are likely referred to the KNH if the facilities have no capacity to manage the injuries and given the fact that KNH is a government facility and perceived as affordable by patients and health care workers.

The most common mechanism of injury was road traffic accidents followed by falls. These findings are consistent with those studies performed in Kenya, Tanzania, Rwanda, Uganda, Botswana, India, the USA and Iran, which showed that road traffic accidents and falls are the most common mechanisms of injury in orthopedic injuries [14, 16, 25, 27, 30, 35,36,37, 40]. This finding is also comparable with that of a multicenter observational study performed on the distribution of orthopedic fractures in low- and middle-income countries, which revealed that falls were the main mechanism of injury for those 60 years and older [44]. Elderly patients are more prone to fragility fractures, and children are more prone to falls, while young people are prone to road traffic accidents and falls from a height.

Almost all admissions were Kenyans, with more than four-fifths coming from Nairobi County and its environs. This finding is similar to studies performed in South Africa, Tanzania, Malawi and Iran, which revealed the majority of patients admitted to tertiary hospitals were from regions co-located with the hospital [35, 41, 45,46,47]. This may be because of the proximity of the hospitals to patients’ site of accident and because patients, relatives and friends prefer their loved ones to be admitted closer home where they can easily visit their sick.

Most of the inpatients with orthopedic injuries were active smokers and consumed alcohol. This finding compares favorably with studies performed in the USA that revealed a consistently high prevalence of drug and alcohol use among orthopedic trauma patients [48,49,50]. Individuals intoxicated are more likely to misjudge situations and therefore injury prone.

Approximately three-fifths of the orthopedic inpatients had closed injuries. This finding compares with those of studies performed at Moshi, Tanzania and a teaching hospital in Bharatpur in Nepal and Iran, which showed that more than two-thirds of orthopedic injuries were closed injuries [35, 42, 51].

Among the open injuries, Gustilo and Anderson class II and class IIIc were the most and least common respectively. However, this finding was subject to sampling bias due to a significant number of open fractures were not classified due to missing information. The importance of documentation of clinical findings needs to be emphasized for decision making and subsequent patient follow-up, not least for research purposes.

The most common orthopedic injuries were lower limb injuries followed by upper limb injuries. Femur injuries were the most common among lower limb injuries, and hand injuries were the most common among upper limb injuries. These findings are consistent with those of studies performed in Kenya, Uganda, Tanzania, Ethiopia, Botswana, India, Nepal and Saudi Arabia, which showed that the most common injuries were lower limb injuries followed by upper limb injuries, with femur injury being the most common injury [14, 16, 23,24,25, 30, 42, 52,53,54,55,56,57].

Approximately one-fifth of the inpatient admissions were polytrauma, and approximately one-tenth had comorbidities. This finding differed from that of a study on the national burden of orthopedic injury in the USA inpatients, in which 47.5% had comorbidities and 34.1% had polytrauma [58]. This may be because the demographic profiles of Kenya and the USA are different. Kenya, which is a developing country, has a younger population, while the USA, which is a developed country, has a greater older/aging population with a greater risk of comorbidities and fragility fractures. However, this also compares favorably with a study done in a private tertiary health facility in Kenya that showed about 83% of injuries were in one body region (not polytrauma) [16].

Patients who were assaulted or had workplace or self-inflected injuries were more likely to be polytrauma patients. This differs from the findings of a study on the national burden of orthopedic injury in USA inpatients which revealed that the proportion of patients with polytrauma was highest for injuries resulting from firearms (43%) and transportation (43%) [58]. This may be because firearm ownership is common in civilian populations in the USA but rare among civilians in Kenya. The incidence of polytrauma is relatively low among road traffic accidents and falls, although these are the most common mechanisms of injury. This finding parallels the findings of studies on the national burden of orthopedic injury in the USA [58].

Children were more likely to have upper limb injuries than adults were. This finding compares with the findings of studies performed in Saudi Arabia and the USA on the pattern of injury in children and adolescents, which revealed that upper limb injuries are the most prevalent [59, 60]. The greater prevalence of upper extremity injuries in these children likely reflects the high frequency of supracondylar humerus fractures due to falls in children.

Young adults aged 15–24 years were more likely to have spine injuries. This finding is comparable with that of a review article on traumatic spinal cord injuries that revealed developing countries tend to have a younger population with spinal cord injuries [61]. However, the findings of the present study contrast with those of a study on the global prevalence and incidence of spinal cord injury, which revealed elderly patients are affected to a greater extent than younger patients are [62, 63]. This may be because the aging population has underlying health comorbidities, such as degenerative spondylosis and osteoporosis that increase susceptibility to spine injuries. In the present study, younger people were more prone to traumatic spine injuries due to their activity levels and because falls and road traffic accidents are the main mechanisms of injury in this younger population [63, 64].

The study demonstrated that comorbidities were more common among young, middle-aged adults and elderly individuals than among children. This finding is in agreement with studies performed in the USA, Australia and Turkey revealing that medical comorbidities increase with increasing age [65,66,67].

Females were more likely to have pelvic injuries and comorbidities. This finding is in agreement with numerous studies that have shown that females tend to have more comorbidities and pelvic injuries than men [66, 68,69,70,71,72,73,74,75]. This could be due to hormonal, genetic and biologic predispositions.

The study depicted that inpatients with a primary education were likely to be polytrauma patients. This finding compares with those of studies performed in Bangladesh, Ethiopia and Iran, which showed that a lower education level was associated with severe and multiple injuries [43, 57, 76]. This may be because patients with lower education levels were less informed about safety measures and were likely to be casuals engaged in risky economic activities.

This study revealed that individuals with a secondary or tertiary education and who were employed were more likely to have upper limb injuries. This finding is in tandem with the findings of studies performed in Sri Lanka and Australia on risk factors for upper limb injuries that showed that high socioeconomic status was associated with a twofold greater risk of having upper limb injury [77, 78]. A high education level and formal employment are invariably associated with higher socioeconomic status. Patients with high socioeconomic status are more often involved in sedentary lifestyles, such as watching videos, computer games, and attending extra classes, among children and adolescents, and these factors have been shown to be risk factors for upper limb injuries.

Those with a tertiary education were more likely to have comorbidities. Casuals who were less educated were less likely to have comorbidities. This finding agrees with studies performed in Australia [56, 75, 79]. This may be because people with higher education levels tend to be older and to have higher socioeconomic status and are therefore more prone to lifestyle diseases.

The study also revealed that patients referred by the government or private health facilities were likely to have upper limb injuries. This agrees with a study performed in the Australia which showed that patients with upper limbs were more likely to require further care after initial treatment [67] and therefore were more likely to be referred to the next level of care. Additionally, a significant proportion of the upper limb injuries were in children with supracondylar humerus fractures [77]; these patients are referred from peripheral health facilities, the majority of whom do not have imaging intensifiers facilities required to fix and stabilize the fracture; hence, patients are referred to the KNH. Most of the patients referred are of low socioeconomic status and therefore are not able to afford treatment at advanced private health facilities; therefore, these patients end up at KNH.

The study revealed that health facility referrals were more likely to be spine injuries. This finding is in tandem with studies performed in northern Tanzania and in rural Rwanda that revealed that more than four-fifths of health facility referrals were from peripheral health facilities [40, 80]. This may be because most of these patients were from rural and poor settlements/backgrounds and have no operative capacity to manage spinal injuries, and they almost always end up being referred to KNH that is deemed well-resourced and affordable.

This study had several limitations. First, there is a possible effect of the COVID-19 pandemic on facility referrals from peripheral health facilities to the KNH. The movement restrictions imposed during the COVID-19 pandemic might have skewed the patterns of facility referrals. This was mitigated by ensuring that the data collection period covered the COVID-19 period, during which inter-county movement restrictions were lifted by the Kenyan government. Second, this was a retrospective cross-sectional study design and hence weak in determining causality. Third, there were missing data from the patient charts likely to result in sampling bias. This was mitigated by increasing the sample size by 10%. Despite these limitations, given the dearth of information on orthopedic injuries in Kenya, these findings could be used not only to help policy makers formulate public health preventive measures but also to help hospital management teams apportion resources appropriately for the care of these orthopedic injuries.

Conclusion

The majority of the inpatient orthopedic injury admissions were young male involved in road traffic accident and therefore the Kenya National Traffic and Safety Authority needs to enforce road safety measures to reduce on road carnage. Road Traffic Accidents and falls are the commonest mechanism of injury. Majority of the admissions were married or single or had primary or secondary education. The most common injuries involved lower and upper limbs and this should guide resource allocations in management of orthopedic injuries. Females were more likely to have pelvic injuries and comorbidities than men. Upper limb injuries were associated with higher education and socioeconomic status; therefore, Ministry of Health and County Governments should increase awareness of modifiable risk factors for upper limb fractures to reduce the incidence and morbidity associated with upper limb injuries. Most of the admissions were mostly from government health facilities and is imperative that the County Health Management Teams to allocate more resources to improve the human and operative capacity for spine and upper limb injuries and reduce referrals to KNH. Kenyatta National Hospital and other tertiary and secondary health care facilities should establish trauma registries to monitor trauma trends and use them in determining resource allocation and prioritization and improve quality of care for better outcomes.