title: Forklift-Related Crush Injuries of the Foot and Ankle.
abstract: BACKGROUND
  Forklift-related crush injuries of the foot and ankle are relatively common in cities with shipping and construction industries. There is a paucity of literature on the incidence and sequelae of such injuries. We aimed to describe the incidence, patterns of injuries, sequelae, and morbidity associated with this type of injury.
  
  
  METHODS
  A retrospective review of all patients with forklift-related crush injuries of the foot and ankle for 4 years was conducted. Patients' demographics, mechanisms and patterns of injury, fracture type, compartment syndrome, number of reconstructive operations, operative details, length of hospital stay, medical leave, repeat evaluation in emergency room, and complications were recorded and analyzed.
  
  
  RESULTS
  There were 113 (2.17%) patients with forklift-related crush injuries out of 5209 patients seen in our institution for injuries of the foot and ankle. Crush injury from the wheels of the forklift truck was the most common mechanism at 71 (62.8%) patients. The forefoot was the most commonly injured region, followed by the midfoot, hindfoot, and ankle, with almost one-third (28.3%) of the patients having multiple injuries to the foot. Nine (8%) had open fractures, while 5 (4.4%) had compartment syndromes. Forty (35.4%) patients required hospitalization, and 35 (87.5%) of those hospitalized required operative intervention. Those who had surgery were more likely to have complications compared with those who did not require operative intervention (16 [45.7%] of 35 patients vs 7 [9%] of 78 patients; P < .05) and more likely to require longer medical leave (mean, 183 vs 30 days, P < .05).
  
  
  CONCLUSIONS
  Forklift-related crush injuries of the foot and ankle are increasingly common in industrialized cities. The forefoot is commonly affected with involvement of multiple regions. Up to one-third of affected patients required hospitalization and multiple operative interventions resulting in loss of productivity, income, and significant morbidity. The possibility of residual disabilities must be clearly defined to the patients and their employers to manage potential workplace limitations and long-term expectations.
  
  
  METHODS
  Level IV retrospective case series.
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore choonchiet@gmail.com.
authors.forename: Choon Chiet
authors.initials: CC
authors.lastname: Hong
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore.
authors.forename: Nazrul
authors.initials: N
authors.lastname: Nashi
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Jing Wen Daniel
authors.initials: JW
authors.lastname: Teh
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore.
authors.forename: Ken Jin
authors.initials: KJ
authors.lastname: Tan
mesh_terms: D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D003444:Crush Syndrome / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D018409:Foot Injuries / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D050723:Fractures, Bone / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D055815:Young Adult
keywords: crush injury of foot and ankle; foot trauma; forklift; morbidity