Cranial injuries secondary to assault with a machete Basil Enicker a, *, Thandinkosi E. Madiba b a Departments of Neurosurgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa b General Surgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa Introduction The use of a machete (shown in Fig. 1) as a weapon during violent attacks has been well documented in the literature and it causes complex injuries to the body [1–3]. Examples include the civil war in Sierra Leone where it was used to mutilate limbs of civilians [4]. There is no South African literature focusing exclusively on cranial injuries secondary to assault with a machete. The aim of this article is to highlight the serious nature of injuries caused by this instrument. We analyzed cranial injuries caused by machetes with regard to their presentation, treatment and Glasgow Outcome Scale (GOS) at discharge in a series of patients treated at a single neurosurgical unit situated in the province of KwaZulu-Natal, South Africa over a 10 year period. Methods and materials This is a retrospective chart review of patients with cranial injuries as a result of assaults with machetes presenting to the Department Of Neurosurgery at Inkosi Albert Luthuli Central Hospital located in KwaZulu-Natal, Durban, South Africa. The study period was from January 2003 to December 2012. The study was granted approval by the Biomedical Research Ethics Committee of the University Of KwaZulu-Natal, reference number BE 298/12. A total 6431 patients with neurosurgical trauma were admitted during this period, of whom 185 suffered cranial injuries inflicted by machetes (2% of neurotrauma). The patients were referred from 31 different hospitals in the province. The unit is the only neurosurgical centre servicing the whole KwaZulu-Natal Province with a population of approximately 10 million people [5] and also admits a small number of patients from surrounding provinces. Indications for surgery in our centre were depressed compound skull fractures, associated brain matter ooze, cerebrospinal fluid Injury, Int. J. Care Injured 45 (2014) 1355–1358 A R T I C L E I N F O Article history: Accepted 18 April 2014 Keywords: Machete Compound depressed skull fracture Intra-cranial haematoma A B S T R A C T Background: Assaults with a machete cause compound skull fractures which present as a neurosurgical emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single neurosurgical unit. Materials and methods: Retrospective data analysis of cranial injuries following assault with a machete, admitted to the neurosurgery ward, from January 2003 to December 2012 was performed. Medical records were analyzed for demographics, clinical presentation, CT scan findings, surgical treatment and Glasgow Outcome Scale (GOS) at discharge. Management involved wound debridement with antibiotic cover. Results: Of 185 patients treated 172 (93%) were male. Mean age was 31  11.4 years. Mean GCS on admission was 13  2. Presenting features were focal neurological deficit (48%), brain matter oozing from wounds (20%), and post traumatic seizures (12%). Depressed skull fractures were found in 162 (88%) patients. Findings on CT brain scan were intra-cranial haematoma (88%), pneumocephalus (39%) and features of raised intra-cranial pressure (37%). Thirty-one patients (17%) presented with septic head wounds. One hundred and fifty seven patients (85%) were treated surgically. The median hospital stay was 8 days (range 1–145). The median GOS at discharge was 5 (range 1–5). Twelve patients died within the same admission (6.5%). Conclusion: Machetes cause complex cranial injuries with associated neurological deficit and should be treated as neurosurgical emergency. Timeous intervention and good surgical principles are advocated to prevent secondary infection and further neurological deterioration. ß 2014 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Neurosurgery, Inkosi Albert Luthuli Central Hospital, Nelson R. Mandela School of Medicine, University of KwaZulu- Natal, Private Bag X03, Mayville 4058, South Africa. Tel.: +27 312401135; fax: +27 312401132. E-mail address: basilenicker@yahoo.com (B. Enicker). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2014.04.036 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.