Trauma is the leading cause of death in the first four decades of life, surpassed only by cancer and atherosclerosis as the major cause of death in all age groups. For every person killed as a result of an injury, threefold more survive and are left permanently disabled. Musculoskeletal injuries, such as fractures and dislocations, are very common manifestations of trauma. The Canadian Institute for Health Information reports 119,301 musculoskeletal injury-related hospitalizations annually in Canada. Globally, trauma-related care costs are over 100 billion dollars per year. Our research in road traffic and associated high energy trauma encompasses three research programs, each of which are described in more detail below.
January 1st, 2011 marked the beginning of the United Nations and World Health Organization’s collaboration for improving education, reducing mortality, and developing primary preventative strategies for road traffic injuries worldwide. The World Health Organization’s Global Road Traffic Safety Report recommended a major focus on research and interventions in developing nations, as over 90 percent of the world’s fatalities on the roads occur in low-income and middle-income countries (LMIC). In contrast to the declining rates of injury seen in Western countries, LMICs are experiencing an increase in injury rates, largely due to increased motorization in these countries. Furthermore, the quality of fracture care is widely variable among LMICs. Previous attempts to characterize the fracture burden in many of these countries have proven inadequate because most LIMCs lack prospective registries to document the volume of injuries, the treatments chosen, and the outcomes achieved. Of the studies that have been performed, most have been limited by insufficient sample size, scope, and generalizability. As a result, the true burden of orthopaedic injuries in many countries remains to be explored. Identification of common trends in diagnosis, management, complications, and outcomes of orthopaedic trauma is the first step toward resolving disparities in global fracture burden.
According to statistics from the National Highway Traffic Safety Administration and from the Canadian provincial governments, distracted driving is a factor in approximately 4 million motor vehicle crashes in North America each year, where distracted drivers are three times more likely to be in a crash with a high risk of fatality. Traffic collision-related health care costs and lost productivity are causing economic losses of at least $10 billion annually. Furthermore, the use of mobile devices while driving is increasing substantially across North America, augmenting the risk of injury due to collision and road fatalities. While there is a growing body of research linking collision with mobile use, there is a lack of evidence describing the burden of distracted driving outcomes, including musculoskeletal injuries and their sequelae.
To enhance this body of research, the Centre for Evidence-Based Orthopaedics is developing a program of research concerning distracted driving in the orthopaedic field. In our research program, we are planning to first conduct a systematic review evaluating the available literature followed by a cross-sectional study in orthopaedic fracture clinics . The cross-sectional study will evaluate the prevalence of distracted driving, its contributing factors and subsequent outcomes (associated burden). Next steps will involve a video study using randomly selected road intersection footage to assess distracted driving across Canada and a focus group study to inform knowledge translation interventions for injury prevention.
High energy fractures are often a result of road traffic accidents and these fractures are often severely displaced; a state in which the fracture ends are widely separated from each other. The displacement necessitates internal fixation surgery where the fracture ends are put together and a metal implant is inserted into the bone to secure the fracture. Unfortunately, complications following internal fixation are common and include implant failure, infection, and nonunion of the fracture. The best methods of treating these challenging fractures remain unknown.
High energy open fractures (fractures that break through the skin) are common manifestations of trauma. Open fractures account for an estimated 250,000 fractures in North America annually. These open fractures are often complicated by infections, wound healing problems, and failure of fracture healing. Infection is estimated to occur in up to 50% of open fractures that are severe or become grossly contaminated due to the mechanism of their injury. The additional treatment required to treat infections, as well as wound and bone healing complications represents a significant increase to health care cost, and a significant impact on the patients’ quality of life. The optimal method of treating open fracture wounds remains unknown.
High Energy Hip Fractures
Hip fractures predominately affect elderly people; however, it is estimated that over 300,000 hip fractures occur worldwide in patients under the age of 50 annually. Research has also shown that fracture patients are vitamin D insufficient and may therefore be at risk for fracture healing complications. These fractures are particularly devastating for younger aged (non-geriatric) patients, causing profound impairments of quality of life and function. The optimal method of fixing hip fractures (femoral neck fractures) in non-geriatric patients remains highly controversial in the surgical community.
Based upon the rationale above, the specific objectives of our research program in road traffic and associated high energy trauma are:
- To explore the factors associated with major outcomes following fracture treatment in low-middle income countries.
- To compare optimal wound irrigation strategies for the initial treatment of severe open fracture wounds.
- To determine the optimal treatment methods for high energy fractures.