Article Text

Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study
  1. Christopher Stephen Crowe1,
  2. Benjamin Ballard Massenburg1,
  3. Shane Douglas Morrison1,
  4. James Chang2,
  5. Jeffrey Barton Friedrich1,
  6. Gdiom Gebreheat Abady3,
  7. Fares Alahdab4,
  8. Vahid Alipour5,6,
  9. Jalal Arabloo5,
  10. Malke Asaad7,
  11. Maciej Banach8,9,
  12. Ali Bijani10,
  13. Antonio Maria Borzì11,
  14. Nikolay Ivanovich Briko12,
  15. Chris D Castle13,
  16. Daniel Youngwhan Cho1,
  17. Michael T Chung14,
  18. Ahmad Daryani15,
  19. Gebre Teklemariam Demoz16,17,
  20. Zachary V Dingels13,
  21. Hoa Thi Do18,
  22. Florian Fischer19,
  23. Jack T Fox13,
  24. Takeshi Fukumoto20,21,
  25. Abadi Kahsu Gebre22,
  26. Berhe Gebremichael23,
  27. Juanita A Haagsma24,
  28. Arvin Haj-Mirzaian25,26,
  29. Demelash Woldeyohannes Handiso27,
  30. Simon I Hay13,28,
  31. Chi Linh Hoang29,
  32. Seyed Sina Naghibi Irvani30,
  33. Jacek Jerzy Jozwiak31,
  34. Rohollah Kalhor32,
  35. Amir Kasaeian33,34,
  36. Yousef Saleh Khader35,
  37. Rovshan Khalilov36,
  38. Ejaz Ahmad Khan37,
  39. Roba Khundkar38,
  40. Sezer Kisa39,
  41. Adnan Kisa40,
  42. Zichen Liu13,
  43. Marek Majdan41,
  44. Navid Manafi42,43,
  45. Ali Manafi44,
  46. Ana-Laura Manda45,
  47. Tuomo J Meretoja46,47,
  48. Ted R Miller48,49,
  49. Abdollah Mohammadian-Hafshejani50,
  50. Reza Mohammadpourhodki51,
  51. Mohammad A Mohseni Bandpei52,
  52. Ali H Mokdad13,28,
  53. Mukhammad David Naimzada53,54,
  54. Duduzile Edith Ndwandwe55,
  55. Cuong Tat Nguyen56,
  56. Huong Lan Thi Nguyen56,
  57. Andrew T Olagunju57,58,
  58. Tinuke O Olagunju59,
  59. Hai Quang Pham56,
  60. Dimas Ria Angga Pribadi60,
  61. Navid Rabiee61,
  62. Kiana Ramezanzadeh62,
  63. Kavitha Ranganathan63,
  64. Nicholas L S Roberts13,
  65. Leonardo Roever64,
  66. Saeed Safari65,
  67. Abdallah M Samy66,
  68. Lidia Sanchez Riera67,68,
  69. Saeed Shahabi69,
  70. Catalin-Gabriel Smarandache70,71,
  71. Dillon O Sylte13,
  72. Berhe Etsay Tesfay72,
  73. Bach Xuan Tran73,
  74. Irfan Ullah74,75,
  75. Parviz Vahedi76,
  76. Amir Vahedian-Azimi77,
  77. Theo Vos13,28,
  78. Dawit Habte Woldeyes78,
  79. Adam Belay Wondmieneh79,80,
  80. Zhi-Jiang Zhang81,
  81. Spencer L James13
  1. 1 Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, Washington, USA
  2. 2 Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, USA
  3. 3 College of Medicine and Health Sciences, Department of Nursing, Adigrat University, Adigrat, Ethiopia
  4. 4 Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota, USA
  5. 5 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  6. 6 Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
  7. 7 Plastic Surgery Department, University of Texas, Houston, Texas, USA
  8. 8 Department of Hypertension, Medical University of Lodz, Lodz, Poland
  9. 9 Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland
  10. 10 Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  11. 11 Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  12. 12 Epidemiology and Evidence Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  13. 13 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  14. 14 Department of Otolaryngology - Head & Neck Surgery, Wayne State University, Detroit, Michigan, USA
  15. 15 Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  16. 16 School of Pharmacy, Aksum University, Aksum, Ethiopia
  17. 17 Addis Ababa University, Addis Ababa, Ethiopia
  18. 18 Center of Excellence in Public Health Nutrition, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  19. 19 Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
  20. 20 Department of Dermatology, Kobe University, Kobe, Japan
  21. 21 Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
  22. 22 School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  23. 23 School of Public Health, Haramaya University, Harar, Ethiopia
  24. 24 Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  25. 25 Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
  26. 26 Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  27. 27 Public Health Department, Madda Walabu University, Bale Goba, Ethiopia
  28. 28 Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
  29. 29 Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  30. 30 Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  31. 31 Department of Family Medicine and Public Health, University of Opole, Opole, Poland
  32. 32 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
  33. 33 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  34. 34 Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
  35. 35 Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
  36. 36 Department of Physiology, Baku State University, Baku, Azerbaijan
  37. 37 Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  38. 38 Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
  39. 39 Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
  40. 40 School of Health Sciences, Kristiania University College, Oslo, Norway
  41. 41 Department of Public Health, Trnava University, Trnava, Slovakia
  42. 42 Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
  43. 43 Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
  44. 44 Plastic Surgery Department, Iran University of Medical Sciences, Tehran, Iran
  45. 45 Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
  46. 46 Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  47. 47 University of Helsinki, Helsinki, Finland
  48. 48 Pacific Institute for Research & Evaluation, Calverton, Maryland, USA
  49. 49 School of Public Health, Curtin University, Perth, Western Australia, Australia
  50. 50 Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  51. 51 Department of Nursing, Shahroud University of Medical Sciences, Shahroud, Iran
  52. 52 Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  53. 53 Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
  54. 54 Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
  55. 55 Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
  56. 56 Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  57. 57 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
  58. 58 Department of Psychiatry, University of Lagos, Lagos, Nigeria
  59. 59 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  60. 60 Health Sciences Department, Muhammadiyah University of Surakarta, Sukoharjo, Indonesia
  61. 61 Department of Chemistry, Sharif University of Technology, Tehran, Iran
  62. 62 Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  63. 63 Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  64. 64 Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
  65. 65 Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  66. 66 Department of Entomology, Ain Shams University, Cairo, Egypt
  67. 67 Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  68. 68 Institute of Bone and Joint Research, University of Sydney, Syndey, New South Wales, Australia
  69. 69 Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  70. 70 Surgery 2nd Department - SUUB, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  71. 71 Surgery 2nd Department, Bucharest Emergency Hospital, Bucharest, Romania
  72. 72 Department of Public Health, Adigrat University, Adigrat, Ethiopia
  73. 73 Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
  74. 74 Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
  75. 75 TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  76. 76 Department of Anatomical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
  77. 77 Trauma Research Center, Nursing Facility, Baqiyatallah University of Medical Sciences, Tehran, Iran
  78. 78 Department of Human Anatomy, Histology, and Embryology, Bahir Dar University, Bahir Dar, Ethiopia
  79. 79 Department of Nursing, Wollo University, Dessie, Ethiopia
  80. 80 Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
  81. 81 Department of Preventive Medicine, Wuhan University, Wuhan, China
  1. Correspondence to Dr Christopher Stephen Crowe, Department of Surgery, University of Washington, Seattle, WA 98121, USA; ccrowe2{at}uw.edu

Abstract

Background As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period.

Methods The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations.

Results The global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%.

Conclusions Certain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.

  • burden of disease
  • hand injury
  • descriptive epidemiology
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Footnotes

  • Funding This study was funded by Bill and Melinda Gates Foundation (grant number: OPP1152504).

  • Competing interests Dr. Jozwiak reports personal fees from TEVA, personal fees from ALAB, personal fees from BOEHRINGER INGELHEIM, personal fees from SYNEXUS, non-financial support from SERVIER, non-financial support from MICROLIFE, and non-financial support from MEDICOVER, outside the submitted work. Dr. James reports grants from Sanofi Pasteur, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data sharing not applicable as no data sets generated and/or analysed for this study. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. Input data availability for public use varies by source. More information is available in documentation on ghdx.healthdata.org. Study results are all publicly available at ghdx.healthdata.org.

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