The Burden of High-Energy Musculoskeletal Trauma in High-Income Countries.

INTRODUCTION TO THE PROBLEM: Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future. REVIEW OF LITERATURE: In 2016, mortality from road traffic injuries (RTIs) between the ages of 15-49 was reported to be 9.5% (9.0-9.9) in high-income countries, accounting for approximately 255 million DALYs. While RTIs do not fully capture the extent of high-energy musculoskeletal trauma, as the most common mechanism, they serve as a useful indicator of the impact on the surgical and economic burden. In 2009, the global losses related to RTIs were estimated to be 518 billion USD, costing governments between 1 and 3% of their gross domestic product (GDP). In the last decade, both the total direct per-person healthcare cost and the incremental direct per-person costs for those with a musculoskeletal injury in the USA rose 75 and 58%, respectively. FUTURE DIRECTIONS: ADDRESSING THE GAPS: While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD-DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.

Forces acting on the clavicle during shoulder abduction, forward humeral flexion and activities of daily living.

BACKGROUND: The forces acting on the human clavicle in vivo are difficult if not impossible to measure. The goal of this study is to quantify the forces acting on the human clavicle during shoulder abduction, forward humeral elevation and three activities of daily living using the Delft Shoulder and Elbow Model. METHODS: The Delft Shoulder and Elbow Model and a computed tomography scan of a clavicle were used to calculate the forces and moments acting on the entire clavicle and on three planes within the middle third of the clavicle during the simulated movements. FINDINGS: The largest resultant force simulated across the clavicle was 126 N during abduction. Maximum resultant moments of 2.4 Nm were identified during both abduction and forward humeral elevation. The highest forces in the middle third of the clavicle were of a compressive nature along the longitudinal axis of the clavicle, increasing to 97 N during forward humeral elevation and 91 N during abduction. Forces in opposite direction along the y-axis were identified on either side of the conoid ligament. The three simulated activities of daily living had similar ranges of forces and moments irrespective of the sagittal plane in which these activities were performed. INTERPRETATION: Peak forces occurred at different locations on the middle third of the clavicle during different movements. The results create an understanding of the forces and their distribution across the clavicle during activities of daily living. These data may be helpful in the development of clavicular fixation devices. LEVEL OF EVIDENCE: Biomechanical study.

Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly.

PURPOSE OF REVIEW: Treatment of osteoporotic and neuropathic ankle fractures in the elderly is challenging. The purpose of this paper is to review recent publications on this topic and to identify the optimal treatment for these fractures. RECENT FINDINGS: Treatment consists of a variety of conservative or operative options all with advantages and disadvantages as described in this review. Little research has been published that specifically focuses on elderly patients with ankle fractures. Operative treatment has a high complication rate. Multiple comorbidities are predictors for complications. SUMMARY: An optimal treatment could not be distilled but based on the available literature, a general treatment algorithm is proposed. Since the elderly typically are accompanied by multiple comorbidities as well as impaired mobility, the physician should focus not only on treating the fractured ankle but also on the patient as a whole. Further research on this specific topic is needed.

Translation and validation of the German version of the foot and ankle outcome score.

PURPOSE: Outcome assessment is critical in evaluating the efficacy of orthopaedic procedures. The Foot and Ankle Outcome Score (FAOS) is a 42-item questionnaire divided into five subscales, which has been validated in several languages. Germany has no validated outcome score for general foot and ankle pathology. The aim of this study was to develop a German version of the FAOS and to investigate its psychometric properties. MATERIALS AND METHODS: Forward and backward translation was executed according to official guidelines. The final version of the FAOS was investigated in 150 patients with various foot and ankle disorders. All patients completed the FAOS, Short Form-36, numeric rating scales for pain and disability, and the Hannover questionnaire. The FAOS was re-administered after 1 week. Test-retest reliability, internal consistency, minimal detectable change, construct validity, and floor and ceiling effects were analyzed. RESULTS: Test-retest reliability and internal consistency of each subscale were excellent (intraclass correlation coefficient, 0.88-0.95; Cronbach's α, 0.94-0.98). The minimal detectable changes of each subscale were 17.1-20.8 at the individual level and 2.0-2.4 at group level. There were moderate to strong correlations between FAOS subscales and physical outcomes and low to moderate correlations between FAOS subscales and mental outcomes. Floor and ceiling effects were not present. CONCLUSION: The German version of the FAOS is a reliable and valid instrument for use in foot and ankle patients.