Beerekamp M S H, de Muinck Keizer R J O, Schep N W L, Ubbink D T, Panneman M J M, Goslings J C
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Injury. 2017 Jul;48(7):1355-1362. doi: 10.1016/j.injury.2017.04.047. Epub 2017 Apr 24.
Insight in epidemiologic data of extremity fractures is relevant to identify people at risk. By analyzing age- and gender specific fracture incidence and treatment patterns we may adjust future policy, take preventive measures and optimize health care management. Current epidemiologic data on extremity fractures and their treatment are scarce, outdated or aiming at a small spectrum of fractures. The aim of this study was to assess trends in incidence and treatment of extremity fractures between 2004 and 2012 in relation to gender and age.
We used a combination of national registries of patients aged ≥ 16 years with extremity fractures. Fractures were coded by the International Classification of Diseases (ICD) 10, and allocated to an anatomic region. ICD-10 codes were used for combining the data of the registries. Absolute numbers, incidences, number of patients treated in university hospitals and surgically treated patients were reported. A binary logistic regression was used to calculate trends during the study period.
From 2004 to 2012 the Dutch population aged ≥16 years grew from 13,047,018 to 13,639,412 inhabitants, particularly in the higher age groups of 46 years and older. The absolute number of extremity fractures increased significantly from 129,188 to 176,129 (OR 1.308 [1.299-1.318]), except for forearm and lower leg fractures. Incidences increased significantly (3-4%) for wrist, hand/finger, hip/upper leg, ankle and foot/toe fractures. In contrast to the older age categories from 66 years and older, in younger age categories from 16 to 35 years, fractures of the extremities were more frequent in men than in women. Treatments gradually moved towards non-university hospitals for all except forearm fractures. Both relative and absolute numbers increased for surgical treatments of clavicle/shoulder, forearm, wrist and hand/finger fractures. Contrarily, lower extremity fractures showed an increase in non-surgical treatment, except for lower leg fractures.
During the study period, we observed an increasing incidence of extremity fractures and a shift towards surgical treatment. Patient numbers in university hospitals declined. If these trends continue, policy makers would be well advised to consider the changing demands in extremity fracture treatment and pro-actively increase capacity and resources.
了解四肢骨折的流行病学数据对于识别高危人群至关重要。通过分析特定年龄和性别的骨折发病率及治疗模式，我们可以调整未来政策、采取预防措施并优化医疗管理。目前关于四肢骨折及其治疗的流行病学数据稀缺、过时或仅针对一小部分骨折。本研究的目的是评估2004年至2012年间四肢骨折发病率及治疗情况与性别和年龄的关系。
我们使用了年龄≥16岁的四肢骨折患者国家登记数据库的组合数据。骨折按照国际疾病分类（ICD）10进行编码，并分配到一个解剖区域。使用ICD - 10编码合并登记数据库的数据。报告了绝对数量、发病率、在大学医院接受治疗的患者数量以及接受手术治疗的患者数量。使用二元逻辑回归计算研究期间的趋势。
从2004年到2012年，荷兰年龄≥16岁的人口从13,047,018增长到13,639,412人，尤其是在46岁及以上的较高年龄组。除前臂和小腿骨折外，四肢骨折的绝对数量从129,188显著增加到176,129（比值比1.308 [1.299 - 1.318]）。手腕、手/手指、髋部/大腿、脚踝和足/趾骨折的发病率显著增加（3 - 4%）。与66岁及以上的老年人群不同，在16至35岁的年轻人群中，男性四肢骨折比女性更频繁。除前臂骨折外，所有骨折的治疗逐渐转向非大学医院。锁骨/肩部、前臂、手腕和手/手指骨折的手术治疗的相对和绝对数量均增加。相反，下肢骨折除小腿骨折外，非手术治疗有所增加。
在研究期间，我们观察到四肢骨折发病率增加且治疗方式向手术治疗转变。大学医院的患者数量下降。如果这些趋势持续，建议政策制定者考虑四肢骨折治疗需求的变化，并积极增加能力和资源。
