Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

Christopher Stephen Crowe, Benjamin Ballard Massenburg, Shane Douglas Morrison, James Chang, Jeffrey Barton Friedrich, Gdiom Gebreheat Abady, Fares Alahdab, Vahid Alipour, Jalal Arabloo, Malke Asaad, Maciej Banach, Ali Bijani, Antonio Maria Borzì, Nikolay Ivanovich Briko, Chris D Castle, Daniel Youngwhan Cho, Michael T Chung, Ahmad Daryani, Gebre Teklemariam Demoz, Zachary V Dingels, Hoa Thi Do, Florian Fischer, Jack T Fox, Takeshi Fukumoto, Abadi Kahsu Gebre, Berhe Gebremichael, Juanita A Haagsma, Arvin Haj-Mirzaian, Demelash Woldeyohannes Handiso, Simon I Hay, Chi Linh Hoang, Seyed Sina Naghibi Irvani, Jacek Jerzy Jozwiak, Rohollah Kalhor, Amir Kasaeian, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Roba Khundkar, Sezer Kisa, Adnan Kisa, Zichen Liu, Marek Majdan, Navid Manafi, Ali Manafi, Ana-Laura Manda, Tuomo J Meretoja, Ted R Miller, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Mohammad A Mohseni Bandpei, Ali H Mokdad, Mukhammad David Naimzada, Duduzile Edith Ndwandwe, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Andrew T Olagunju, Tinuke O Olagunju, Hai Quang Pham, Dimas Ria Angga Pribadi, Navid Rabiee, Kiana Ramezanzadeh, Kavitha Ranganathan, Nicholas L S Roberts, Leonardo Roever, Saeed Safari, Abdallah M Samy, Lidia Sanchez Riera, Saeed Shahabi, Catalin-Gabriel Smarandache, Dillon O Sylte, Berhe Etsay Tesfay, Bach Xuan Tran, Irfan Ullah, Parviz Vahedi, Amir Vahedian-Azimi, Theo Vos, Dawit Habte Woldeyes, Adam Belay Wondmieneh, Zhi-Jiang Zhang, Spencer L James, Christopher Stephen Crowe, Benjamin Ballard Massenburg, Shane Douglas Morrison, James Chang, Jeffrey Barton Friedrich, Gdiom Gebreheat Abady, Fares Alahdab, Vahid Alipour, Jalal Arabloo, Malke Asaad, Maciej Banach, Ali Bijani, Antonio Maria Borzì, Nikolay Ivanovich Briko, Chris D Castle, Daniel Youngwhan Cho, Michael T Chung, Ahmad Daryani, Gebre Teklemariam Demoz, Zachary V Dingels, Hoa Thi Do, Florian Fischer, Jack T Fox, Takeshi Fukumoto, Abadi Kahsu Gebre, Berhe Gebremichael, Juanita A Haagsma, Arvin Haj-Mirzaian, Demelash Woldeyohannes Handiso, Simon I Hay, Chi Linh Hoang, Seyed Sina Naghibi Irvani, Jacek Jerzy Jozwiak, Rohollah Kalhor, Amir Kasaeian, Yousef Saleh Khader, Rovshan Khalilov, Ejaz Ahmad Khan, Roba Khundkar, Sezer Kisa, Adnan Kisa, Zichen Liu, Marek Majdan, Navid Manafi, Ali Manafi, Ana-Laura Manda, Tuomo J Meretoja, Ted R Miller, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Mohammad A Mohseni Bandpei, Ali H Mokdad, Mukhammad David Naimzada, Duduzile Edith Ndwandwe, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Andrew T Olagunju, Tinuke O Olagunju, Hai Quang Pham, Dimas Ria Angga Pribadi, Navid Rabiee, Kiana Ramezanzadeh, Kavitha Ranganathan, Nicholas L S Roberts, Leonardo Roever, Saeed Safari, Abdallah M Samy, Lidia Sanchez Riera, Saeed Shahabi, Catalin-Gabriel Smarandache, Dillon O Sylte, Berhe Etsay Tesfay, Bach Xuan Tran, Irfan Ullah, Parviz Vahedi, Amir Vahedian-Azimi, Theo Vos, Dawit Habte Woldeyes, Adam Belay Wondmieneh, Zhi-Jiang Zhang, Spencer L James

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.

Keywords: burden of disease; descriptive epidemiology; hand injury.

Conflict of interest statement

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.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Age-standardised incidence rate of hand and wrist fractures in 2017 (A) and percentage change in hand and wrist fracture incidence rate from 1990 to 2017 (B).
Figure 2
Figure 2
Age-standardised incidence rate of thumb amputations in 2017 (A) and percentage change in thumb amputation incidence rate from 1990 to 2017 (B).
Figure 3
Figure 3
Age-standardised incidence rate of non-thumb digit amputations in 2017 (A) and percentage change in non-thumb digit amputation incidence rate from 1990 to 2017 (B).
Figure 4
Figure 4
Age-standardised incidence of hand and wrist trauma by Socio-demographic Index (SDI).
Figure 5
Figure 5
Causes of hand and wrist fracture (A), thumb amputation (B) and non-thumb digit amputation (C) by region.

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