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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 30  |  Issue : 1  |  Page : 35-37

Pattern of extremity fractures among patients with musculoskeletal injuries: A hospital based study from North India


1 Department of Orthopaedics, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
2 Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India

Date of Web Publication5-Feb-2016

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.175847

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  Abstract 

Background: A study on the pattern of fracture is an important area of public health. Analysis of skeletal fracture data is the essence of fracture epidemiology. Objective: To find out the pattern of extremity fractures among patients with musculoskeletal injuries. Materials and Methods: The study was a prospective, descriptive hospital based, conducted over a period of 1 year at a tertiary care center in a rural area of Himachal Pradesh, a sub-Himalayan state of India. Results: The most common fracture in upper extremities was distal end radius (n = 150, 17.2%) followed by fracture both bone forearm (n = 59, 6.7%). The most common fracture in lower extremities was both bone leg (n = 68, 7.8%) followed by fracture metatarsals (n = 52:5.9%). Conclusions: Understanding pattern of fractures may help plan prevention and management strategies for fractures.

Keywords: Extremity fractures, musculoskeletal injuries, pattern


How to cite this article:
Awasthi B, Raina SK, Kumar N, Sharma V, Kalia S, Thakur L. Pattern of extremity fractures among patients with musculoskeletal injuries: A hospital based study from North India. J Med Soc 2016;30:35-7

How to cite this URL:
Awasthi B, Raina SK, Kumar N, Sharma V, Kalia S, Thakur L. Pattern of extremity fractures among patients with musculoskeletal injuries: A hospital based study from North India. J Med Soc [serial online] 2016 [cited 2019 Dec 14];30:35-7. Available from: http://www.jmedsoc.org/text.asp?2016/30/1/35/175847


  Introduction Top


Fracture of bone is a medical condition in which there is a break in the continuity of the bone. It can be a result of high force impact or stress, or trivial injury or as a result of certain medical conditions that weaken the bones. Analysis of skeletal fracture data is the essence of fracture epidemiology. Its application to clinical practice allows clinicians to determine definable and preventable characteristics that predispose to skeletal fracture and ensure the provision of appropriate treatment strategies.

The study was planned with the aim to understand the pattern of extremity fractures among patients presenting with injuries to a tertiary care center in rural North-West India.


  Materials and Methods Top


The study was a prospective, descriptive hospital based, conducted over a period of 1 year at a tertiary care center in a rural area of Himachal Pradesh, a sub-Himalayan state of India. For the purpose of the study, a hospital based register was established in the Department of Orthopaedics. Patients of all age groups presenting to Department of Orthopaedics with musculoskeletal injuries secondary to trauma were included in the register. In case of disoriented and minor patients history on injury and sociodemographic variables was collected from guardian/parent of the patient. A detailed survey was conducted on each patient and to establish the diagnosis, X-ray of part of interest was performed. A total of 800 patients with traumatic extremity fractures were recruited over a period of 1 year from June 1, 2012, to May 31, 2013 for this study.


  Results Top


[Table 1] shows that the most common fracture in upper extremities was distal end radius (n = 150, 17.2%) followed by fracture both bone forearm (n = 59, 6.7%). The distribution of all fractures in upper extremities was found to be statistically nonsignificant with P > 0.05. [Table 2] depict that the most common fracture in lower extremities was both bone leg (n = 68, 7.8%) followed by fractured metatarsals (n = 52: 5.9%). The distribution of all fractures in lower extremities was found to be statistically nonsignificant (P > 0.05). As far as, the mechanism of injury was concerned; "fall" represented the most common mechanism of injury (74.6%) followed by roadside accidents (14.6%). Fall while walking contributed to 44.5%. More common were fall from stairs (11.53%) followed by fall from height (17.41%).
Table 1: Pattern of fractures in upper extremity

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Table 2: Pattern of fractures in lower extremity

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  Discussion Top


The study was aimed at arriving at the pattern of extremity fractures in patient's suffering from traumatic musculoskeletal injuries. A similar study conducted on children (0-16 years) reported a higher prevalence of fractures in the left upper extremity as compared with right and the most common site injured being elbow (0-6 years) and distal radius (7-16 years). [1] In many other studies, it was found that upper limb fractures were more common than lower limb. [2],[3],[4] Similar observations were made in our study. The distal end radius was most common fracture results being similar to established studies. [4]

Fall-related injuries are much more common in our set up, primarily because of the hilly terrain in this part of India. The geographical terrain of Himachal predisposes its population to injuries by fall. Injuries sustained while walking on the narrow path, fall from trees while harvesting fodders, fall from stairs due to traditional housing could be the reason for this.

Similar results have been shown by studies conducted in India and other parts of the world. A study from nearly all hospitals in Australia (2001-2002) shows fall and transport accidents as the most common types of events resulting in a hospitalized fractures. [5] A study from rural Vietnam points to fall in elderly as major reason of musculoskeletal while road traffic injuries as the most common among children. [6]

A study conducted in Delhi discusses fall-related injuries in detail. The study reported fall as the most common mode of injury with the slippery surface as the most common factor responsible for the occurrence of fall (63.5%) at same levels. More common in the study was fall from a ladder (42.8%) followed by fall from a building (21.5%) in the case of fall from height.

In fall-related injuries, it is a human tendency to use upper limb as a defense mechanism to prevent fall. While in the case of roadside accidents fractures involving both bone leg may be common due to bones of the leg being superficial with no soft tissue to absorb the energy of impact. This has been reported by earlier studies like the one conducted in Karnataka, wherein lower limb involvement (59.91%) was much higher compared to upper limb (30.66%) involvement. [7] Similar results have been reported by Okaro and Ohadugha, [8] Akiode et al. [9] and Archibong and Onuba. [10] Therefore, it appears that mode of injury may be an important factor determining the pattern of extremity fractures. In this way, an understanding of the pattern of fractures may help plan prevention and management strategies for fractures.


  Disclosure Top


The authors declare that there is no conflict of interest.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.  Back to cited text no. 1
    
2.
Verma PK, Tewari KN. Injury Prevention and Control, An epidemiological study of injuries in the area of Municipal Corporation of Delhi. World Health Organization; 2003. Available from: http://www.searo.who.int/LinkFiles/whd04_Documents_Accidents-7.pdf. [Last accessed on 2o15 Oct 22]  Back to cited text no. 2
    
3.
Meena RK, Singh AM, Singh CA, Chishti S, Kumar AG, Langshon R. Pattern of fractures and dislocations in a tertiary hospital in North East India. Int J Epidemiol 2013;11:13-5.  Back to cited text no. 3
    
4.
Shaheen MA, Badr AA, al-Khudairy N, Khan FA, Mosalem A, Sabet N. Patterns of accidental fractures and dislocations in Saudi Arabia. Injury 1990;21:347-50.  Back to cited text no. 4
    
5.
Bradley C, Harrison J. Descriptive Epidemiology of Traumatic Fractures in Australia. Injury Research and Statistics Series Number 17. Adelaide: AIHW (AIHW Cat No. INJCAT 57); 2004.  Back to cited text no. 5
    
6.
Hoang MH. Epidemiology of Unintentional Injuries in rural Vietnam. Umea: Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umea University, Sweden: Print & Media; 2004.  Back to cited text no. 6
    
7.
Bhaskara K, Padmanabha TS, Nandini T, Sindhu. Pattern of fractures and dislocations in a tertiary care hospital, North East Karnataka. Int J Med Res Health Sci 2014;3:847-50.  Back to cited text no. 7
    
8.
Okaro IO, Ohadugha CO. The anatomic pattern of fractures and dislocations among accident victims in Owerri, Nigeria. Niger J Surg Res 2006;8:54-6.  Back to cited text no. 8
    
9.
Akiode O, Shonubi AM, Musa A, Sule G. Major limb amputations: An audit of indications in a suburban surgical practice. J Natl Med Assoc 2005;97:74-8.  Back to cited text no. 9
    
10.
Archibong AE, Onuba O. Fractures in children in South Eastern Nigeria. Cent Afr J Med 1996;42:340-3.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015
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[Pubmed] | [DOI]



 

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Introduction
Materials and Me...
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