Chapter 2. Musculoskeletal Trauma Surgery

Injury has become a major cause of death and disability globally. Trauma is the leading cause of death for people age 1–34 years of all races and socioeconomic levels and the third leading cause of death for all age groups. Traumatic motor vehicle accidents (MVAs) are the leading cause of traumatic death. Approximately 1.3 million people die on the world's roads every year. Over 20 million people sustain nonfatal injuries. In 2010, death from road traffic accidents was the ninth cause of all deaths; it is estimated to be the fifth leading cause of death by 2030, resulting in 2.4 million fatalities per year. The economic impact of MVAs is approximately $230 billion in the United States and 180 billion in the European Union. The global losses due to road traffic injuries are estimated to be $518 billion, and these injuries cost governments between 1 and 3% of their gross national product. Low-income and middle-income countries account for $65 billion, which is more than they receive in development assistance.

Gunshot injuries are the third cause of all injury-related deaths in the United States. There are 60,000–80,000 nonfatal gunshot wounds annually in the United States. In 2006, 30,896 persons died from firearm injuries in the United States, with estimated lifetime medical costs over $2 billion.

Trauma is the leading cause of death and disability in children, accounting for some 11 million hospitalizations, 150,000 disabilities, and 15,000 deaths every year in the United States. Although direct costs of pediatric trauma exceed $8 billion per year, indirect costs to families and society are impossible to estimate but undoubtedly substantial.

With an unprecedented increase in population and life expectancy, age-related musculoskeletal conditions such as fragility fractures and sports-related ligamentous injuries are now more common than ever, even in the elderly population. Approximately 1.6 million hip fractures occur worldwide each year. By 2050, this number is expected to increase three- or fourfold. In 2005 in the United States, over 2 million osteoporotic fractures cost $17 billion.

Both natural and man-made disasters have caused hundreds of thousands of deaths and disabilities in the past 20 years, and the World Health Organization estimates an overall increase over the next two decades. Although true mass casualty situations are rare, the earthquake in Haiti in 2010 left 300,000 injured behind. These situations require highly organized trauma systems for optimal outcomes.

While considering the cost of musculoskeletal injuries, effects on the patient, the family, and society in general should be considered. Practitioners should keep in mind that there are direct expenditures for diagnosis, treatment, and rehabilitation, and also indirect economic costs associated with lost labor and diminished productivity.