Trends in burden of work-related upper limb amputation in South Korea, 2004-2013: a nationwide retrospective cohort study.

OBJECTIVES: This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend. DESIGN: Ecological study. SETTING: National level data in Korea between 2004 and 2013. PARTICIPANTS: 49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation. MAIN OUTCOME MEASURES: The disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence. RESULTS: The burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years. CONCLUSIONS: The decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.

Playground-related Extremity Fractures in an Asian Setting over the Last Decade - Are We Safe?

The cost of playground-related injuries remains significant. Measures adopted to prevent such fractures or reduce their severity would translate into appreciable financial savings. Our study looks at the changes in playground-related extremity fracture epidemiology over the past decade after the implementation of latest playground standards. This is a retrospective case series approved by the local ethics board comparing the results of two descriptive studies; one conducted prior to the implementation of the Singapore Productivity and Standards Board Singapore Standards SS 457: 2007 and the other thereafter. The demographics have remained the same. The proportion of public playground injuries has fallen significantly from 89.6% to 76.3% (p < 0.05), whereas school playground injuries have risen from 5.9% to 18.0% (p < 0.05). Fractures related to monkey bars and the flying fox have shown a significant improvement, decreasing to 38.1% from 47.6% (p < 0.05) and 1% from 6.9% (p < 0.05), respectively. There has been a decrease of 33% in playground-related injuries. The total financial cost of sustaining one playground-related extremity fracture has generally increased by 50%. However, considering the 37.4% drop in surgeries, the actual overall costs to the healthcare system have essentially fallen. Safety standards have had a positive effect on playground safety in Singapore. There are now fewer and less severe playground-related extremity fractures.

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania.

BACKGROUND: Although musculoskeletal injuries have increased in sub-Saharan Africa, data on the economic burden of non-fatal musculoskeletal injuries in this region are scarce. OBJECTIVE: Socioeconomic costs of orthopedic injuries were estimated by examining both the direct hospital cost of orthopedic care as well as indirect costs of orthopedic trauma using disability days and loss of work as proxies. METHODS: This study surveyed 200 patients seen in the outpatient orthopedic ward of the Kilimanjaro Christian Medical Center, a tertiary hospital in Northeastern Tanzania, during the month of July 2016. FINDINGS: Of the patients surveyed, 88.8% earn a monthly income of less than $250 and the majority of patients (73.7%) reported that the healthcare costs of their musculoskeletal injuries were a catastrophic burden to them and their family with 75.0% of patients reporting their medical costs exceeded their monthly income. The majority (75.3%) of patients lost more than 30 days of activities of daily living due to their injury, with a median (IQR) functional day loss of 90 (30). Post-injury disability led to 40.6% of patients losing their job and 86.7% of disabled patients reported a wage decrease post-injury. There were significant associations between disability and post-injury unemployment (p < .0001) as well as lower post-injury wages (p = .022). CONCLUSION: This exploratory study demonstrates that in this region of the world, access to definitive treatment post-musculoskeletal injury is limited and patients often suffer prolonged disabilities resulting in decreased employment and income.

Direct Health Care Cost and Work Incapacity Related to Complex Regional Pain Syndrome in Switzerland: A Retrospective Analysis from 2008 to 2015.

OBJECTIVE: First, to determine the number of accident-related complex regional pain syndrome (CRPS) cases from 2008 to 2015 and to identify factors associated with an increased risk for developing CRPS. Second, to analyze the duration of work incapacity and direct health care costs over follow-up periods of two and five years, respectively. DESIGN: Retrospective data analysis. SETTING: Database from the Statistical Service for the Swiss National Accident Insurances covering all accidents insured under the compulsory Swiss Accident Insurance Law. SUBJECTS: Subjects were registered after an accident between 2008 and 2015. METHODS: Cases were retrospectively retrieved from the Statistical Service for the Swiss National Accident Insurances. Cases were identified using the appropriate International Classification of Diseases, 10th Revision, codes. RESULTS: CRPS accounted for 0.15% of all accident cases. Age, female gender (odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.47-1.60), and fracture of the forearm (OR = 38, 95% CI = 35-42) were related to an increased risk of developing CRPS. Over five years, one CRPS case accumulated average insurance costs of $86,900 USD and treatment costs of $23,300 USD. Insurance costs were 19 times and treatment costs 13 times the average costs of accidents without CPRS. Within the first two years after the accident, the number of days lost at work was 20 times higher in patients with CRPS (330 ± 7 days) than in patients without CRPS (16.1 ± 0.1 days). Two-thirds of all CRPS cases developed long-term work incapacity of more than 90 days. CONCLUSION: CRPS is a relatively rare condition but is associated with high direct health care costs and work incapacity.

Trends in Pediatric Traumatic Upper Extremity Amputations.

Background: Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. Methods: Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed. Results: Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits. Conclusions: Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.

The long-term burden of work-related carpal tunnel syndrome relative to upper-extremity fractures and dermatitis in Washington State.

BACKGROUND: Carpal tunnel syndrome (CTS) is among the most burdensome of all musculoskeletal disorders as measured by workers' compensation claims costs and lost earnings. But the burden of CTS extends beyond direct claim costs. METHODS: A survey covering health, social, economic and work-related outcomes was administered to 1,255 injured workers whose Washington State Fund workers' compensation claims had closed 6 years previously. Logistic and linear regression methods were used to model the outcomes of CTS claimants across four separate outcome domains. RESULTS: Workers diagnosed with CTS suffer substantial deficits across all four outcome domains as compared to the two comparison groups of claimants. Former CTS claimants were almost twice as likely not to be working as compared to the fractures cohort. CONCLUSIONS: A comprehensive measurement of the burden of CTS shows losses extend beyond direct claims costs to include continuing pain, loss of function, adverse financial impacts and household disruption which extend long after claim closure. Am. J. Ind. Med. 58:1255-1269, 2015. © 2015 Wiley Periodicals, Inc.

Extremity injuries as predictors of emergency care resource needs among blunt trauma patients in Japan.

This study aimed to exhaustively examine associations between prehospital variables and emergency care resource needs among blunt trauma patients. The study included blunt trauma patients aged 15 years or older who were admitted to a tertiary care medical center in Osaka, Japan, from January 2005 to December 2009. The primary end point was a composite measure of overall emergency care resource needs. Predictive variables were easily detectable upper and lower extremity injuries. A multivariate logistic regression model was used to identify associations between the predictive variables and the end point; this model included other covariates known to be associated with emergency care resource needs (demographic characteristics, mechanism of injury, and physiological parameters). Of 982 blunt trauma patients, 81 died, and 573 required overall emergency care resources. Upper extremity injury (odds ratio [OR], 2.60) and lower extremity injury (OR, 4.50) were significantly associated with overall emergency care resource needs after controlling for other covariates. The results of this study suggest that easily detectable extremity injuries may be useful predictors of the emergency care resource needs of trauma patients. Further studies are needed to validate the predictive values of these injuries and to determine ways to use information about extremity injuries to improve triage decisions.

Frequency and cost of claims by injury type from a state workers' compensation fund from 1998 through 2008.

OBJECTIVE: To determine which work-related injuries are the most frequent and costly. DESIGN: Secondary analysis of workers' compensation claims data. SETTING: Data were provided by a large, Maryland workers' compensation insurer from 1998 through 2008. PARTICIPANTS: Not applicable. INTERVENTIONS: None. MAIN OUTCOMES MEASURES: For 45 injury types, the number of claims and compensation amount was calculated for total compensation and for medical and indemnity compensation separately. RESULTS: Back and knee injuries were the most frequently occurring single injury types, whereas heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost of injury (mean cost × number occurrences), back, knee, and shoulder injuries were the most expensive single injury types. CONCLUSIONS: Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries.

Arm and shoulder conditions, active component, U.S. Armed Forces, 2003-2012.

This analysis estimated the incidence and health care burden of acute and chronic conditions of the arm and shoulder among active component service members of the Armed Forces from 1 January 2003 through 31 December 2012. There were 196,789 diagnosed incident cases of acute arm and shoulder conditions for a rate of 13.7 cases per 1,000 person-years. The annual incidence rates of sprains, the most common acute condition, nearly doubled during the period. Diagnoses of chronic conditions (overall rate of 28.8 per 1,000 person-years) increased 25 percent during the period, mainly associated with a doubling of the incidence of diagnoses of joint pain. Incidence rates of chronic disorders were progressively higher among successively older age groups of service members. The health care burden of all arm and shoulder conditions together steadily increased during the period, as indicated by numbers of health care encounters, individuals affected, and lost work time. The most commonly documented causes associated with acute and chronic conditions are described.

Trends in incidence and costs of injuries to the shoulder, arm and wrist in The Netherlands between 1986 and 2008.

BACKGROUND: Upper extremity injuries account for a large proportion of attendances to the Emergency Department. The aim of this study was to assess population-based trends in the incidence of upper extremity injuries in the Dutch population between 1986 and 2008, and to give a detailed overview of the associated health care costs. METHODS: Age-standardized incidence rates of upper extremity injuries were calculated for each year between 1986 and 2008. The average number of people in each of the 5-year age classes for each year of the study was calculated and used as the standard (reference) population. Injury cases were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). An incidence-based cost model was applied in order to estimate associated direct health care costs in 2007. RESULTS: The overall age-adjusted incidence of upper extremity injuries increased from 970 to 1,098 per 100,000 persons (13%). The highest incidence was seen in young persons and elderly women. Total annual costs for all injuries were 290 million euro, of which 190 million euro were paid for injuries sustained by women. Wrist fractures were the most expensive injuries (83 million euro) due to high incidence, whereas upper arm fractures were the most expensive injuries per case (4,440 euro). Major cost peaks were observed for fractures in elderly women due to high incidence and costs per patient. CONCLUSIONS: The overall incidence of upper extremity injury in the Netherlands increased by 13% in the period 1986-2008. Females with upper extremity fractures and especially elderly women with wrist fractures accounted for a substantial share of total costs.

Workers' compensation and outcomes of upper extremity surgery.

Clinical outcomes following upper extremity surgery among workers' compensation patients have traditionally been found to be worse than those of non-workers' compensation patients. In addition, workers' compensation patients take significantly longer to return to their jobs, and they return to their preinjury levels of employment at a lower overall rate. These unfavorable prognoses may stem from the strenuous physical demands placed on the upper extremity in this group of patients. Further, there is a potential financial benefit within this patient population to report severe functional disability following surgery. Orthopaedic upper extremity surgeons who treat workers' compensation patients should be aware of the potentially prolonged period before return to work after surgical intervention and should counsel this group of patients accordingly. Vocational training should be considered if a patient's clinical progress begins to plateau.

The cost of sustaining playground related extremity fractures in Singapore.

PURPOSE: To study the cost of sustaining a fracture of the extremity caused by playground equipment. These costs include financial, psychological, clinical and others like loss of school days. METHOD: This is a prospective study of 226 children seen at the Paediatric Orthopaedic Department for a1-year period starting June 2005. Once confirmed to have a playground related fracture by the Orthopaedic specialist, three sets of data are collected. First is the clinical data. Second is the playground related data. This is done on site independently by another investigator. Third is the radiological data,which is assessed independently by an Orthopaedic surgeon to ensure consistency. RESULTS: Out of the 226 children seen, two-thirds were boys. The average age was 7.5 years. 35.8% were forearm fractures and 28.8% were supracondylar fractures with the rest being mostly fractures in the upper limb. 64.2% were treated with immobilisation only whilst 24.2% required closed manipulation and reduction. 1.2% required admission for treatment of their fractures. The average period of cast immobilisation was 34 days. The average number of consults, including that at the emergency department, was 4 with an average length of follow up of 67.2 days. Based on the above, in our institution, the average cost for outpatient treatment would be about S$680.00 (US$485.71) (US$1.00 = S$1.40; 1/1/2010) per injury. The inpatient cost for non-surgical treatment cost would be S$1000.00 and for surgical stabilisation the average cost would be S$3300.00 (US$2357.14). CONCLUSION: Playgrounds are meant for children to play safely. Yet, there appears to be a significant number of injuries sustained. Whilst these fractures are relatively minor, requiring outpatient treatment,there are costs. Besides the financial costs, there are hidden psychological costs of loss of school days and inability to participate in sports. Finally, as with any injury, there can be long-term complications which present further clinical costs. SIGNIFICANCE: Most studies on playground injuries tend to concentrate on the equipment and very superficially cover the clinical aspects, less so the costs. This paper looks at the clinical aspects in greater depth and emphasises that there are significant costs, beyond financial, when a child sustains a playground injury. The next thing to do is to examine what playgrounds factors significantly contribute to these injuries and remedy them when planning the construction of playgrounds.

Economic consequences of accidents to hands and forearms by log splitters and circular saws: cost of illness study.

We estimated costs associated with injuries to hands from log splitters and circular saws used to cut up firewood and assessed the value of prevention. The study was carried out as a cost of illness study with an incidence approach based on 57 consecutive patients (median age 51; range 8-81) with injuries to the hand or forearm. Twenty-six of the 57 had an amputation which required microsurgery and 31/57 had various injuries. Median Hand Injury Severity Score (HISS) reflecting the severity of all injuries was 67 (range 6-332). Median DASH score after 2-7 years was 12.5 (0-73.3). Total cost (direct costs, costs of lost productivity, and lost quality of life) was estimated to roughly EUR 14 million (EUR 2.8 million/year), where the cost of lost quality of life is 82% of the total cost and loss of productivity and direct costs are 9% each. Injuries sustained from log splitters and circular saws account for considerable costs, but first and foremost human suffering.

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

BACKGROUND: The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. METHODS: The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. RESULTS: The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. CONCLUSIONS: In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement. TRIAL REGISTRATION NUMBER: NTR1117.

[Financing of inpatient orthopedics and trauma surgery in the G-DRG system 2010]. / Finanzierung der stationären Orthopädie und Unfallchirurgie im G-DRG-System 2010.

BACKGROUND: The German DRG (diagnosis-related groups) system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also additional and innovation payments. This paper analyzes and evaluates the relevant developments of the G-DRG System 2010 for orthopedics and traumatology from the medical and classification perspectives. METHODS: Analyses of relevant diagnoses, medical procedures and G-DRGs in the versions 2009 and 2010 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI) were carried out. RESULTS: The DRG catalog is has grown from 8 to 1,200 G-DRGs. A number of codes for surgical measures have been newly established or modified. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopedics and traumatology has been changed, especially in the areas of spinal surgery and surgery of the upper and lower extremities. The actual impact of the changes may vary depending on the individual hospital services. CONCLUSION: For the first time since the introduction of the G-DRG system, the pure numerical changes at the level of DRGs themselves are so marginal that only part of the DRG users in the hospitals will register them. The changes implemented not only a high selectivity between complex and less complex scenarios, but partly also unintended and unjustified revaluation of less complex measures. The G-DRG system has gained complexity again. Especially the G-DRG allocation of spinal surgery and multiple surgical interventions of the upper and/or lower extremities have reached such a complexity that only a few DRG users can follow them.

Comparison of vacuum-assisted closure to the antibiotic bead pouch for the treatment of blast injury of the extremity.

The surgical care of modern combatants involves treatment of massive extremity wounds from blast mechanism. Currently up to 70% of combat wounds are extremity related. Clinical outcomes for these patients are dependent on the care of these wounds. The Vacuum-Assisted Closure (VAC) Therapy system (KCI Inc, San Antonio, Texas) is ubiquitous in theater and is often considered the only way to treat these wounds. However, the VAC Therapy system is not without problems. It is expensive and requires extensive amounts of product and machinery, as well as functioning suction, and therefore a power source at all times. In addition, the VAC Therapy system requires a trained and vigilant nursing staff. We hypothesized that the antibiotic bead pouch would be a viable alternative to the VAC Therapy system for such blast injuries. We retrospectively analyzed 2 matched groups of 12 patients in terms of outcome and cost. We found that the VAC Therapy system produced more late methicillin-resistant Staphylococcus aureus infections (30%), more unanticipated returns to the operating room for wound problems (4:12 vs 0:12), and required more surgeries overall until closure of the wounds. In addition, the VAC Therapy system cost $12,000 more for 12 patients than the antibiotic bead pouch. We recommend the bead pouch be considered as an equivalent option to the VAC Therapy system in the treatment of blast injury.

[Primary definitive cast therapy on the upper and lower extremities. Indications and cost analysis]. / Primäre definitive Stützverbandbehandlung mit Softcast an der oberen und unteren Extremität. Anwendung und Kostenanalyse.

BACKGROUND: Soft cast (SC) is a semirigid cast material which opened new possibilities for fracture care in adults and children. The primary definitive cast technique (PDCT) with SC is a new casting method that uses a combination of fiberglass and polyurethane resin. Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. METHODS: Time, personnel, and material costs for producing plaster casts using the conventional technique (primary plaster cast and secondary hard cast, or POPHC) were prospectively compared with PDCT using SC on upper and lower extremities. RESULTS: Compared with PDCT, the costs for POPHC were always higher: 138% for upper arm casts, 142% for lower arm and scaphoid casts, 219% for ankle joint casts, 157% for ankle splints, 336% for first-toe bandage/orthesis, and 289% for geisha shoes. CONCLUSION: The procedure using PDCT with SC can contribute to cost savings and improve patient comfort.

Worker's compensation litigation of the upper extremity claim.

This article presents an overview of the issues presented to physicians and lawyers in evaluating, treating, litigating, and concluding an upper extremity workers' compensation claim. This analysis includes a review of the unique considerations involved in the workers' compensation patient/claimant, a general examination of workers' compensation law, and the interplay between litigation and the medical management of the patient.

[Prevention of work-related muscular-skeletal disorders of upper limbs: a social challenge and economic obligation]. / Prévenir les troubles musculosquelettiques du membre supérieur: un enjeu social et économique.

Work-related muscular-skeletal disorders of upper limbs (WRMSDul) represent 66% of all occupational injuries and diseases (OD). The total number of cases has multiplied by 8 over the past eleven years, and in 2002 there were 21126 OD incidents recorded. Although OD statistical data are not necessarily a truly precise reflection of the reality of associated risks, examination of these trends shows that over the past 10 years the most serious diseases, like rotator cuff tendonitis, have increased more rapidly than have the totality of WRMSDul cases as a whole. It is likely that the number of injured workers will continue to increase over the course of the coming years. An evaluation of indirect costs also demonstrates that there are significant social consequences associated with these diseases and which put into question the employability of the affected workers, who are often aged between 40 and 60 years old. This paper therefore brings to the surface the importance of prevention principles and proposes an ambitions prevention plan. This emblematic occupational health risk will constitute, along with professionally related cancers, one of the major challenges for prevention in the coming years.