RESUMO
INTRODUCTION: Pelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures. MATERIALS AND METHODS: This retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay. RESULTS: Among a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6-12 months (2011: 24.7% vs. 9.5-16.9%; 2017: 26.1% vs. 6.1-11.0%) and >12 months (2011: 15.8% vs. 9.8-10.2%; 2017: 13.3% vs. 1.9-8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted 18,726,630 and 9637,189 in the periods 2011-2020 and 2017-2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was 19,079 for injuries from 2011 and 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures. CONCLUSIONS: Work-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.
Assuntos
Fraturas Ósseas , Fraturas do Quadril , Ossos Pélvicos , Fraturas da Coluna Vertebral , Humanos , Masculino , Seguro de Acidentes , Acetábulo/lesões , Estudos Retrospectivos , Fraturas do Quadril/complicações , Fraturas Ósseas/etiologia , Fraturas da Coluna Vertebral/complicações , Ossos Pélvicos/lesões , Acidentes , Fatores SocioeconômicosRESUMO
OBJECTIVE: To analyse the results after tibial plateau fractures with a focus on socioeconomic consequences. METHODS: On the basis of the data from the rehabilitation documentation of the German Statutory Accident Insurance (DGUV) on tibial plateau fractures (Code 83), a retrospective anonymised evaluation of the injuries which occurred in 2010 and 2016 was carried out. The registry data allowed subdivision into 3 groups: Medial, lateral and bicondylar tibial plateau fractures. The data have been analysed with regard to the following parameters: age, gender, treatment, time of return to work (AU), costs per case, total costs, workers compensation (MdE) and total payments. RESULTS: The analysis includes 1046 isolated tibial plateau fractures for 2010 and 1072 for 2016. In 2016, 798 fractures could be assigned to the medial, lateral or bicondylar fracture groups. In 551 cases, both condyles were involved. In another 221 cases, the lateral plateau and in 26 the medial plateau was injured. There were 476 (59.7%) men and 322 (40.4%) women. The mean age was 43.4 (SD ± 16.7) years with a peak of 180 cases in the 55-60 year subgroup and 98 aged 15-20 years. The mean age of the cases with isolated lateral plateau involvement was 48.1 (SD ± 13.8) and was 47.5 (SD ± 16.6) in those with medial plateau fractures and 41.4 (SD ± 17.2) years in the subgroup with bicondylar patterns. The mean time of return to work was 39.4 (SD ± 25.3) weeks for the bicondylar tibial plateau fractures, 28.1 (SD ± 27.2) weeks for the medial and 24.5 (SD ± 22.8) weeks for the lateral groups. For the 2016 group, the mean costs were 5212 for outpatient, 10358 for inpatient and 7622 for rehab costs per case (total costs over three years of 4247443 for outpatient and 7506508 for acute inpatient treatment). The highest costs per case were caused by the inpatient acute treatment of bicondylar tibial plateau fractures, at a mean of 22292 . 17.6% of the 2016 casualty group resulted in compensation of at least 20%. The treatment costs for the 2010 group over 9 years (2010-2019) amounted to 4190855 for outpatient treatments and 9565313 for inpatient treatments. In addition, compensations of 8632448 and lump-sum payments of 483289 were paid from 2010 to 2019. Over a period of 9 years, 456 (66%) of 692 patients needed another in patient follow-up treatment. A total of 51% (n = 353) needed these treatments within the first year. CONCLUSION: Tibial plateau fractures, in particular bicondylar tibial plateau fractures, show long-term, cost-intensive healing processes with reduced occupational capacity. Tibial plateau fractures are of economic importance in the statutory accident insurance in the long term. Preventive measures, optimal care and rehabilitation are therefore essential, together with innovative research to improve clinical outcomes.