Objectives: To investigate the characteristics of age, gender, occupation, causes, propertiesb of bone fracture in the motor organs at 103 Military Hospital. Subjects and methods: A crosssectional study, retrospective secondary data on 4,918 records of patients of all ages with bone fracture in the motor organs, who entered 103 Military Hospital in emergency or for treatment for the first time in January 2010 to December 2014.
Journal of military pharmaco-medicine no1-2018 SOME EPIDEMIOLOGICAL CHARACTERISTICS OF BONE FRACTURE OF MOTOR ORGANS IN YEARS AT THE 103 MILITARY HOSPITAL Nguyen Huu Chien*; Pham Dang Ninh*; Nguyen Tien Binh** SUMMARY Objectives: To investigate the characteristics of age, gender, occupation, causes, properties of bone fracture in the motor organs at 103 Military Hospital Subjects and methods: A crosssectional study, retrospective secondary data on 4,918 records of patients of all ages with bone fracture in the motor organs, who entered 103 Military Hospital in emergency or for treatment for the first time in January 2010 to December 2014 Results: The average age of bone fractured patients was 39.7 ± 18.2 The working age group of 20 - 59 years old accounted for the highest rate (74.1%) 69% were males, 31% females The rate of traffic accidents in men was 47.4%, 43.3% for women meanwhile occupational accidents were found in 11.9% for men and 4.3% for women Distribution of fractures by occupation: Farmers accounted for the highest percentage (27.6%), followed by freelance workers (20.2%), workers (17.8%), officials (17.0%), students (13.5%) and the lowest was soldiers (3.9%) The number of patients with one fractured bone occupied the highest proportion (90.42%) whereas two fractured bones were only in 8.03% Conclusions: Bone fractures can occur at any ages, gender, occupation with difference causes The percentage of open, closed fractures and types of bone fracture also can differentiate statically * Keywords: Bone fracture; Motor organs; Epidemiological characteristics INTRODUCTION Bone fracture of the motor organs such as spinal fracture, pelvic bone fracture, or fracture of the extremities not only has a significant impact on the health and the wealth of the people but also causes urgent social issues There are many causes of bone fractures, and the rate of fracture can vary from one country to another In developed countries, the most common causes of fracture are daily activities, athletes overtraining; while in Vietnam the most common causes of fracture are traffic and occupational accidents [3, 7] In the world, there are comprehensive studies on epidemiological characteristics of bone fracture in specific countries and regions to provide important information for prevention and treatment planning of accidents [8, 9] * 103 Military Hospital * Vietnam Military Medical University Corresponding author: Nguyen Huu Chien (nhchienkhth@gmail.com) Date received: 20/10/2017 Date accepted: 18/12/2017 172 Journal of military pharmaco-medicine no1-2018 In Vietnam, there have been a number of general studies on the epidemiological characteristics of accidental injuries, but there are very few specific studies of the epidemiological characteristics of bone fracture of the motor organs Therefore, we conducted this study in order to: Investigate the characteristics of age, gender, occupation, causes, properties of bone fracture in the motor organs * Selection of research samples: - Sample selection criteria: Clear, informative records of all patients of all ages with bone fracture in motor organs alone or in combination with other lesions - Exclusion criteria: The patient records without sufficient research information; records of patient entered the hospital for the repeated treatment; patients with disease-induced bone fracture; patients with skull trauma, spinal trauma or pelvic bone fracture alone; patients with bone fracture who died before getting to the hospital SUBJECTS AND METHODS Subjects All the records of patients of all ages with bone fracture in the motor organs, who entered 103 Military Hospital in emergency or for treatment for the first time in January 2010 to December 2014 Data processing methods Data from patient records were collected in the form of raw data sheets, then processed and analyzed according to research objectives by SPSS 22.0 software Methods * Study design: Cross-sectional study, retrospective secondary data RESULTS AND DISCUSION Characteristics of the subjects Table 1: Distribution of subjects by age and sex (n = 4,918) Ages Male Female Total p-values n % n % n % - 19 414 12.2 124 8.1 538 10,9 0.000 a 20 - 29 992 29.2 242 15.9 1,234 25.1 0.000 a 30 - 39 667 19.6 244 16.0 911 18.5 0.003 a 40 - 49 552 16.3 232 15.2 784 15.9 0.331 a 50 - 59 461 13.6 254 16.7 715 14.5 0.004 a 60 - 69 186 5.5 207 13.6 393 8.0 0.000 a 70 - 79 76 2.2 108 7.1 184 3.7 0.000 a 80 - 99 47 1.4 112 7.4 159 3.2 0.000 a Total 3,395 69.0 1,523 31.0 4,918 100.0 0.000 e X ± SD (Min - max) 36.5 ± 16.3 (1 - 97 ) 46.7 ± 20.1 (2 - 99) 39.7 ± 18.2 (1 - 99) (a: Chi-squared test; e: Mann-Withney test) 173 Journal of military pharmaco-medicine no1-2018 The average age of patients was 39.7 ± 18.2 years old (from - 99) The average age of females was 46.7 ± 20.1 years old which is significantly higher than that of male patients (46.5 ± 20.1 years old) (p < 0.01) Chinh et al (2011) [5] on 62,229 injuries in the Viet-Germany Hospital showed that patients aged from 20 to 60 years old accounted for 71.1% and patients under 15 years old accounted for 9.9% Le Quang Anh (2012) [6] found that patients in working age accounted for 78.41% (from 19 to 60 years old) Nguyen Thi Nhu Tu et al [7] reported that the average age was 30.6 ± 15.6 (from to 90 years); the most common age was from 16 to 30 years old (51.7% for males and 48.2% for females) Ameri M et al (2016) [8] studied 2,480 patients (29.9 ± 17.8 years) who were treated at ShafaYahyaeian Hospital (Tehran, Iran) (2013 - 2013), there were 685 patients with lower limb bone fracture (male: 73% and female: 27%) The working group aged from 20 to 59 years old accounted for the highest rate (74.1%), of which, the age from 21 to 30 constituted the highest rate (25.1%) and the patients from 31 to 40 years old was found in 18.5% Since the people of these ages travel and work more, therefore the rates of traffic and labor accidents are higher The age difference in the two groups of men and women was significantly different (p < 0.01) Research by Nguyen Duc Table 2: Distribution of subjects by accidents and sex (n = 4,918) Male Female Total Type of accident p-values n % n % n % 403 11.9 66 4.3 469 9.5 Traffic accident 1,609 47.4 659 43.3 2,268 46.1 Others 1,383 40.7 798 52.4 2,181 44.4 3,395 69.0 1,523 31.0 4,918 100,0 Working accident Total < 0.01 (a: Chi-squared test) The rate of men with occupational accidents and traffic accidents were 11.9% and 47.4%, respectively, which were higher than that of women (occupational accidents 4.3% and traffic accidents 43.3%) (p < 0.01) With other types of accidents, female patients accounted for 52.4%, higher than male patients (40.7%) (p < 0.01) 174 According to the WHO report, the global trauma-induced fatality of men doubles that of women Do Van Dung et al (2003) [9] examined the trauma prevalence in the South East provinces and found that the rate traffic trauma in men (n = 9,456, 17.8/1,000, 95%CI: 15.3 - 20.6) was almost twice as high as Journal of military pharmaco-medicine no1-2018 that in women (n = 9,697; 10.1/1,000: 95%CI: 8.3 - 12.3) It is supposed that the cause of fractures in men due to traffic accidents was mainly associated with drinking alcohol, high speed driving On the other hand, men often more heavy, dangerous jobs than women, so the occupational accident rate is also higher According to the study, the number of patients with traffic accidents was the highest (47.7%), followed by daily accidents (43.6%) and at least occupational accidents (8.7%), which is similar to some studies by other authors For fractures in the upper and lower extremities, traffic accidents also accounts for the highest percentage Le Thai Ha (2014) studied 58 patients with tibial fractures found 89.7% of traffic accidents and 10.3% daily accidents Hoang Duc Thai (2016) in a study on 99 cases of fractures found the main cause was due to traffic accidents (92.9%) According to Ameri M et al (2016) [8], the mechanism of traumatic injury in male patients was local falls (34.8%), direct trauma (24.6%), motorcycle accident (10%), fall from buildings (7.9%) The most common mechanisms of traumatic injury in female patients were local falls (54.2%), direct trauma (15.8%) and fall from buildings (7.5%) Table 3: Distribution by occupation (n = 4,918) Male Occupation Female Total n % n % n % Farmer 787 23.2 572 37.6 1,359 27.6 Worker 724 21.3 151 9.9 875 17.8 Official 556 16.4 280 18.4 836 17.0 Student 505 14.9 160 10.5 665 13.5 Soldier 181 5.3 10 0.7 191 3.9 Freelance workers 642 18.9 350 23.0 992 20.2 3,395 69.0 1,523 31.0 4,918 100.0 Total Farmer patients accounted for the highest proportion (27.6%) and soldiers occupied the lowest rate of 3.9% Nguyen Thi Nhu Tu et al (2012) showed that farmers (41%), workers (15.3%) and children (3%) Farmers (27.7%) and freelance workers (21%), followed by workers (13.7%), traffic participants (10%); pupils, students, civil servants and housewives made up about 6% Huynh Thi Kim Khoi (2015) [11]: 38.0% were farmers, 17.5% were self-employed, followed by students (12.7%), workers, civil servants, pensioners and housewives (5.5%) Le Van Sen (2015) [12]: farmers constituted 38.2%, followed by other occupations (elderly, children, nonworking) (23.1%), traffic participants (16.9%) and the lowest was found in housewives (2.5%) 175 Journal of military pharmaco-medicine no1-2018 Traffic accident was the leading type of injury in all occupations and was the most common in farmers (52.3%) Fall was the most common type of trauma and was frequently encountered in other occupations (44.4%) Some characteristics of bone fracture patients in motor organs Table 4: Relationship between number of fractured bone patients and fracture condition (n = 4,918) Number of fractured bones Open fracture patients Closed fracture patients p-values Total n % n % n % bone 1,071 86.86 3,376 91.61 4,447 90.42 bones 137 11.11 258 7.0 395 8.03 ≥ bones 25 2.02 51 1.38 76 1.55 1,233 25.1 3,685 74.4 4,918 100.0 Total < 0.01 (a: Chi-squared test) The number of patients with one fractured bone was the highest (90.42%) whereas 8.03% of the patients had fractured bones The patients with or more fractured bones accounted for 1.55% In group with one bone fracture, the rate of closed fracture was higher than open fracture, but in group with two bone fractures, the rate of open fracture was higher than closed fracture (p < 0.01) With fractures of more than two bones, the incidence of closed fractures and open fractures was statistically insignificant, with p > 0.05 There was no significant difference in the rate of closed fracture and open fracture (p > 0.05) Figure 1: Distribution of patients by site and type of fracture 176 Journal of military pharmaco-medicine no1-2018 Open fracture of leg bones (40.9%) had the highest incidence of fractures, followed by closed thigh bone fracture (28.9%), open forearm bone fracture (13.6%), hand and fingers fracture (20.7%), foot and toes fracture (10%) We did not experience any fractures in the spine The above chart shows that the highest rate was fracture of the two tibias in which the rate of open two-tibia fracture (40.9%) was significantly higher than that of closed two-tibia fracture (22.1%) Closed fracture of femur ranked second (28.9%), in which closed femur fracture accounted for 13.1% Fracture of the hand and finger bone accounted for 20.7%, ranked the third among the most common types of bone fracture Forearm bone fracture accounted for 13.6% Fracture of the foot and toe bone accounted for 10% Research by Nguyen Thi Chinh et al (2013) on a study of 289 cases treated at Ducgiang Hospital showed that the location of injuries was chiefly in the limbs (the lower limb was high with 122 cases and over 80 cases) CONCLUSION Studying some epidemiological characteristics of bone fracture in motor organs in 103 Military Hospital in years (1 - 2010 to 12 - 2014), we found: - Fractures can occur at any age, the average age was 39.7 ± 18.2 (from to 99 years) The average age of women was 46.7 ± 20.1, the average age of men was 36.5 ± 16.3 years The working age group of 20 - 59 years old accounted for the highest rate (74.1%) Males outnumbered females with the corresponding rates of 69% and 31% The rate of traffic accidents was 47.4% for men, 43.3% for women; meanwhile 11.9% of men and 4.3% of women suffered from occupational accidents - Distribution of fractures by occupation: Farmers accounted for the highest percentage (27.6%), freelance workers (20.2%), workers (17.8%), officials (17,0%), students (13.5%) and the lowest was soldier (3.9%) - The number of patients with one fractured bone accounted for the highest proportion (90.42%), followed by two fractured bones with 8.03% REFERENCES Dang Hanh De, Nguyen Duc Phuc et al Traumatic injury emergency medicine Medical Publishing House Hanoi 2006 Nguyen Duc Chinh, Tran Van Oanh, Tran Tuan Anh et al Emergency situation of accidental injury in Viet-Germany Hospital 2009 - 2010 Journal of Practical Medicine 2006, 10 (787), pp.7-9 Le Quang Anh Study on situation of accidental injury in the Longthanh and Nhontrach communities in 2011 Journal of Practical Medicine 2012, 12 (854), pp.57- 59 Nguyen Thi Nhu Tu, Ngo Van Toan, Vo Hong Phong Research on causes of traffic accidents in Binh Dinh province in 2011 Journal of Practical Medicine 2012, (838), pp.43-45 177 Journal of military pharmaco-medicine no1-2018 Do Van Dung, Phan Hong Minh, Dang Hai Nguyen et al Traumatic situation in South East Provinces Journal of Medical Research Hochiminh City Medicine 2003, Vol 7, Supplement of No 1, pp.17- 24 Nguyen Thi Truc Linh Current status of alcohol use, injury status and treatment cost of road traffic accident patients in Emergency Department, Nguyen Dinh Chieu Hospital, Bentre province Master Thesis Hanoi University of Public Health 2014 Court Brown C M, Caesar B Epidemiology of adult fractures: A review Injury 2006, 37, pp.691-697 178 Burns S.T, Gugala Z, Jimenez C.J et al Epidemiology and patterns of musculoskeletal motorcycle injuries in the USA F1000Res 2016, 12 (4), p.114 Court Brown C.M Caesar B Epidemiology of adult fractures: a review Injury 2006, 37, pp.691-697 10 Ameri M, Aghakhani K, Mehrpisheh S et al Epidemiological review of relation between gender and traumatic injuries in hospitals in Iran Glob J Health Sci 2016, (12), 55504 ... studies of the epidemiological characteristics of bone fracture of the motor organs Therefore, we conducted this study in order to: Investigate the characteristics of age, gender, occupation,... properties of bone fracture in the motor organs * Selection of research samples: - Sample selection criteria: Clear, informative records of all patients of all ages with bone fracture in motor organs. .. Some characteristics of bone fracture patients in motor organs Table 4: Relationship between number of fractured bone patients and fracture condition (n = 4,918) Number of fractured bones Open fracture