Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000-2005

Abstract

BackgroundThe epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population.MethodsA 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases.ResultsDuring 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle.ConclusionsIn Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure.

Cost analysis and outcomes of simple elbow dislocations

“…The current literature is limited in terms of the health economics of treating simple elbow dislocations. To the best of our knowledge there is only one study by Yang et al [3] reporting on the direct medical costs of these injuries. More specifically, the authors published a retrospective series of 428 simple and complex elbow dislocations treated in Taiwan, calculating the direct medical cost to be $504 per patient (included inpatient expenditure by admission and ambulatory care expenditure by visit) [3] .…”

“…Yet, our findings are in line with the literature, thus providing sufficient evidence to support changes even with comparatively low numbers. Another limitation is the fact that elbow "stiffness" and loss of function was defined as an arc of elbow motion less than 100°[ 3,5,[15][16][17][18][19] . Nevertheless, recent studies report that the functional elbow range of motion that is necessary for activities of daily living may actually be greater than this [25] .…”

“…In the United States population alone, the incidence of elbow dislocation has been reported as high as 5.21 per 100000 habitants, with males 10-19 years of age, having the highest risk for dislocation [2] . Seventeen per cent of these dislocations are associated with fractures [3] , with nearly half of them occurring in sports [2] . Falls represent the primary mechanism of injury being responsible for 56.5% of elbow dislocations overall [2] .…”

“…The primary functional outcome has been defined as achieving early active motion within the limits of pain with or without the use of a sling or a hinged brace [5,10] . Numerous complications of simple elbow dislocation have been described including neurovascular injury, joint instability, heterotopic ossification, occult distal radio-ulnar joint disruption and post-traumatic stiffness, most commonly defined as an arc of elbow motion less than 100°[ 3,5,[15][16][17][18] . Biomechanical studies have shown that arcs of motion between 30° to 130° are required for most daily activities [19] and that a loss of 50° in the arc of motion, can cause up to an 80% loss of function [18] .…”

Sex differential association of dermatomyositis with Sjögren syndrome

“…This representative national sample has comparable distribution in age, sex or mean insured payroll-related amount between the claimants in the sampled data and the original NHIRD. 26 Under NHI regulations, insured beneficiaries who have catastrophic diseases, including dermatomyositis and Sjögren syndrome, can apply for registration in the Registry of Catastrophic Illness. If registration is approved, copayment is waived.…”