Financial burden of orthopaedic gunshot-related injury management at a major trauma centre

Background. Violence and injuries are a significant global public health concern, and have a substantial emotional, physical and economic impact on society. In South Africa (SA), the Western Cape Injury Mortality Profile shows that homicides increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016. This increase is directly related to an increase in firearm-related homicides, which doubled from 2010 to 2016. Previous research estimated the average cost per gunshot wound (GSW)-related orthopaedic patient at USD2 940. GSW-related patient numbers as well as treatment costs have escalated exponentially over the past few years.Objectives. To calculate the financial costs involved in managing gunshot-related orthopaedic injuries both surgically and non-surgically at a tertiary centre in SA.Methods. After ethics approval, a retrospective review of all GSW patients seen in the emergency unit at Tygerberg Hospital in 2017 was undertaken. Patient records yielded data on the following parameters: injury site and characteristics, imaging modalities, orthopaedic management, hospital admission and duration of hospitalisation, theatre episodes, orthopaedic implants and blood products administered. Cost analysis was performed using this information.Results. A total of 389 patients (360 male and 29 female), average age (range, standard deviation) 28 (3 - 69, 9.50) years, were treated during the study period. Patient records identified a total of 449 orthopaedic injuries. A total of 187 patients were admitted, with 175 requiring surgical fixation. The conservatively calculated cost of managing this patient group was ZAR10 227 503. The average management cost per patient was ZAR26 292, with an average of ZAR46 670 per case requiring surgical management and ZAR8 810 for non-surgical cases (the average USD-ZAR exchange rate in 2017 was USD1-ZAR13.30).Conclusions. The total cost of managing 389 patients with gunshot-related orthopaedic injuries at a tertiary hospital was ZAR10 227 503. Improved understanding of these costs will help the healthcare system better prioritise orthopaedic trauma funding and training and highlights the urgent need for cost-saving measures, specifically primary prevention initiatives

Financial burden of orthopaedic gunshot-related injury management at a major trauma centre

CITATION: Van Heukelum, M. et al. 2020. Financial burden of orthopaedic gunshot-related injury management at a major trauma centre. South African Medical Journal, 110(9):882-886, doi:10.7196/SAMJ.2020.v110i9.14638.The original publication is available at http://www.samj.org.zaBackground: Violence and injuries are a significant global public health concern, and have a substantial emotional, physical and economic impact on society. In South Africa (SA), the Western Cape Injury Mortality Profile shows that homicides increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016. This increase is directly related to an increase in firearm-related homicides, which doubled from 2010 to 2016. Previous research estimated the average cost per gunshot wound (GSW)-related orthopaedic patient at USD2 940. GSW-related patient numbers as well as treatment costs have escalated exponentially over the past few years. Objectives: To calculate the financial costs involved in managing gunshot-related orthopaedic injuries both surgically and non-surgically at a tertiary centre in SA. Methods: After ethics approval, a retrospective review of all GSW patients seen in the emergency unit at Tygerberg Hospital in 2017 was undertaken. Patient records yielded data on the following parameters: injury site and characteristics, imaging modalities, orthopaedic management, hospital admission and duration of hospitalisation, theatre episodes, orthopaedic implants and blood products administered. Cost analysis was performed using this information. Results: A total of 389 patients (360 male and 29 female), average age (range, standard deviation) 28 (3 - 69, 9.50) years, were treated during the study period. Patient records identified a total of 449 orthopaedic injuries. A total of 187 patients were admitted, with 175 requiring surgical fixation. The conservatively calculated cost of managing this patient group was ZAR10 227 503. The average management cost per patient was ZAR26 292, with an average of ZAR46 670 per case requiring surgical management and ZAR8 810 for non-surgical cases (the average USD-ZAR exchange rate in 2017 was USD1-ZAR13.30). Conclusions: The total cost of managing 389 patients with gunshot-related orthopaedic injuries at a tertiary hospital was ZAR10 227 503. Improved understanding of these costs will help the healthcare system better prioritise orthopaedic trauma funding and training and highlights the urgent need for cost-saving measures, specifically primary prevention initiatives.http://www.samj.org.za/index.php/samj/article/view/13068Publisher's versio

Fitness and body composition profiling of elite junior South African rugby players

Objective. The aim of this study was to describe the body composition, strength and speed characteristics of elite junior South African rugby players. Design. Cross-sectional. Setting. Field study. Subjects. Rugby players (16 and 18 years old, N = 174) selected for the South African Rugby Union National Green Squad. Outcome measures. Body composition, 10 m and 40 m speed, agility, 1RM bench press, underhand pull-ups, push-ups, multistage shuttle run. Results. The under-16 players were on average shorter (175.6 ± 5.7 v. 179.2 ± 6.7 cm), weighed less (76.5 ± 8.2 v. 84.8 ± 8.3 kg) had less upper body absolute strength (77.1 ± 11.8 kg v. 95.3 ± 16.7 kg) and muscular endurance (41 ± 12 v. 52 ± 15 push-ups) and aerobic fitness (87.1 ± 19.4 v. 93.5 ± 15.3 shuttles) than the under-18 players. There were no differences in body fat, sprinting speed (10 m and 40 m) or agility between the two age groups. There were differences between playing positions, with the props having the most body fat, strongest upper bodies, slowest sprinting speed, least agility and lowest aerobic capacity compared with players in the other positions. Conclusion. This study provides data for elite junior rugby players and can be used to monitor the progression of players after intervention while also assisting with talent identification for the different playing positions

Fitness and body composition profiling of elite junior South African rugby players

Objective. The aim of this study was to describe the body composition, strength and speed characteristics of elite junior South African rugby players. Design. Cross-sectional. Setting. Field study. Subjects. Rugby players (16 and 18 years old, N = 174) selected for the South African Rugby Union National Green Squad. Outcome measures. Body composition, 10 m and 40 m speed, agility, 1RM bench press, underhand pull-ups, push-ups, multistage shuttle run. Results. The under-16 players were on average shorter (175.6 ± 5.7 v. 179.2 ± 6.7 cm), weighed less (76.5 ± 8.2 v. 84.8 ± 8.3 kg) had less upper body absolute strength (77.1 ± 11.8 kg v. 95.3 ± 16.7 kg) and muscular endurance (41 ± 12 v. 52 ± 15 push-ups) and aerobic fitness (87.1 ± 19.4 v. 93.5 ± 15.3 shuttles) than the under-18 players. There were no differences in body fat, sprinting speed (10 m and 40 m) or agility between the two age groups. There were differences between playing positions, with the props having the most body fat, strongest upper bodies, slowest sprinting speed, least agility and lowest aerobic capacity compared with players in the other positions. Conclusion. This study provides data for elite junior rugby players and can be used to monitor the progression of players after intervention while also assisting with talent identification for the different playing positions. South African Journal of Sports Medicine Vol. 18 (2) 2006: pp. 38-4

Acetabular fractures following rugby tackles: a case series

<p>Abstract</p> <p>Introduction</p> <p>Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury.</p> <p>Case presentation</p> <p>In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences.</p> <p>Conclusion</p> <p>Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting 'the tackle' to only two players may well reduce the likelihood of this life-altering injury.</p

Incidence, severity, aetiology and type of neck injury in men's amateur rugby union: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>There is a paucity of epidemiological data on neck injury in amateur rugby union populations. The objective of this study was to determine the incidence, severity, aetiology and type of neck injury in Australian men's amateur rugby union.</p> <p>Methods</p> <p>Data was collected from a cohort of 262 participants from two Australian amateur men's rugby union clubs via a prospective cohort study design. A modified version of the Rugby Union Injury Report Form for Games and Training was used by the clubs physiotherapist or chiropractor in data collection.</p> <p>Results</p> <p>The participants sustained 90 (eight recurrent) neck injuries. Exposure time was calculated at 31143.8 hours of play (12863.8 hours of match time and 18280 hours of training). Incidence of neck injury was 2.9 injuries/1000 player-hours (95%CI: 2.3, 3.6). As a consequence 69.3% neck injuries were minor, 17% mild, 6.8% moderate and 6.8% severe. Neck compression was the most frequent aetiology and was weakly associated with severity. Cervical facet injury was the most frequent neck injury type.</p> <p>Conclusions</p> <p>This is the first prospective cohort study in an amateur men's rugby union population since the inception of professionalism that presents injury rate, severity, aetiology and injury type data for neck injury. Current epidemiological data should be sought when evaluating the risks associated with rugby union football.</p