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THE HIGH COST OF MUSCULOSKELETAL TRAUMA

Accidents, or unintentional injuries, are the fourth leading cause of death in the United States and the leading cause of death for those aged 1 to 44 years. As of 2015, motor vehicle accidents (MVAs) were the leading cause of death in humans in their first three decades, with 35,000 people killed and 2.3 million injured every year. Globally, approximately 1.3 million humans die every year and over 20 million sustain nonfatal injuries from road traffic accidents. In 2016, road traffic accidents were the eighth leading cause of death and estimated to be the fifth leading cause of death by 2030. The economic impact for MVAs is around $230 billion in the United States and €180 billion in the European Union. The global losses due to road traffic injuries are estimated to be $518 billion and cost governments between 1% and 3% of their gross domestic product.

In 2016, gunshot injuries were the third leading cause of all accidental, or unintentional, injury-related deaths in the United States. There are 60,000 to 80,000 nonfatal gunshot wounds annually in the United States. In 2017, 39,773 persons died from gun-related injuries in the United States, with estimated lifetime medical costs over $2 billion.

In children, trauma is the leading cause of death and disability and accounts for approximately 11 million hospitalizations, 150,000 disabilities, and 15,000 deaths every year in the United States. Although direct costs of pediatric trauma exceed $8 billion per year, indirect costs to families and society are impossible to estimate but are undoubtedly substantial.

With an unprecedented increase in population and life expectancy, age-related musculoskeletal conditions, such as fragility fractures and sports-related ligamentous injuries, are now more common as well. Approximately 1.6 million hip fractures occur worldwide each year. By 2050, this number is expected to increase three- or four-fold. According to the National Osteoporosis Foundation, in 2018, the cost of osteoporosis-related fractures to the health care system was $52 billion. Another national health care issue is opioid abuse, which had an economic burden of approximately $78.5 billion in the United States in 2013. Implementation of new laws at the state and national level are attempting to curb opioid abuse, mortality, and the cost to the health care system.

Both natural and manmade disasters have caused hundreds of thousands of casualties and disabilities over the past 20 years, and the World Health Organization estimates an overall increase over the next two decades. Although true mass casualty situations are rare, the earthquake in Haiti in 2010 left 300,000 individuals injured. These situations require highly organized trauma systems for optimal outcomes.

While considering the cost of musculoskeletal injuries, the effects on the patient, family, and society should also be considered. Health care practitioners should keep in mind that there are direct expenditures for diagnosis, treatment, and rehabilitation as well as indirect economic costs ...

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