Grant: Operating Grant

Trauma is the leading cause of death in the first four decades of life surpassed only by cancer and atherosclerosis. For every person killed as a result of an injury, multiple individuals are left permanently disabled. The vast majority of trauma occurs outside of North America. Musculoskeletal injuries, such as fractures and dislocations, are very common manifestations of trauma occurring in over 60% of victims. Orthopaedic injuries are likely the greatest trauma burden worldwide; however, large prospective studies evaluating musculoskeletal injury burden in developing nations are limited due to poor resources and high trauma volumes. Given the degree of human suffering and societal costs associated with musculoskeletal trauma, there is a need to identify modifiable factors associated with complications. We propose the International Orthopaedic Multi-centre Study in Fracture Care (INORMUS) which is a large prospective cohort study of 40,000 men and women with musculoskeletal trauma in low-middle countries (LMICs). The purpose of INORMUS is to determine the frequency of major complications (i.e. deaths, re-operations, and infections) following a musculoskeletal injury (i.e. fracture of a bone or dislocation of a joint), and to determine factors associated these major complications. INORMUS will include 40 clinical sites from China, Africa, India/Nepal, Southeast Asia, and Latin America. Our proposal is strengthened by a simple design, our ability to recruit a sufficiently large sample of patients in countries with high volumes of musculoskeletal trauma, a qualified and highly collaborative international team of researchers and surgeons, and a successful pilot feasibility study. The results of INORMUS will not only inform prognostic factors for outcomes following orthopaedic injuries in LMICs, but provide important insight towards the development of clinical trials to test simple, life and limb saving interventions applicable to injured patients around the world.