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 Trauma Test 3: Topics of Interest
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:290-297 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

The Incidence of Fractures and Dislocations Referred for Orthopaedic Services in a Capitated Population

Mark R. Brinker, MD1 and Daniel P. O'Connor, PhD1

1 The Center for Musculoskeletal Research and Outcome Studies (M.R.B.), Fondren Orthopedic Group (M.R.B.), and Joe W. King Orthopedic Institute (M.R.B. and D.P.O'C.), Texas Orthopedic Hospital (M.R.B. and D.P.O'C.), 7401 South Main Street, Houston, TX 77030. E-mail address for M.R. Brinker: brinker{at}jwkoi.com

Investigation performed at The Center for Musculoskeletal Research and Outcome Studies, Fondren Orthopedic Group, and Joe W. King Orthopedic Institute at Texas Orthopedic Hospital, Houston, Texas

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to determine the annual incidence rates of non-work-related traumatic fractures and dislocations (excluding head and facial injuries) referred for orthopaedic services in a large population enrolled under a capitated insurance contract.

Methods: The number of fractures and dislocations that were referred for orthopaedic services were recorded prospectively from among an average of 135,333 persons per year who were enrolled under a capitated insurance contract during the three-year study period. These data were used to determine the gender-specific and age-specific incidence rates of fractures and dislocations referred for orthopaedic services.

Results: A total of 3440 fractures and 422 dislocations were referred for orthopaedic services during the three-year study period. The incidence rate of fractures referred for orthopaedic services was 8.47 per 1000 member-years, with a significantly (p < 0.0001) higher rate among males. Members between the ages of ten and fourteen years had the highest rate of fractures referred for orthopaedic services (21.52 per 1000 member-years). The lifetime risk of a traumatic fracture referred for orthopaedic services to the age of sixty-five years was one in two for both males and females. The incidence rate of dislocations referred for orthopaedic services was 1.04 per 1000 member-years, which did not differ significantly (p = 0.75) between genders. Members between the ages of fifteen and nineteen years had the highest rate of dislocations referred for orthopaedic services (2.75 per 1000 member-years). The lifetime risk of a traumatic dislocation referred for orthopaedic services to the age of sixty-five years was one in sixteen for both male and female members.

Conclusions: Young males had the highest rate of traumatic fractures referred for orthopaedic services. Adolescents of both genders had high rates of traumatic dislocations referred for orthopaedic services. The lifetime risk of a non-work-related fracture referred for orthopaedic services to the age of sixty-five years is approximately equal to that of coronary artery disease.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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