SYMPOSIUM: ABJS/C.T. BRIGHTON WORKSHOP ON TRAUMA IN THE DEVELOPING WORLD

Musculoskeletal injuries are a major public health problem globally, contributing a large burden of disability and suffering. This burden could be considerably lowered by implementation of affordable and sustainable strategies to strengthen orthopaedic trauma care, especially in lowand middle-income countries. This article summarizes the global burden of musculoskeletal injuries and provides several examples of successful programs that have improved care of injuries in health facilities in lowand middle-income countries. Finally, it discusses WHO efforts to build on the country experiences and to make progress in lowering the burden of musculoskeletal injuries globally. Introduction Injury has become a major cause of death and disability globally. This is true in countries at all economic levels. There is often a misperception that injuries are primarily a health problem of high-income countries. To the contrary, injury mortality rates are significantly higher in most lowand middle-income countries (LMICs). Mortality rates from injury are higher in LMICs compared with high-income countries (HICs) (Table 1). This is in part due to rising rates of injuries from increased use of motorized transport and also due to less developed trauma care systems [12]. The rates of injury have been coming down in HICs due to a combination of injury prevention and improved trauma care. At the same time, rates of injury-related death and disability have been steadily rising in most LMICs. As the world’s population primarily lives in LMICs, these trends have led to increasing rates of injury globally. If current trends continue, most injury-related causes of death will rise in their ranking of global disease burden. For every person who dies from injury, many more are injured, with temporary or permanent disability. We do not have as comprehensive global data for these non-fatal injuries as we do for death. However, the data that we do have are fairly unanimous and uncontroversial in showing a huge burden of disability from musculoskeletal injuries. Some of these data come from individual country studies, such as a population-based survey that showed that 0.83% of Ghanaians had an injury-related disability. The vast majority (78%) of such disabilities were due to extremity injuries. Such disabilities should be readily amenable to low-cost improvements in orthopaedic care and rehabilitation, in contrast to the more difficult to treat neurological injuries (head and spinal) that are relatively more frequent causes of disability in high-income countries [9]. The author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Presented in part at the ABJS/Carl T. Brighton Workshop on Musculoskeletal Trauma in Low and Middle Income Countries, Ahmedabad, India, December 11–14, 2007. Disclaimer: The authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization. C. Mock (&) Department of Violence and Injury Prevention and Disability, WHO, 20 Avenue Appia, 1211 Geneva 27, Switzerland e-mail: mockc@who.int M. N. Cherian Department of Essential Health Technologies, WHO, Geneva, Switzerland 123 Clin Orthop Relat Res (2008) 466:2306–2316 DOI 10.1007/s11999-008-0416-z