School of Population Health

International Orthopaedic Multicenter Study in Fracture Care (INORMUS)

Image - trafficGlobally, trauma is among the top three leading causes of death in the first four decades of life. For every death attributable to trauma, three patients survive but are permanently disabled. Majority of trauma results from road traffic injuries, which are disproportionately high in low to middle income countries (LMICs): over 90% of road traffic deaths occur in LMICs, which account for 84% of the world’s population. Musculoskeletal injuries are common manifestations of trauma, occurring in over 60% of injured people. Despite the magnitude of this problem, the burden of musculoskeletal injuries remains unknown in LMICs.

To address this knowledge gap, a global research initiative, spanning 3 continents, was set up in 2015. The International Orthopaedic Multicenter Study in Fracture Care (INORMUS) is an observational study across 18 countries and 40 clinical sites, with over 40,000 participants. This research is investigating fracture care pathways and recovery outcomes in patients in Asia, Latin American and Africa. Professor Rebecca Ivers, head of the School of Population Health, UNSW, is one of the study Principal Investigators and leads the Asian methods centre for the study (based at the George Institute for Global Health), funded by an National Health and Medical Research Council of Australia project grant, which she leads.

INORMUS seeks to determine:

  • the incidence of major complications (mortality, re-operation, and infection) following a musculoskeletal injury, and
  • factors associated with these major complications in LMICs

Funded by the National Health and Medical Research Council, the project has enrolled trauma patients across clinical sites in the said continents. Patients diagnosed with an acute fracture, dislocation, or fracture dislocation of the appendicular skeleton (upper and lower extremities, shoulder girdle, and pelvic girdle) or spine are being observed.

“The INORMUS study will valuable new information about care of fractures in resource poor settings and provide insight into better ways of treatment”, says Prof Ivers, summarising the objective of this project.

This large prospective observational study coincides with the World Health Organization’s Global Road Traffic Safety Decade (2011-2020) and other international efforts to reduce the burden of injury on developing populations. In contrast to the declining rates of injury seen in Western countries, low-middle income countries (LMICs) are experiencing an increase in injury rates, largely due to increased motorization in these countries.

Previous attempts to characterize the fracture burden in many of these countries have proven inadequate because most LMICs lack prospective registries to document the volume of injuries, the treatments chosen, and the outcomes achieved. Of the studies that have been performed, most have been limited by insufficient sample size, scope, and generalizability. As a result, the true burden of orthopaedic injuries in many countries remains to be explored. Identification of common trends in diagnosis, management, complications, and outcomes of orthopaedic trauma is the first step toward resolving disparities in global fracture burden.

To date over 37,000 participants have now been recruited across Asia, Africa and Latin America. Read more about INFORMUS.

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