title: Estimating the global incidence of femoral fracture from road traffic collisions: a literature review.
abstract: BACKGROUND
  Worldwide, road injuries cause over 1.3 million deaths and many more disabilities annually, disproportionately affecting the young and the poor. Approximately one in ten road injuries involves a femoral shaft fracture that is most effectively treated with surgery. Current femoral shaft fracture incidence according to country and age group is unknown and difficult to measure directly but is critical to designing and evaluating interventions.
  
  
  METHODS
  We modeled femoral shaft fracture incidence from road traffic collisions with use of World Bank, World Health Organization, and Global Burden of Disease Study data for 176 countries and five age groups. We used road traffic death rates, ratios of road traffic deaths to injuries, and proportions of road traffic injuries that were femoral shaft fractures to calculate the fracture incidence.
  
  
  RESULTS
  The worldwide annual femoral shaft fracture incidence from road traffic collisions was between 1.0 and 2.9 million. Incidence rates were significantly higher in low and middle income countries compared with high income countries. Overall, low and middle income countries had a mean femoral shaft fracture incidence between 15.7 and 45.5 per 100,000 people per year, with a rate ratio of 2.08 (95% confidence interval, 2.02 to 2.13; p < 0.001) relative to high income countries.
  
  
  CONCLUSIONS
  Our results demonstrate a substantial worldwide burden and disparities in femoral shaft fracture incidence between low to middle income and high income countries, and the young are disproportionately affected, underscoring the potential impact of improved access to treatment. We believe that the methodology of this study can be applied to estimate the burden of other diseases, allowing for better direction of global health efforts.
authors: Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
authors: Kiran J
authors: KJ
authors: Agarwal-Harding
authors: Program in Global Surgery and Social Change, Harvard Medical School (J.G.M. and S.L.M.G.), and Departments of Anesthesia and Surgery (D.Z.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.
authors: John G
authors: JG
authors: Meara
authors: Program in Global Surgery and Social Change, Harvard Medical School (J.G.M. and S.L.M.G.), and Departments of Anesthesia and Surgery (D.Z.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.
authors: Sarah L M
authors: SL
authors: Greenberg
authors: International Pediatrics and Pediatric Surgery, Department of Clinical Sciences, Lund University Children's Hospital, Box 117, SE-221 00 Lund, Sweden.
authors: Lars E
authors: LE
authors: Hagander
authors: Program in Global Surgery and Social Change, Harvard Medical School (J.G.M. and S.L.M.G.), and Departments of Anesthesia and Surgery (D.Z.), Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.
authors: David
authors: D
authors: Zurakowski
authors: Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address: gdyer@partners.org.
authors: George S M
authors: GS
authors: Dyer
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D005264:Femoral Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult