MINISTRY OF EDUCATION

MINISTRY OF DEFENCE

AND TRAINING
VIETNAM MILITARY MEDICAL UNIVERSITY

NGUYEN HUU CHIEN

RESEARCH ON EPIDEMIOLOGICAL CHARACTERISTICS
AND THE FIRST AID STATUS OF BONE FRACTURES OF
MOTOR ORGANS IN PATIENTS TREATED AT 103
MILITARY HOSPITAL
Speciality: Surgery
Code: 9720104

SUMMARY OF MEDICAL DOCTORAL THESIS

HANOI - 2019


This research was carried out in
Vietnam Military Medical University

Supervisors:
1. Nguyen Tien Binh, M.D., Ph.D., Prof.
2. Pham Dang Ninh, M.D., Ph.D., Assoc.Prof.

Reviewer 1: Nguyen Van Thach, M.D., Ph.D., Assoc.Prof.
Reviewer 2: Nghiem Đinh Phan, M.D., Ph.D., Assoc.Prof.
Reviewer 3: Nguyen Thai Son, M.D., Ph.D., Assoc.Prof.

reduce the severity and mortality of injuries (Nguyen Thuy Quynh, 2013).
Bone fractures are interested in researchs by domestic and foreign
authors. In the world, most countries have accident and injury prevention
centers. In Vietnam, the aspects of injury prevention, the first aid of bone
fractures in motor organs has been noticed for about 10 years.
In order to have basic and systematic information of the epidemiological
characteristics and the first aid status of bone fractures in motor organs, this
reseach: “Research on epidemiological characteristics and the first aid
status of bone fractures in motor organs in patients treated at 103 Military
hospital” was perfomed with the following objectives:
1. To identify some epidemiological characteristics of fractures of
motor organs in patients treated at 103 Military hospital in the period of
2010 - 2014.
2. To survey the first aid status of bone fractures of motor organs in
patients treated at 103 Military hospital during this time.


2
2. Scientific significance
The thesis has provided data about some epidemiological
characteristics of motor fractures: results of age, gender and occupational
characteristics of fractured people; characteristics of causes and time of
fracture occurrence; fracture structural characteristics and fracture
properties ...
Furthermore, the thesis has provided information on the first aid status
of bone fractures in motor organs: the results of the proportion of patients
who were given first aid, the time from the accident to the emergency, the
means of transport, the rate of fracture were provided in accordance with
the principle.
3. Practical significance

morphology and properties, according to Quinquist and Hansen, AO
synthesis classification.
1.2. Epidemiological of bone fractures in motor organs
The bone fractures in motor organs has been studied by many authors in
the world such as China, Iran, India, Brazil, America... Johansen A. et al.
studied fractures in the emergency department of the Cardiff Royal Hospital
found that the fracture rate was 21.1 / 1000 people / year (male: 23.5 / 1,000
people / year; female : 18.8 / 1,000 people / year). The frequency of fractures
was similar to that of the US, Australia and Norway, but higher in the UK in
the 1960s (9 / 1,000 people / year) (Johansen A. et al, 1997). In Vietnam,
bone fractures in motor organs are the leading cause of death and disability.
The burden of disability in both sexes was 2.7 million YLD in 2008 (Hanoi
School of Public Health, 2011).
Studies showed that the fracture rate had very different points, the
difference was not only by age, gender, region, even by race, skin color.
Humerus fractures accounted for about 1-3% of the total fractures. The
forearm fractures accounted for about 1.2% of total fractures, the femoral
fractures accounted for about 0.9% of total fractures, spinal fractures
accounted for 3 - 4% of the total fractures ...
1.3. The status of first aid and diagnosis of factures in Vietnam
The emergency situation of transporting patients in different countries
in the world is very diverse in form, types of participating forces, levels
of training and service access time.


4
There are many methods of transporting patients to hospitals such as
simple vehicles (rudimentary vehicles, trailers...), motor vehicles
(motorcycles, cars, small buses ...) and modern, high-speed vehicles (plane).
Countries have been focused on training the first responders in the field of



5
Chapter 2. SUBJECTS AND METHODS
2.1. Subjects
4918 patients with bone fractures of motor organs who were treated at
103 Military Hospital during 5 years (2010-2014).
* Selection criteria:
- Patients with fractures of motor organs whose medical records have
fully and clearly information according to the form of research medical
records.
- Patients who were initially treated at 103 Military Hospital (underwent
first aid at the accident place or the medical facility or the regional clinic
after undergoing fractures), and never been treated at any other hospital.
- Patients were diagnosed with arm, forearm, metacarpal-phalange,
femoral, tibia, fibula, metatarsal-phalange, vertebral and pelvic fractures
combined or not with other lesions (X-ray film with fractures also required).
* Exclusion criteria:
- Patients was hospitalized for the second and third time treatment... since
having fractures.
- Did not have all the necessary information of the patients in the form of
research medical record.
- Patient suffered a fracture due to another condition.
- Patients with traumatic brain injury.
- Patients suffered a fracture but they died before going to the hospital.
2.2. Methods
2.2.1. Research design
Cross-sectional descriptive study with continued follow-up on all
fracture patients at the hospital.
2.2.2. Sample size and sampling method

2.2.3. Information collection method
The Toolkit used to collect information for the study is a research medical
record. This form was based on the research contents and objectives, has
been commented by experts in the specialized field and tested and revised
before officially conducting research.
2.2.4. Research variables
The general information of patients (age, gender, address, ethnicity,
religion, occupation, education level, cause of accident, type of vehicle, time
of accident, status before/after first aid and hospitalization), fracture position,
fracture, number of fractures, fractures characteristic: open fracture, joint
fracture, vascular injury, nerve damage, trauma, first aid place, time from
accident to first aid, first aid at grassroots health, first aid in emergency
room, first aid provider, fixed principles and means (length, firmness), pain
reduction, bandage wound, washing wounds, antibiotics and time of use,
injection of SAT and injection site, time from accident to hospital admission,
X-ray examination, diagnosis of grassroots health, clinics of 103 Military
Hospital and treated department, CT scanner / MRI.
2.2.5. Data processing methods


7
The data of the research records that were entered into the computer
by Excel software, were analyzed according to the research objectives
and processed by SPSS 22.0 software.
Apply descriptive statistical algorithms, calculate frequency, rate,
average and standard deviation, χ2 and p ... analyze the relationship
between variables.
2.2.6. Ethical issues of research
- Research protocol approved by the Ethics Council in Biomedical
Research of the Military Medical University.

242

Ages

30 – 39
40 – 49
50 – 59
60 – 69
70 – 79
80 – 99
Total
 ± SD
(Min – Max)

29,2

667
19,6
552
16,3
461
13,6
186
5,5
76
2,2
47
1,4
3.395 69,0
36,5 ± 16,3

18,5
784
15,9
715
14,5
393
8,0
184
3,7
159
3,2
4.918 100,0
39,7 ± 18,2
(1 – 99)

p-values
0,000a
0,000a
0,003a
0,331a
0,004a
0,000a
0,000a
0,000a
0,000e


8
a. Chi-squared test
e.Mann-Withney test

9.9
875
17.8
Official
556
16.4
280
18.4
836
17.0
Student
505
14.9
160
10.5
665
13.5
Soldier
181
5.3
10
0.7
191
3.9
Freelance
642
18.9
350
23.0
992

n

%

403

11.9

66

4.3

469

9.5

Car
Traffic
accident

Motorb
ike
Others

Total

95(4.2%)
1,609

47.4

100

1,523

100

4,918

100

The rate of patients with traffic accidents was the highest (46.1%),
accidents in other activities (44.4%) and occupational accidents (9.5%).
In traffic accidents groups, motorbike accidents accounted for the highest
proportion (89.6%), others (6.2%), cars (4.2%).
The rate of men with occupational accidents and traffic accidents
were 11.9% and 47.4% respectively, which were higher than that of
women (occupational accidents 4.3% and traffic accidents 43.3%)(p

Propotion
bones
patients
(%)
Total
4,918
100
The number of patients with one fractured bone was highest
(90.42%), the number of patients with 2 fractured bones was 8.03%, the
patients with 3 or more fractured bones accounted for 1.55%.
The combined lesions of common limb fractures were articular, major
vascular and nerve injuries. The rate of upper limb injuries ranged from
29.7% to 34.3%, of lower limb injuries ranged from 26.1% to 32.7%.
The rate of upper limb fractures with shock was 5.1%; the rate of
lower limb fractures with shock was 6.2%; The rate of fracture with
shock was 24.6%.
Table 3.5. Distribution of patients by site and type of fracture
Opened
Closed
Total
fracture
fracture
p(n=4,918)
(n=1,233)
(n=3,685)
values
n
%
n
%

7
13.
28.
Femur
162
1064
1226 24.9
0.0001
1
9
40.
22.
Tibia, fibula
505
816
1321 26.9
0.0001
9
1
Metatarsals,
10.
123
99
2.7
222
4.5
0.0001
phalanges
0
0.0

accounted for 20.7%, ranked the third among the most common types of
bone fracture. Opened forearm bone fracture accounted for 13.6%.
Opened fracture of the foot and toe bone accounted for 10%.
3.2. The first aid status of bone fractures in motor organs in patients
Table 3.5.Distribution of patients under went first aid by accident place
and by first aid place (n = 4,918)
Medical
Accident
Emergency
facilities
places
rooms
Accident
(n=480)
(n=3,179)
(n=1,259)
place
n
%
n
%
n
%
Urban
179
37.3
433
34.4
1,186
37.3

was highest percentage. Patients in high land who underwent first aid at
Vertebrae

0

0.0
0

544


12
accident places accounted for 3.1%, and patients in medical facilities
who underwent first aid in emergency rooms accounted for 2.7%, which
was lowest percentage. The difference between regions in terms of first
aid was statistically significant with p 15 – 30
182
3.7

Total
4,918
100
The above table shows that: the patients transportation from the
accident place to the following route were mostly motorcycles (54.8%),
automobiles (39.4%). 115 ambulance accounted for a very low rate
(1.6%).
Table 3.8. Distribution of first responders at the accident place (n =
480)
First responders
n
%
Non - medical staff
390
81.3


13
Medical staff
90
18.7
Total
480
100
The above table shows that: the rate of non - medical first responders
is high (81.3%). The rate of medical first responders is low (18.7%).
Table 3.9. Distribution of type of first aid methods by route
Acciden
Medical Emergenc
pt place

59.
55.
79
167
476
722
0.001
*)
2
5
0
9
33 70. 1,19 94. 2,78 87. 4,32 87.
Fixation
0.001
8
4
5
9
7
7
0
8
Antibiotic
20.
18.
17.
s and SAT
0 0.0
59

made splint, splint that was enough length, splint that was stabilized
accounted for 48.4%, 51.6%, 92.1% and 96.5%, respectively.
85.1% of patients received painkillers, of which 19.3% used oral
medicines, 80.7% used injections. 56.1% of painkillers were used before
giving fixation and 43.9% of them were used after giving
immobilization.
18.6% of patients were given antibiotic prophylaxis , of which 8.8% used
oral medicines and 91.2% used injections.
The percentage of opened and closed fracture patients with wound
software given SAT were 44.0% at medical facilities, 60.9% in emergency
rooms. There was not any cases given SAT at accident places.
The percentages of opened fracture patients given bandages and wound
washing were 55.2% at accident places, 48.5% at medical facilities and
59.0% in emergency rooms.


15
Chapter 4. DISCUSSION
4.1. Some epidemiological characteristics of fractures of motor
organs
- Age: Our research results were consistent with Bui Thi Tu Quyen's
research. In the author's study, the average age of 93 motorbike injury
victims was 36.2. Traffic injury victims were mainly in the age group 2140 (55%), and the age group under 20 accounts for 16%. The study of
Dong Ngoc Duc and colleagues showed an association between age and
risk of traffic accidents. The risk of traffic accidents of the group of under
20 years old was 5.47 times higher than that of the group of over 60 years
old, 5.73 times higher than that of the 20-39 year old group and 4.61
times higher than that of the 40-59 age group. Le Quang Anh's study
found that the age group 25-40 accounted for 57.8%; the 41-60 age group
accounted for 20%.

53.4
46.6
72.9
27.1

Bui Thi Tu Quyen (2004)

93

77,0

23,0

Luong Mai Anh (2012)
Dang Tuan An et al (2014)
Nguyen Huu Chien, 2019

2,036
385
4,918

63.1
74.6
69.0

36.9
25.4
31.0

We believed that men who participate in traffic had drunk alcohol,

Giang
Hospital

Traffic
accident

Occupational
accident

Accidents
in other
activities

7.55
1

75,3

24,5

0,3

717

51,1

29,6

1,0


the country and the rapid urbanization rate in the regions was an increase
in types of injuries. Currently, injury accidents increased in all areas of
social life, especially injuries. According to the study, the highest number
of fracture patients due to injuries accounted for the highest rate (46.1%)
and the number of fracture patients due to occupational accidents was the


17
lowest (9.5%). Our research results were similar to some studies of
domestic authors.
- Fractures location: The fracture rate in our study was also consistent
with some other studies. Nguyen The Do (2012) treated 128 patients with
closed humerus fractures which were combined with screws. The author
found that there were 127 lesions combined in 128 patients (99.2%).
Patients with multiple injuries including abdominal and chest injuries and
humerus fractures accounted for 20.3%. The software wound was the
most common (32.8%). Chest injury, rib fracture, pleural effusion and
pneumothorax accounted for 14.8%. Radius and ulna fractures on the
same side accounted for 10.9%. Fibula and tibia fracture accounted for
6.3%. The rate of radial nerve paralysis before surgery was 21.7%. The
most common radial nerve paralysis position was in the middle third
accounting for 11.6%, 1/3 (10.1%). Vascular injuries accounted for 2.3%.
Phan Quang Tri (2015) studied 102 cases with distal humerus fractures
showed that injuries in the left side accounted for 60.8% and injuries in
the right side accounted for 39.2%.
According to Gartland classification, most of them were type III
deviation (27.5% of type IIIA; 24.5% of type IIIB), followed by type II
(40.2%) and 7.8% of type IIIC. There were 14 cases of vascular and
nerve damage (13.72%). In which 6 cases of nerve damage (5.88%): 2
rarial nerve damage cases, 3 middle nerve damage cases and 01 middle

failure after combining bone. Morphological fractures: 78.1% of patients
were unstable intertrochanteric fractures, 17.1% of patients were solidly
intertrochanteric fractures; 4.8% of patients were not instant because of the
failure after combining bone.
Le Quang Tri (2014) treated the elderly intertrochanteric fractures with
external fixation found that the number of fracture patients on the left
(60.6%) was more than the right (39.4%). Classifying fracture according
to Jensen found that most of the patients in both study groups classified
group II and III fractures, each group accounted for 45%; group Ib only
accounted for 10%.
The results of our study on fibula and tibia fractures were similar to those
of Ho Van Binh (2005). The author studied 102 patients with opened fibula
and tibia fractures treated with the Fessa external fixation. He found that
fracture of the 1/3 middle was most common (46.1%), fractures on the left
side was 3 times more than on the right side. 6.9% of fractured patients with
2-stage fractures are severe fractures and complex for treatment. Broken
fragments with high frequency (62.3%) showed great injury power and the
software also hurted a lot. Opened fracture grade IIIB was the most
common (37.3%). The rate of fracture grade III was high (63.7%). Grade
II accounted for a high proportion (36.3%). The rate of vascular injury
was 11.5%.


19
4.2. The first aid status of bone fractures in motor organs in patients
- First aid place: First aid was extremely important in the program of
injury prevention. Studies have shown that if emergency cases are treated
promptly and effectively, it can reduce the severity and death of injuries.
The research results showed that the number of first aid patients in rural
areas accounted for the highest proportion with 59.6%, followed by


20
was 55.2% at the accident place, 48.5% at the medical facilities, 59.0%
with bandages in the emergency room. The difference is statistically
significant with p