Background: 

Injuries are one of the leading causes of global death and disability and commonly have substantial economic implications. The economic impact of injuries is particularly pronounced in low- and middle-income countries, where 90% of injuries occur. In this study, we aimed to assess return-to-work rates of individuals who sustained a lower-limb long-bone fracture in South Africa and to identify factors that influence the ability to return to employment.

Methods: 

This prospective cohort study was conducted across 2 tertiary trauma centers in Cape Town, South Africa. Adults who received intramedullary nail fixation for a lower-limb fracture between September 2017 and December 2018 were recruited and followed for 18 months postoperatively. The participants’ return to employment was assessed at 6 and 18 months post-injury. Multivariate logistic regression was used to identify factors that influence post-injury employment.

Results: 

Of the 194 participants enrolled, 192 completed follow-up. The study population had a median age of 33.0 years, and most of the participants (76.6%) were male. Seventy-five percent of the participants were employed before their injury. At 6 and 18 months post-injury, 34.4% and 56.3% of participants, respectively, were employed. Of those employed pre-injury, 70.1% had returned to work at 18 months. Multivariate regression identified increasing age, unemployment prior to injury, and working in the informal employment sector as factors that impede an individual’s likelihood of working 18 months post-injury. For those in employment prior to injury, increasing age was the only factor found to impede the likelihood of returning to work following an injury.

Conclusions: 

This study highlights the profound effect that lower-limb long-bone fractures may have on an individual’s ability to return to work in South Africa, with the potential to cause substantial economic impact on an individual’s livelihood and that of their dependents.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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在南非进行下肢长骨骨折髓内钉固定后重返工作岗位

背景： 

伤害是全球死亡和残疾的主要原因之一，通常会产生重大的经济影响。伤害对经济的影响在低收入和中等收入国家尤其明显，90% 的伤害发生在这些国家。在这项研究中，我们的目的是评估南非下肢长骨骨折患者的重返工作率，并确定影响重返就业能力的因素。

方法： 

这项前瞻性队列研究是在南非开普敦的两个三级创伤中心进行的。招募2017年9月至2018年12月期间因下肢骨折接受髓内钉固定的成年人，并进行术后18个月的随访。参与者在受伤后 6 个月和 18 个月时返回工作岗位进行评估。使用多变量逻辑回归来确定影响伤后就业的因素。

结果： 

在 194 名参与者中，192 名完成了随访。研究人群的中位年龄为 33.0 岁，大多数参与者 (76.6%) 为男性。百分之七十五的参与者在受伤前有工作。受伤后 6 个月和 18 个月时，分别有 34.4% 和 56.3% 的参与者找到工作。在受伤前就业的人中，70.1% 在 18 个月后重返工作岗位。多元回归发现，年龄增长、受伤前失业以及在非正规就业部门工作是阻碍个人在受伤后 18 个月内工作可能性的因素。对于受伤前就业的人来说，年龄增长是阻碍受伤后重返工作岗位的唯一因素。

结论： 

这项研究强调了下肢长骨骨折可能对个人返回南非工作的能力产生深远影响，并有可能对个人及其家属的生计造成重大经济影响。

证据级别： 

预后III 级。有关证据级别的完整描述，请参阅作者须知。