The George Institute For Global Health
United Kingdom

International Orthopaedic Multicenter Study in Fracture Care (INORMUS)

Project status: 
Start date: 
Fact sheet

Worldwide, 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.

Globally, the majority of trauma results from road traffic injuries, which ranks in the top 10 causes of all-cause disability.

Over 90% of road traffic deaths occur in low to middle income countries (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.

International Orthopaedic Multicenter Study in Fracture Care (INORMUS) is an observational study across three continents, 18 countries and 40 clinical sites with over 40,000 participants. This research work is a collaborative project with The George Institute for Global Health, Australia the Canadian Institute of Health Research and McMaster University.


The primary objective of INORMUS is to determine among adult individuals admitted to hospital with musculoskeletal trauma (e.g. fractures or dislocations) the following;

  1. The incidence of major complications (mortality, re-operation and infection) as a composite outcome and as individual components within 30 days post-hospital admission.
  2. The factors (system and patient variables) associated with the composite of major complications (mortality, re-operation and infection) within 30 days post-hospital admission.

Inclusion criteria

  • Adults (≥18 years).
  • Patients who are diagnosed with an acute fracture, dislocation or fracture dislocation of the appendicular skeleton (upper and lower extremities, shoulder girdle, and pelvic girdle) or spine in the last three months from the date of admission.
  • Admitted (requiring a bed for management) to participating hospital.
  • Able (or by proxy) to provide informed consent.

Exclusion criteria

  • Patients who only have fractures of the skull, face and ribs will not be eligible.
  • Those unwilling or unable to adhere to follow-up.

Study Design

INORMUS is a multicentre, observational trial.

Study Sample Size

The George Institute for Global Health is the co-ordinating centre for sites across Asia and will use 40,000 participants from low to middle income countries across the globe.


The study results will determine the burden of musculoskeletal trauma and identify modifiable factors associated with complications. The findings will help develop important interventions to reduce morbidity and mortality in musculoskeletal trauma patients in the developing world.


Study has commenced and is being conducted across 12 hospitals. About 40% patients have been recruited.

Our Collaborators

  • Professor Mohit Bhandari
  • Professor P J Deveraux

Publications to date: