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Chebli D, Dhaif F, Ridha A, Schade A, Khatri C. A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries. Trop Doct 2024; 54:272-281. [PMID: 38410846 DOI: 10.1177/00494755241232171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Open tibia fractures are devastating, life changing injuries, with infection associated with substantial morbidity to the patient. Reducing infection is a research priority, but before interventional studies can be designed, the incidence of infection following this injury needs to be better defined. Our aim was to estimate the global incidence of infection following an open tibia fracture. A systematic review was performed of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), Web of Science and Global Index Medicus. We included randomised controlled trials with more than ten participants which reported infections after open diaphyseal or distal fractures (AO 42 or 43). Primary outcome was deep infection according to the Centres for Disease Control and Prevention criteria. Secondary outcome included causative micro-organisms. A meta-analysis using a random effects model to assess incidence and between-treatment effects was performed. Thirteen studies including 1463 adults from seven middle-income countries, seven high-income countries and one low-income country were included. The incidence of infection was 12.12 person-years (95% CI 7.95-18.47). A subgroup analysis compared external fixation and intramedullary nailing showed no difference between infection rates. There were limited data on organisms, but Staphylococcus aureus was the most commonly identified. There are limited to no data on antimicrobial resistance.
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Affiliation(s)
- Djenna Chebli
- Medical Student, Warwick Medical School, University of Warwick, Coventry, UK
| | - Fatema Dhaif
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Ali Ridha
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alexander Schade
- Wellcome Trust PhD Fellow, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
| | - Chetan Khatri
- Specialist Registrar, Warwick Orthopaedic Speciality Training Rotation, Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Academic Foundation Doctor, Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, UK
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Ahmed AN, Lysaght R, Addissie A, Zewdie A, Finlayson M. One-year outcomes of traumatic injuries among survivors in Ethiopia: a cross-sectional study on the employment outcomes and functioning state. Trauma Surg Acute Care Open 2024; 9:e001209. [PMID: 38646619 PMCID: PMC11029386 DOI: 10.1136/tsaco-2023-001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/23/2024] [Indexed: 04/23/2024] Open
Abstract
Background Traumatic injury is one of the top public health challenges globally. Injury survivors often experience poor health and functioning and restricted participation in employment. In Ethiopia, there is a paucity of evidence about the long-term consequences of injuries, particularly about their employment outcomes and disability status. This study characterizes injury survivors by their preinjury status, injury characteristics, postinjury employment outcomes and disability status 1 year post injury. Methods An institution-based cross-sectional study was conducted on injury survivors who received services from a large public hospital in Addis Ababa. Medical records of all emergency room patients who visited the hospital within a 3-month period were reviewed to identify those who were eligible. A structured questionnaire was completed using a telephone interview. Descriptive statistics were used to characterize the outcomes. Results Of the 254 participants, 78% were men, 48% were young adults (age 25-39 years), 41% were injured by road traffic collision, 52% were admitted to the hospital for up to a week and only 16% received compensation for the injury. Before the injury, 87% were working in manual labor. One-year after the injury, the total return to work (RTW) rate was 59%; 61% of participants experienced some level of disability, 33% had at least one type of chronic illness and 56% reported challenges of physical stressors when attempting to RTW. Among the 150 who returned to work, 46% returned within 12 weeks, 78% to the same employer and most received support from multiple sources, including community-level institutions (88%) and families/friends (67%). Conclusion Traumatic injury substantially impacted the employment outcomes of survivors and contributed to increased disability in Ethiopia. This study lays a foundation for future research and contributes crucial evidence for advocacy to improve injury prevention and trauma rehabilitation in low and middle-income contexts. Level of evidence II.
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Affiliation(s)
- Ansha Nega Ahmed
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Queen's University, Kingston, Ontario, Canada
| | | | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- Department of Emergency Medicine, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
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Kumar P, Singal S, Chaudhary R, Kochar S. Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1233-S1235. [PMID: 37694088 PMCID: PMC10485494 DOI: 10.4103/jpbs.jpbs_149_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 09/12/2023] Open
Abstract
Background To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. Materials and Methods The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Results Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). Conclusions The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.
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Affiliation(s)
- Pankaj Kumar
- Department of Psychiatry Dayanand Medical College and Hospital (DMC and H) Ludhiana, Punjab, India
| | - Shekhar Singal
- Department of Orthopedics Dayanand Medical College and Hospital (DMC and H) Ludhiana, Punjab, India
| | - Rupesh Chaudhary
- Department of Psychiatry Dayanand Medical College and Hospital (DMC and H) Ludhiana, Punjab, India
| | - Sunil Kochar
- Department of Psychiatry Dayanand Medical College and Hospital (DMC and H) Ludhiana, Punjab, India
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Mavragani A, Rosen HE, Mitra S, Neki K, Mbugua LW, Hyder AA, Paichadze N. Estimating the Burden of Disability From Road Traffic Injuries in 5 Low- and Middle-Income Countries: Protocol for a Prospective Observational Study. JMIR Res Protoc 2023; 12:e40985. [PMID: 36723997 PMCID: PMC9932872 DOI: 10.2196/40985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are a leading cause of death and unintentional injuries globally. They claim 1.35 million lives and produce up to 50 million injuries each year, causing a major drain on health systems. Despite this high burden, there is a lack of robust data on the long-term consequences of RTIs, specifically the level of disability experienced by many survivors and its impact on their everyday lives. OBJECTIVE This study aims to characterize RTIs, disability level, and related consequences affecting adult road traffic crash survivors in 5 low- and middle-income countries (LMICs). In addition, this study estimates the role of demographic and crash- and treatment-related factors in predicting adverse outcomes and disability as well as examining the disability level among patients with RTIs, likelihood of return to normal life, and the environmental factors that may influence these outcomes after discharge from the hospital. METHODS This prospective observational study was conducted at selected hospitals in Bangladesh, Cambodia, Ethiopia, Mexico, and Zambia. The study sample included all adult patients with RTIs admitted to the hospital for at least 24 hours. Consecutive sampling was performed until the minimum required sample size of 400 was reached for each participating country. Data were collected from patients or their caregivers using a hospital-based surveillance tool administered at the participating sites as well as a telephone-based follow-up instrument administered 1, 3, and 6 months after discharge. Descriptive analysis and multivariate models will be used to estimate the contribution of a range of factors in predicting adverse outcomes, disability, and return to normal life. RESULTS Enrollment began in June 2021 and was completed in April 2022. Follow-up data collection ended in September 2022. Data analysis is currently underway, with results expected for publication in mid-2023. Expected results include estimates of disability among patients with RTIs as well as identifying the predictors of adverse outcomes, disability, and the likelihood of return to normal life. CONCLUSIONS Research findings will help better understand the long-term burden of disability from RTIs in the 5 LMICs and the challenges facing survivors of road traffic crashes. They will be used to inform interventions aimed at improving the health care, social, physical, and policy conditions in LMICs that can facilitate recovery and rehabilitation for patients with RTIs, reduce the burden of disability, and enhance their participation in society. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40985.
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Affiliation(s)
| | - Heather E Rosen
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Sudeshna Mitra
- Global Road Safety Facility, World Bank, Washington, DC, United States
| | - Kazuyuki Neki
- Global Road Safety Facility, World Bank, Washington, DC, United States
| | | | - Adnan A Hyder
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Nino Paichadze
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
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Kyengera DK, O’Hara NN, Slobogean GP, Howe AL, Blachut PA, O’Brien PJ, Stockton DJ. Unreamed Intramedullary Nailing Versus External Fixation for the Treatment of Open Tibial Shaft Fractures in Uganda: A Randomized Clinical Trial. J Orthop Trauma 2022; 36:349-357. [PMID: 35234730 PMCID: PMC9391253 DOI: 10.1097/bot.0000000000002362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare unreamed intramedullary nailing versus external fixation for the treatment of Gustilo-Anderson type II and IIIA open tibial fractures admitted to a hospital in rural Uganda. DESIGN Randomized clinical trial. SETTING Regional referral hospital in Uganda. PATIENTS Fifty-five skeletally mature patients with a Gustilo-Anderson type II or IIIA open tibia shaft fracture treated within 24 hours of injury between May 2016 and December 2019. INTERVENTION Unreamed intramedullary nailing (n = 31) versus external fixation (n = 24). MAIN OUTCOME MEASUREMENTS The primary outcome was function within 12 months of injury, measured using the Function IndeX for Trauma (FIX-IT) score. Secondary outcomes included health-related quality of life (HRQoL) using the 3-level version of the 5-dimension EuroQol instrument (EQ-5D-3L), radiographic healing using the Radiographic Union Scale for Tibia (RUST) fractures score, and clinical complications. RESULTS Treatment with an intramedullary nail resulted in a 1.0-point higher [95% credible intervals (CrI), 0.1 to 1.9] FIX-IT score compared with external fixation. Results were similar for the secondary patient-reported outcomes, EQ-5D-3L and the visual analog scale component of the EuroQol instrument (EQ-VAS). RUST scores were not different between groups at any time point. Treatment with an intramedullary nail was associated with a 22.1% (95% CrI, -42.6% to 1.7%) lower rate of malunion and a 20.8% (95% CrI, -44.0% to 2.9%) lower rate of superficial infection. CONCLUSION In rural Uganda, treatment of open tibial shaft fractures with an unreamed intramedullary nail results in marginal clinically important improvements in functional outcomes, although there is likely an important reduction in malunion and superficial infection. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel K. Kyengera
- Department of Orthopaedics, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Andrea L. Howe
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Piotr A. Blachut
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia
| | - Peter J. O’Brien
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia
| | - David J. Stockton
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia
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Schade AT, Sibande W, Kumwenda M, Desmond N, Chokotho L, Karasouli E, Metcalfe A, Harrison WJ. "Don't rush into thinking of walking again": Patient views of treatment and disability following an open tibia fracture in Malawi. Wellcome Open Res 2022; 7:204. [PMID: 36110835 PMCID: PMC9453110 DOI: 10.12688/wellcomeopenres.18063.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Open tibia fractures are a common injury following road traffic accidents in Malawi and can lead to long term disability. Very little is known about patients' experiences of the healthcare system and the disability in low-income countries following this injury. The aim of the study was to explore patient experiences of treatment and disability following an open tibia fracture in Malawi. Methods: A qualitative study was conducted using semi-structured interviews with ten patients with open tibia fractures at a central hospital in Blantyre, Malawi. A mixed deductive-inductive thematic analysis was used to identify broad themes of treatment and disability. Written informed consent was obtained from all participants. Results: Patient characteristics included an average age of 39.1 years old (22-63) and 80% were male. Broad themes found were delays in receiving treatment, change in individuals' societal role and delayed recovery associated with pain and immobility. Conclusions: Open tibia fractures in Malawi have a devastating impact on patients and their families. Further studies are required to explore the reasons for the delays in open fracture emergency treatment.
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Affiliation(s)
- Alexander Thomas Schade
- Public Health, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Clinical Trials Unit, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, Queen Elizabeth Central Hospital, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Wakumanya Sibande
- Public Health, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moses Kumwenda
- Public Health, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicola Desmond
- Public Health, Malawi-Liverpool-Wellcome Trust, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Linda Chokotho
- Trauma and Orthopaedics, Queen Elizabeth Central Hospital, Blantyre, Malawi
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von Kaeppler EP, Kramer EJ, Donnelley CA, Wu HH, Marseille E, Eliezer E, Roberts HJ, Shearer D, Morshed S. The Initial Economic Burden of Femur Fractures on Informal Caregivers in Dar es Salaam, Tanzania. Malawi Med J 2021; 33:135-139. [PMID: 34777709 PMCID: PMC8560354 DOI: 10.4314/mmj.v33i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Femur fracture patients require significant in-hospital care. The burden incurred by caregivers of such patients amplifies the direct costs of these injuries and remains unquantified. Aim Here we aim to establish the in-hospital economic burden faced by informal caregivers of femur fracture patients. Methods 70 unique caregivers for 46 femoral shaft fracture patients were interviewed. Incurred economic burden was determined by the Human Capital Approach, using standardized income data to quantify productivity loss (in $USD). Linear regression assessed the relationship between caregiver burden and patient time-in-hospital. Results The average economic burden incurred was $149, 9% of a caregiver's annual income and positively correlated with patient time in hospital (p<0.01). Conclusion Caregivers of patients treated operatively for femur fractures lost a large portion of their annual income, and this loss increased with patient time in hospital. These indirect costs of femur fracture treatment constitute an important component of the total injury burden.
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Affiliation(s)
- Ericka P von Kaeppler
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco
| | | | - Claire A Donnelley
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco
| | - Hao-Hua Wu
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco
| | - Elliot Marseille
- Global Health Economics Consortium at the University of California San Francisco
| | | | - Heather J Roberts
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco
| | - David Shearer
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco
| | - Saam Morshed
- Institute of Global Orthopaedics and Traumatology at the University of California San Francisco.,Yale University School of Medicine.,Health Strategies International.,Global Health Economics Consortium at the University of California San Francisco.,Muhimbili Orthopaedic Institute
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Rajaguru PP, Massawe H, Jusabani M, Temu R, Sheth NP. Definitive surgical femur fracture fixation in Northern Tanzania: implications of cost, payment method and payment status. Pan Afr Med J 2021; 39:126. [PMID: 34527142 PMCID: PMC8418167 DOI: 10.11604/pamj.2021.39.126.25878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Kilimanjaro Christian Medical Centre (KCMC) covers major orthopaedic trauma for a catchment population of 12.5 million people in northern Tanzania. Femur fractures, the most common traumatic orthopaedic injury at KCMC (39%), require open reduction and internal fixation (ORIF) for definitive treatment. It is unclear whether payment affects care. This study sought to explore associations of payment method with episodes of care for femur fracture ORIFs at KCMC. Methods we performed a retrospective review of orthopaedic records between February 2018 and July 2018. Patients with femur fracture ORIF were eligible; patients without charts were excluded. Ethical clearance was obtained from the KCMC ethics committee. Statistical analysis utilized descriptive statistics, Chi-squared and Fisher’s exact Tests, and Student´s t-tests where appropriate. Results of 76 included patients, 17% (n=13) were insured, 83% (n=63) paid out-of-pocket, 11% (n=8) had unpaid balance, and 89% (n=68) fully paid. Average patient charge ($417) was 42% of per capita GDP ($998). Uninsured patients had higher bills ($429 vs $356; p=0.27) and were significantly more likely to pay an advance payment (95.2% vs 7.7%; p<0.001). Inpatient care was equivalent regardless of payment. Unpaid patients were less likely to receive follow-up (76.5% vs. 25%; p=0.006) and waited longer from injury to admission (31.5 vs 13.3 days; p<0.001), from admission to surgery (30.1 vs 11.1 days; p<0.001), and from surgery to discharge (18.4 vs 7.1 days; p<0.001). Conclusion equal standard of care is provided to all patients. However, future efforts may decrease disparities in advance payment, timeliness, and follow-up.
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Affiliation(s)
- Praveen Paul Rajaguru
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Honest Massawe
- Department of Orthopaedics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mubashir Jusabani
- Department of Orthopaedics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Rogers Temu
- Department of Orthopaedics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Neil Perry Sheth
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, United States of America
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Schade AT, Nyamulani N, Banza LN, Metcalfe AJ, Leather A, Madan JJ, Lallloo DG, Harrison WJ, MacPherson P. Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines. Wellcome Open Res 2021; 6:228. [PMID: 35505977 PMCID: PMC9034175 DOI: 10.12688/wellcomeopenres.17145.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Road traffic injury (RTI) is the largest cause of death amongst 15–39-year-old people worldwide, and the burden of injuries such as open tibia fractures are rapidly increasing in Malawi. This study aims to investigate disability and economic outcomes of people with open tibia fractures in Malawi and improve these with locally delivered implementation of open fracture guidelines. Methods: This is a prospective cohort study describing function, quality of life and economic burden of open tibia fractures in Malawi. In total, 160 participants will be recruited across six centres and will be followed-up with face-to-face interviews at six weeks, three months, six months and one year following injury. The primary outcome will be function at one year measured by the short musculoskeletal functional assessment (SMFA) score. Secondary outcomes will include quality of life measured by EuroQol EQ-5D-3L, catastrophic loss of income and implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) at one year. A nested pilot pre-post implementation study of an interventional bundle for all open fractures will be developed based on other implementation studies from low- and middle-income countries (LMICs). Regression analysis will be used to model and investigate associations between SMFA score and fracture severity, infection and the pre- and post-training course period. Outcome: This prospective cohort study will report patient reported outcomes from open tibia fractures in low-resource settings. Subsequent detailed evaluation of both the clinical and implementation components of the study will promote sustainability of improved open fractures management in the study sites and further scale-up of open fracture management guidelines. Ethics: Ethics approval has been obtained from the Liverpool School of Tropical Medicine and College of Medicine Research and Ethics committee.
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Affiliation(s)
- Alexander Thomas Schade
- Public Health, Malawi-Liverpool Wellcome Trust, Blantyre, P.O.Box 30096, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Nohakhelha Nyamulani
- Trauma and Orthopaedics surgery, Queen Elizabeth Central Hospital, Blantyre, BOX 95, Malawi
| | - Leonard Ngoe Banza
- Trauma and Orthopaedic surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Andrew Leather
- King’s College Centre for Global Health and Health Partnerships, King's College Hospital, London, London, WC2R 2LS, UK
| | - Jason J. Madan
- Warwick medical school, University of Warwick, Coventry, W Midlands, UK
| | | | | | - Peter MacPherson
- Public Health, Malawi-Liverpool Wellcome Trust, Blantyre, P.O.Box 30096, Malawi
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Characteristics and Injury Patterns of Road Traffic Injuries in Urban and Rural Uganda-A Retrospective Medical Record Review Study in Two Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147663. [PMID: 34300111 PMCID: PMC8304504 DOI: 10.3390/ijerph18147663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022]
Abstract
In the ongoing Second Decade of Action for Road Safety, road traffic crashes pose a considerable threat especially in low-income countries. Uganda shows a vast burden of non-fatal injuries and resides at the top range of countries with the highest death rates due to unsafe roads. However, little is known about the differences in road traffic associated injuries between urban and rural areas and potential influence factors. Here, we used a cross-sectional study conducted by a retrospective medical record review from trauma cases admitted in 2016 to hospitals in rural and urban areas in Uganda. Injury severity scores were calculated and descriptive analysis was carried out while multivariate logistic regression was applied to assess significant covariates. According to the 1683 medical records reviewed, the mean age of trauma patients in the dataset under investigation was 30.8 years with 74% male. The trauma in-hospital mortality was 4% while prevalence of traumatic injuries is 56.4%. Motorcycle users (49.6%) and pedestrians (33.7%) were identified as the most vulnerable groups in both urban and rural setting while mild injuries of extremities (61.6%) and the head/neck-region (42.0%) were registered most. The frequency of road traffic injuries was homogenous in the urban and rural hospitals investigated in this study; interventions should therefore be intensified ubiquitously. The identification of significant differences in road traffic crash and injury characteristics provides the opportunity for specific programmes to decrease the socio-economic and health burden of unsafe roads. In addition to law enforcement and introduction of a Systems Thinking approach to road safety including infrastructural and educational concepts, the strengthening of trauma care and health resources is recommended.
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11
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The economic burden of open tibia fractures: A systematic review. Injury 2021; 52:1251-1259. [PMID: 33691946 DOI: 10.1016/j.injury.2021.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/14/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Open tibia fractures are a common injury following road traffic collisions and place a large economic burden on patients and healthcare systems. Summarising their economic burden is key to inform policy and help prioritise treatment. METHODS All studies were identified from a systematic search of Medline, Embase and the Cochrane Central Register of Controlled Trials. We included any human with a diagnosed open tibia fracture, following any intervention. The primary outcome was any costs reported or patient return to work status. Secondary outcomes included average length of stay, wage loss, absenteeism and complications such as infection, amputation and nonunion. Data was extracted and we performed a descriptive narrative summary. RESULTS We reviewed 1,204 studies from our searches. A total of 34 studies were included from 14 different countries. The average age was 37.7 years old and 76% of the patients were male. 6.5% were Gustilo I, 12% Gustilo II and 82% Gustilo III. Initial direct hospitalisation costs were reported to be between £356 to £126,479 with an average length of stay of 56 days (3.1-244). 89% of participants were working pre-injury, 60% fully returned to work, 17% returned to work part time or changed profession and 22% did not return to work at one-year. The most common complications reported were 22% infection, 11% nonunion and 16% amputation. Mean follow-up duration for the studies was 25 months. CONCLUSION The economic burden of open tibia fractures varies greatly, but it is costly for both hospitals and patients. The current evidence is predominantly from high-income countries (HICs), especially the USA. Further research is required to investigate the costs of open tibia fractures using validated costing tools, especially in low-income countries (LICs), to help inform and direct policy.
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Grant M, Mehdian-Staffell R, Webb M, Scott S. Hip fractures in the young polytrauma patient: a review and the latest data from the UK. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:817-823. [PMID: 33748883 DOI: 10.1007/s00590-021-02923-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
Managing a hip fracture in a young adult patient in the setting of polytrauma is a particularly challenging prospect. In the UK between 2018 and 2020, 11,969 patients were recorded in the Trauma Audit and Research Network as a patient with polytrauma. Of these patients, 611 (5.1%) had a hip fracture. In this article, we discuss the initial assessment and management of these patients and common problems that are encountered and how the evidence available can help guide management.
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Affiliation(s)
- Michael Grant
- Liverpool University Foundation Teaching Hospital, Aintree, Lower Lane, Liverpool, L9 7AL, Merseyside, UK.
| | | | - Mark Webb
- St George's University Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Sharon Scott
- Liverpool University Foundation Teaching Hospital, Aintree, Lower Lane, Liverpool, L9 7AL, Merseyside, UK
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Chatukuta M, Groce N, Mindell JS, Kett M. Road traffic injuries in Namibia: health services, public health and the motor vehicle accident fund. Int J Inj Contr Saf Promot 2021; 28:167-178. [PMID: 33567973 DOI: 10.1080/17457300.2021.1879870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Namibia is one of five countries in sub-Saharan Africa that has a fuel tax levy designed to support road injury victims. This study examines how the scheme operates from the perspective of seriously injured or permanently disabled beneficiaries. Using qualitative methods, we conducted semi-structured interviews with RTI survivors in Namibia, and healthcare workers involved in caring for them, in order to investigate the role played by the MVAF. While some wealthier drivers continue to buy private insurance, most Namibians now rely on the MVAF. The analysis show the MVAF is effectively helping to enhance access to rehabilitation and other health services for RTI survivors. There however exist some weaknesses in the system which can be addressed. It is hoped these findings will contribute to discussions about whether the current system is fit for purpose and could serve as a replicable model in other low and middle-income countries (LMICs).
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von Kaeppler E, Donnelley C, Roberts HJ, O'Hara NN, Won N, Shearer DW, Morshed S. Impact of North American Institutions on Orthopedic Research in Low- and Middle-Income Countries. Orthop Clin North Am 2020; 51:177-188. [PMID: 32138856 DOI: 10.1016/j.ocl.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There exists an unmet need for locally relevant and sustainable orthopedic research in low- and middle-income countries. Partnerships between high-income countries and low- and middle-income countries can bridge gaps in resources, knowledge, infrastructure, and skill. This article presents a select list of models for high-income countries/low- and middle-income countries research partnerships including academic partnerships, international research consortia, professional society-associated working groups, and nongovernmental organization partnerships. Models that produce research with lasting legacy are those that promote mutually beneficial partnerships over individual gains.
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Affiliation(s)
- Ericka von Kaeppler
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Claire Donnelley
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Heather J Roberts
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Suite 300, 110 South Paca Street, Baltimore, MD 21201, USA
| | - Nae Won
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - David W Shearer
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of California San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA 94110, USA.
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Schade AT, Hind J, Khatri C, Metcalfe AJ, Harrison WJ. Systematic review of patient reported outcomes from open tibia fractures in low and middle income countries. Injury 2020; 51:142-146. [PMID: 31767370 DOI: 10.1016/j.injury.2019.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/30/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Open tibia fractures are a common cause of admission following road traffic accidents in low and middle income countries (LMICs), resulting in substantial mortality and disability. It is important to summarise the clinical course of this injury using patient reported scores in order to assess best treatment in LMICs. OBJECTIVES To summarise the disability after sustaining an open tibia fracture in LMICs METHODS: All studies were identified from a systematic search of Medline, Embase and the Cochrane Central Register of Controlled Trials. We included any human with a diagnosed open tibia fracture, following any intervention. Studies were performed in a low or middle income country. The primary outcome was any validated patient reported outcome score reported after three months. Secondary outcomes included economic impact and complications such as infection, non-union and amputation. Data was extracted and summarised. RESULTS We reviewed 3,593 articles from our search. A total of 18 studies were included from 10 countries with 8 different outcome scores. The average age was 35 years old and 86% of the patients were male. Thirty-one percent were Gustilo I, 28% Gustilo II, 19% Gustilo IIIA, 17% Gustilo IIIB and 5% Gustilo IIIC. The most common complications reported were 18% infection, 15% non-union and 15% amputation. Economic impact was reported in only one study with 100% patients working pre-injury and 20% post-injury at 12 months. Mean follow-up duration for outcome scores was 19.8 months. There was heterogeneity between the studies in terms of subject of the studies, outcome criteria, fracture type, surgical technique and length of follow-up. Therefore, no meta-analysis could be performed. CONCLUSION The clinical history of open tibia fractures in low or middle income countries remains largely unknown in terms of patient reported outcomes. Further studies are required to define these outcomes in open tibia fractures before best treatments can be assessed.
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Affiliation(s)
| | - Jamie Hind
- Worcestershire Acute Hospitals NHS Trust, United Kingdom
| | - Chetan Khatri
- University of Warwick Medical School, United Kingdom
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O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One 2020; 15:e0227907. [PMID: 31940334 PMCID: PMC6961943 DOI: 10.1371/journal.pone.0227907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8–109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8–30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient’s socioeconomic well-being, which may negatively affect a person’s psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.
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Affiliation(s)
- Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Marckenley Isaac
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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The willingness of orthopaedic trauma patients in Uganda to accept financial loans following injury. OTA Int 2019; 2:e028. [PMID: 33937660 PMCID: PMC7997123 DOI: 10.1097/oi9.0000000000000028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/22/2018] [Indexed: 11/26/2022]
Abstract
Background: Early access to a monetary loan may mitigate some of the socioeconomic burden associated with surgical treatment and lost wages following injury. The primary objective of this study was to determine the willingness of orthopaedic trauma patients in Uganda to accept a formal financial loan shortly after their time of injury. Methods: A consecutive sample of adult orthopaedic trauma patients admitted to Uganda's national referral hospital was included in the survey. The primary outcome was the self-reported willingness to accept a financial loan. Secondary outcomes included the preferred loan terms, fracture treatment costs, and the factors associated with loan willingness. Results: Of the 40 respondents (mean age, 40 years; 58% male), the median annual income was $582 United States dollars (USD) (range: $0–$6720). Around 50% reported a willingness to accept a loan with any terms. Patients requested loans with a median principal of $500 USD and a median interest rate of 5% with 12 months to pay back. Patients had received loans with a median principal of $142 USD, an interest rate of 10%, and payback of 6 months. These received loans covered a mean of 63% of the treatment costs. Patients with higher median incomes ($857 USD vs $342 USD) were more willing to accept a loan. Conclusion: This study demonstrated a limited interest of orthopaedic trauma patients in Uganda to procure loans through formalized lending. This observed resistance must be overcome in future programs that rely on mechanisms such as conditional cash transfers or microfinancing to improve clinical and socioeconomic outcomes after injury.
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Abstract
There is increasing recognition of both the impact and value of trauma care in low- and middle-income countries (LMICs). However, data supporting the value of musculoskeletal trauma care specifically are lacking. This review discusses methods of economic analysis relevant to low-resource settings and provides a review of cost studies related to orthopaedic trauma care in these settings. In general, microcosting methods are preferred in LMICs because of the lack of databases with aggregate cost data. It is important that studies use a societal perspective that includes the indirect costs of treatment in addition to direct costs of medical care. Cost-effectiveness studies most commonly report cost per disability-adjusted life year, particularly in LMICs, but quality-adjusted life years are an acceptable alternative that is based on more empiric data. There are solid economic data supporting potential cost savings and improved outcomes with intramedullary nailing for femoral shaft fractures. Trauma care hospitals and educational initiatives have also been found to be highly cost-effective. However, very little data exist to support other interventions in orthopaedic trauma. Orthopaedic surgeons should strive to understand these methodologies and support the conduct of rigorous economic analysis to better establish the value of musculoskeletal trauma care in LMICs.
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Singaram S, Naidoo M. The physical, psychological and social impact of long bone fractures on adults: A review. Afr J Prim Health Care Fam Med 2019; 11:e1-e9. [PMID: 31170796 PMCID: PMC6556928 DOI: 10.4102/phcfm.v11i1.1908] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 01/31/2023] Open
Abstract
Background Long bone fractures are common injuries caused by trauma and are a common cause for referral to hospitals. Little consideration has been given to the impact of long bone fractures in adults despite the World Health Organization’s statement that such injuries cause substantial morbidity in low- and middle-income countries. Aim This review targeted published studies conducted from 1990 to 2017 that examined the impact of long bone fractures on the psychological, social, financial, occupational and physical health of adults. Method This scoping review involved a systematic literature search using key terms in Science Direct, Cochrane Library, BMJ Online, PubMed, Jstor, SpringerLink, Emerald Insight and Ebscohost Research databases and Google Scholar. Results From a total of 297 publications, 19 met the inclusion criteria: four publications focused on the impact of fractures of the humerus, one publication looked at ulna fractures, six publications focused on distal radius fractures, five looked at femur fractures and three focused on tibial fractures. Conclusion Long bone fractures have a considerable impact on many facets of a patient’s life. In some cases, the fracture prevents patients from working and meeting financial obligations. The injury limited previously normal social interactions and pre-injury functioning. Future research should examine the impact of long bone fractures in Africa, as there were very limited studies, which were identified.
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Affiliation(s)
- Sevani Singaram
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban.
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Prevalence and patterns of traumatic bone loss following open long bone fractures at Mulago Hospital. OTA Int 2019; 2:e015. [PMID: 33937651 PMCID: PMC7953543 DOI: 10.1097/oi9.0000000000000015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 09/24/2018] [Indexed: 11/25/2022]
Abstract
Introduction: Significant traumatic bone loss in developed countries occurs in a high proportion of open fractures ranging from 11.4% to 40%. However, literature from developing countries such as Uganda scarcely documents the prevalence and patterns of traumatic bone loss. Direct trauma and iatrogenic factors have been associated with traumatic bone loss as possible etiologies. Objective: The study was aimed at establishing the prevalence and patterns of traumatic bone loss following open long bone fractures, and identifying factors associated with traumatic bone loss among patients presenting to Mulago Hospital within 24 hours of sustaining the injury up to completion of the initial fracture debridement, reduction, and fixation. Methodology: It was a prospective cohort study conducted at Mulago Hospital. A total of 136 open long bone fractures were registered and physically examined for traumatic bone loss. Patients who consented were recruited consecutively to participate in the study. Data on the patients’ sociodemographics and fracture patterns were collected using pretested questionnaires and analyzed using Stata version 12. Results: From 123 patients, a total of 136 open long bone fractures were registered. The prevalence of traumatic bone loss following open long bone fractures was 26.5%. Of the 36 open long bone fractures with traumatic bone loss, the more common pattern (61.1%) was significant traumatic bone loss (≥ 2.5 cm long). Commercial motorcycle riders (22.0%) and traders (20.3%) were the most common occupations associated with open long bone fractures. Gunshot injuries were the leading cause of traumatic bone loss in open long bone fractures. Conclusion: Our setting has a high prevalence of traumatic bone loss among open long bone fractures with the majority occurring in Gustilo type IIIB injuries of the tibia. The likelihood of traumatic bone loss is higher in open fractures caused by gunshots.
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Abstract
Background: Although musculoskeletal injuries have increased in sub-Saharan Africa, data on the economic burden of non-fatal musculoskeletal injuries in this region are scarce. Objective: Socioeconomic costs of orthopedic injuries were estimated by examining both the direct hospital cost of orthopedic care as well as indirect costs of orthopedic trauma using disability days and loss of work as proxies. Methods: This study surveyed 200 patients seen in the outpatient orthopedic ward of the Kilimanjaro Christian Medical Center, a tertiary hospital in Northeastern Tanzania, during the month of July 2016. Findings: Of the patients surveyed, 88.8% earn a monthly income of less than $250 and the majority of patients (73.7%) reported that the healthcare costs of their musculoskeletal injuries were a catastrophic burden to them and their family with 75.0% of patients reporting their medical costs exceeded their monthly income. The majority (75.3%) of patients lost more than 30 days of activities of daily living due to their injury, with a median (IQR) functional day loss of 90 (30). Post-injury disability led to 40.6% of patients losing their job and 86.7% of disabled patients reported a wage decrease post-injury. There were significant associations between disability and post-injury unemployment (p < .0001) as well as lower post-injury wages (p = .022). Conclusion: This exploratory study demonstrates that in this region of the world, access to definitive treatment post-musculoskeletal injury is limited and patients often suffer prolonged disabilities resulting in decreased employment and income.
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Role of North-South Partnership in Trauma Management: Uganda Sustainable Trauma Orthopaedic Program. J Orthop Trauma 2018; 32 Suppl 7:S21-S24. [PMID: 30247395 DOI: 10.1097/bot.0000000000001290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Uganda, as do many low-middle income countries, has an overwhelming volume of orthopaedic trauma injuries. The Uganda Sustainable Trauma Orthopaedic Program (USTOP) is a partnership between the University of British Columbia, McMaster University and Makerere University that was initiated in 2007. The goal of the project is to reduce the disabilities that occur secondary to musculoskeletal trauma in Uganda. USTOP works with local collaborators to build orthopaedic trauma capacity through teaching, innovation, and research. USTOP has maintained a multidisciplinary approach to training, involving colleagues in anesthesia, nursing, rehabilitation, and sterile reprocessing. The project was initiated at the invitation of the Department of Orthopaedics at Makerere University and Mulago Hospital in Kampala. The project is a collaboration between Canadian and Ugandan orthopaedic surgeons and is driven by the needs identified by the Ugandan surgeons. The program has also worked with collaborators to develop several technologies aimed at reducing the cost of providing orthopaedic care without compromising quality. As orthopaedic trauma capacity in Uganda advances, USTOP strives to continually evolve and provide relevant support to colleagues in Uganda to ensure that changes result in sustainable improvements in patient care.
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Orthopaedic Trauma in the Developing World: Where Are the Gaps in Research and What Can Be Done? J Orthop Trauma 2018; 32 Suppl 7:S43-S46. [PMID: 30247400 DOI: 10.1097/bot.0000000000001293] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE There are an estimated 1.2 million deaths from road traffic injuries annually, disproportionately affecting patients in low-resource settings. The purpose of this scoping review is to identify knowledge gaps in global orthopaedic trauma in an effort to help prioritize future research. METHODS Using the 6-stage Arksey and O'Malley framework for conducting a scoping review, orthopaedic trauma literature was reviewed over a ten-year period from 2004 to 2014. Studies from low-resource settings were included and categorized by geographic location, anatomic region, study type, and level of evidence. RESULTS Of 548 included studies, 51.4% were from low- and middle-income countries in South Asia and 33.7% were from sub-Saharan Africa. Therapeutic (53.3%), epidemiologic (26.4%), and qualitative (8.9%) studies were most common. Only 10.2% of the studies were considered high level of evidence, whereas the vast majority (89.8%) was level 3 or below. Overall, lower extremity injuries were much more frequently represented in the literature compared with upper extremity injuries (233 vs. 78). Pelvic and acetabular fractures were the least studied anatomic region of the lower extremity (3.4%). CONCLUSIONS Our study identified a lack of cost-effectiveness analyses pertaining to injury and intervention, paucity of high-quality research, and under-representation of pelvic, acetabular, and upper extremity injuries. Improved and prioritized research in low- and middle-income countries may help optimize care and inform policy makers of how to reduce the global burden of musculoskeletal trauma.
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Trafton PG. Orthopaedic Trauma Outcomes in Developing Countries: Commentary on an article by Nathan N. O'Hara, MHA, et al.: "The Socioeconomic Implications of Isolated Tibial and Femoral Fractures from Road Traffic Injuries in Uganda". J Bone Joint Surg Am 2018; 100:e48. [PMID: 29613939 DOI: 10.2106/jbjs.17.01542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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O'Hara NN, Mugarura R, Potter J, Stephens T, Rehavi MM, Francois P, Blachut PA, O'Brien PJ, Mezei A, Beyeza T, Slobogean GP. The Socioeconomic Implications of Isolated Tibial and Femoral Fractures from Road Traffic Injuries in Uganda. J Bone Joint Surg Am 2018; 100:e43. [PMID: 29613934 DOI: 10.2106/jbjs.17.00439] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the socioeconomic implications of isolated tibial and femoral fractures caused by road traffic injuries in Uganda. METHODS This prospective longitudinal study included adult patients who were admitted to Uganda's national referral hospital with an isolated tibial or femoral fracture. The primary outcome was the time to recovery following injury. We assessed recovery using 4 domains: income, employment status, health-related quality of life (HRQoL) recovery, and school attendance of the patients' dependents. RESULTS The majority of the study participants (83%) were employed, and they were the main income earner for their household (74.0%) at the time of injury, earning a mean annual income of 2,375 U.S. dollars (USD). All of the patients had been admitted with the intention of surgical treatment; however, because of resource constraints, only 56% received operative treatment. By 2 years postinjury, only 63% of the participants had returned to work, and 34% had returned to their previous income level. Overall, the mean monthly income was 62% less than preinjury earnings, and participants had accumulated 1,069 USD in debt since the injury; 41% of the participants had regained HRQoL scores near their baseline, and 62% of school-aged dependents, enrolled at the time of injury, were in school at 2 years postinjury. CONCLUSIONS At 2 years postinjury, only 12% of our cohort of Ugandan patients who had sustained an isolated tibial or femoral fracture from a road traffic injury had recovered both economically and physically. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rodney Mugarura
- Department of Orthopaedics, Makerere University, Kampala, Uganda
| | - Jeffrey Potter
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Trina Stephens
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - M Marit Rehavi
- Vancouver School of Economics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Francois
- Vancouver School of Economics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Piotr A Blachut
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Mezei
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tito Beyeza
- Department of Orthopaedics, Makerere University, Kampala, Uganda
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Stephens T, Mezei A, O'Hara NN, Potter J, Mugarura R, Blachut PA, O'Brien PJ, Beyeza T, Slobogean GP. When Surgical Resources are Severely Constrained, Who Receives Care? Determinants of Access to Orthopaedic Trauma Surgery in Uganda. World J Surg 2018; 41:1415-1419. [PMID: 28097413 DOI: 10.1007/s00268-017-3874-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic intervention routinely exceeds the capacity of available surgical resources. The objective of this study was to identify predictors of surgical care for lower extremity fracture patients at a high-demand, resource-limited public hospital in Uganda. METHODS Skeletally mature patients admitted with the intention of definitive surgical treatment of an isolated tibia or femur fractures to the national referral hospital in Uganda were recruited to participate in this study. Demographic, socioeconomic, and clinical data were collected through participant interviews at the time of injury and 6 months post-injury. Social capital (use of social networks to gain access to surgery), financial leveraging, and ethnicity were also included as variables in this analysis. A probit estimation model was used to identify independent and interactive predictors of surgical treatment. RESULTS Of the 64 patients included in the final analysis, the majority of participants were male (83%), with a mean age of 40.6, and were injured in a motor vehicle accident (77%). Due to resource constraints, only 58% of participants received surgical care. The use of social capital and femur fractures were identified as significant predictors of receiving surgical treatment, with social capital emerging as the strongest predictor of access to surgery (p < 0.05). CONCLUSION Limited infrastructure, trained personnel, and surgical supplies rations access to surgical care. In this environment, participants with advantageous social connections were able to self-advocate for surgery where demand for these services greatly exceeded available resources.
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Affiliation(s)
- Trina Stephens
- School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Alexander Mezei
- Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Baltimore, MD, 21201, USA
| | - Jeffrey Potter
- Division of Orthopaedic Surgery, Queen's University, 76 Stuart St., Kingston, ON, L7L 2V7, Canada
| | - Rodney Mugarura
- Department of Orthopaedics, Makerere University, PO Box 7051, Kampala, Uganda
| | - Piotr A Blachut
- Department of Orthopaedics, University of British Columbia, 3114 - 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Peter J O'Brien
- Department of Orthopaedics, University of British Columbia, 3114 - 910 West 10th Ave, Vancouver, BC, V5Z 1M9, Canada
| | - Tito Beyeza
- Department of Orthopaedics, Makerere University, PO Box 7051, Kampala, Uganda
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca St., Baltimore, MD, 21201, USA.
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