1
|
DeMaio EL, Marra G, Suleiman LI, Tjong VK. Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US. Curr Rev Musculoskelet Med 2024; 17:439-448. [PMID: 39240419 PMCID: PMC11465105 DOI: 10.1007/s12178-024-09917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW The burden of musculoskeletal disease is increasing globally and disproportionately affecting people in low and middle income countries (LMIC). We sought to review global access to orthopaedic care, burden of trauma, research infrastructure, impact of surgical mission trips, implant availability, and the effect of COVID-19 upon the delivery of orthopaedic care worldwide. RECENT FINDINGS The majority of people in LMIC do not have access to safe, quality surgical care, and there are few fellowship-trained orthopaedic traumatologists. Road traffic accidents are the leading cause of long bone fractures in LMIC and result in significant morbidity and mortality. Of the orthopaedic literature published globally in the last 10 years, less than 15% had authors from LMIC. There has been growth in surgical mission trips to LMIC, but few organizations have established bidirectional partnerships. Among the challenges to delivering quality musculoskeletal care in LMIC is timely access to quality orthopaedic implants. Implant options in LMIC are more limited and subjected to less rigorous testing and regulation than high income countries (HIC). The COVID-19 pandemic dramatically reduced elective surgeries but saw the increase in telemedicine utilization which has prevailed in both HIC and LMIC. Awareness of global inequities in orthopaedic care is growing. Much can be learned through collaborations between orthopaedic surgeons from HIC and LMIC to advance patient care worldwide. There is a need for high quality, accurate data regarding incidence and prevalence of musculoskeletal disease, care utilization/availability, and postoperative outcomes so resources can be allotted to make orthopaedic care more equitable globally.
Collapse
Affiliation(s)
- Emily L DeMaio
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Guido Marra
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital Arkes Family Pavilion, Investigation Performed at McGaw Medical Center of Northwestern University, 676 N Saint Clair, Ste 1350, Chicago, IL, 60611, USA.
| |
Collapse
|
2
|
Schader JF, Zderic I, Gehweiler D, Dauwe J, Mys K, Danker C, Acklin YP, Sommer C, Gueorguiev B, Stoffel K. Standardized artificially created stable pertrochanteric femur fractures present more homogenous results compared to osteotomies for orthopaedic implant testing. BMC Musculoskelet Disord 2021; 22:371. [PMID: 33879133 PMCID: PMC8058974 DOI: 10.1186/s12891-021-04234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background With regard to biomechanical testing of orthopaedic implants, there is no consensus on whether artificial creation of standardized bone fractures or their simulation by means of osteotomies result in more realistic outcomes. Therefore, the aim of this study was to artificially create and analyze in an appropriate setting the biomechanical behavior of standardized stable pertrochanteric fractures versus their simulation via osteotomizing. Methods Eight pairs of fresh-frozen human cadaveric femora aged 72.7 ± 14.9 years (range 48–89 years) were assigned in paired fashion to two study groups. In Group 1, stable pertrochanteric fractures AO/OTA 31-A1 were artificially created via constant force application on the anterior cortex of the femur through a blunt guillotine blade. The same fracture type was simulated in Group 2 by means of osteotomies. All femora were implanted with a dynamic hip screw and biomechanically tested in 20° adduction under progressively increasing physiologic cyclic axial loading at 2 Hz, starting at 500 N and increasing at a rate of 0.1 N/cycle. Femoral head fragment movements with respect to the shaft were monitored by means of optical motion tracking. Results Cycles/failure load at 15° varus deformation, 10 mm leg shortening and 15° femoral head rotation around neck axis were 11324 ± 848/1632.4 ± 584.8 N, 11052 ± 1573/1605.2 ± 657.3 N and 11849 ± 1120/1684.9 ± 612.0 N in Group 1, and 10971 ± 2019/1597.1 ± 701.9 N, 10681 ± 1868/1568.1 ± 686.8 N and 10017 ± 4081/1501.7 ± 908.1 N in Group 2, respectively, with no significant differences between the two groups, p ≥ 0.233. Conclusion From a biomechanical perspective, by resulting in more consistent outcomes under dynamic loading, standardized artificial stable pertrochanteric femur fracture creation may be more suitable for orthopaedic implant testing compared to osteotomizing the bone.
Collapse
Affiliation(s)
- J F Schader
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland.
| | - I Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - D Gehweiler
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - J Dauwe
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland.,Department of Trauma Surgery, UZ Leuven, Leuven, Belgium
| | - K Mys
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - C Danker
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - Y P Acklin
- University Hospital Basel, Basel, Switzerland
| | - C Sommer
- Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - B Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos Platz, Switzerland
| | - K Stoffel
- University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
| |
Collapse
|
3
|
Miclăuş T, Valla V, Koukoura A, Nielsen AA, Dahlerup B, Tsianos GI, Vassiliadis E. Impact of Design on Medical Device Safety. Ther Innov Regul Sci 2020; 54:839-849. [PMID: 32557299 PMCID: PMC7362883 DOI: 10.1007/s43441-019-00022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
The growing number of emerging medical technologies and sophistication of modern medical devices (MDs) that improve both survival and quality of life indexes are often challenged by alarming cases of vigilance data cover-up and lack of sufficient pre- and post-authorization controls. Combining Quality with Risk Management processes and implementing them as early as possible in the design of MDs has proven to be an effective strategy to minimize residual risk. This article aims to discuss how the design of MDs interacts with their safety profile and how this dipole of intended performance and safety may be supported by Human Factors Engineering (HFE) throughout the Total Product Life-Cycle (TPLC) of an MD in order to capitalize on medical technologies without exposing users and patients to unnecessary risks.
Collapse
Affiliation(s)
- Teodora Miclăuş
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Vasiliki Valla
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Angeliki Koukoura
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Anne Ahlmann Nielsen
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | - Benedicte Dahlerup
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| | | | - Efstathios Vassiliadis
- Evnia Group, Copenhagen Business Center, Hellerup Strandvejen 60, 2900, Copenhagen, Denmark
| |
Collapse
|