Purpose: Great variety and controversies surround the management strategies of acute multiligament knee injuries (aMKLIs) and no established guidelines exist for resource-limited practices. The aim of this study was to compare the management approach of acute knee dislocations (AKDs) by orthopedic surgeons from nations with different economic status. Methods: This descriptive cross-sectional scenario-based survey compares different management strategies for aMLKIs of surgeons in developed economic nations (DEN) and emerging markets and developing nations (EMDN). The main areas of focus were operative versus non-operative management, timing and staging of surgery, graft choice and vascular assessment strategies. The members of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT) were approached to participate and information was collected regarding their demographics, experience, hospital setting and management strategies of aMLKIs. These were analyzed after categorizing participants into DEN and EMDN based on the gross domestic product (GDP) per capita. Results: One-hundred and thirty-eight orthopedic surgeons from 47 countries participated in this study, 67 from DEN and 71 (51.4%) from EMDN. DEN surgeons had more years of experience and were older (p < 0.05). Surgeons from EMDN mostly worked in public sector hospitals, were general orthopedic surgeons and treated patients from a low-income background. They preferred conservative management and delayed reconstruction with autograft (p < 0.05) if surgery was necessary. Surgeons from DEN favored early, single stage arthroscopic ligament reconstruction. Selective Computerized Tomography Angiography (CTA) was the most preferred choice of arterial examination for both groups. Significantly more EMDN surgeons preferred clinical examination (p < 0.05) and duplex doppler scanning (p < 0.05) compared to DEN surgeons. More surgeons from EMDN did not have access to a physiotherapist for their patients. Conclusions: Treatment of aMLKIs vary significantly based on the economic status of the country. Surgeons from DEN prefer early, single stage arthroscopic ligament reconstruction, while conservative management is favored in EMDN. Ligament surgery in EMDN is often delayed and staged. EMDN respondents utilize duplex doppler scanning and clinical examination more readily in their vascular assessment of aMLKIs. These findings highlight very distinct approaches to MLKIs in low-resource settings which are often neglected when guidelines are generated.

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ObjectiveTo determine the incidence of injuries and associated risk factors, as well as the severity of injuries sustained by professional male MMA athletes competing at the Extreme Fighting Championships Africa (EFC Africa) from 2010 to June. Design Results from this descriptive study were compared to a similar study done in the United States of America (USA). SettingMedical records of all professional events (2010–2014) were obtained from EFC Africa (custodian). ParticipantsData was obtained from 173 male competitors aged 18 to 44 years, participating in 300 professional MMA fights. Outcome measuresStatistical analyses include descriptive statistics and a stepwise logistic regression. The odds of an injury were predicted with six independent variables: fight outcome, age, weight division, number of fights, injuries in preceding fight and years of fighter experience. Main resultsInjuries to the head, face and neck were most common (45.9%), followed by traumatic brain injuries (knock-outs) (16.6%) and hypoxic brain injuries (chokes) (10.2%). Losing a fight was a significant predictor of injury when a stepwise logistic regression model was employed (p=0.040). The odds ratio indicated that preceding fight injury almost doubled the risk of sustaining an injury in following fight (1.91; p=0.163). TBI in the SA group (16.6%) was substantially higher than the USA group (1.8%).ConclusionThe high rate of TBI’s in SA competition is concerning. This could reflect superior refereeing in the USA group, as fights may be ended sooner by referee stoppage, versus allowing fights to continue until one fighter is knocked-out. Competing interestsNone.