Longstanding pain and social strain: patients’ and health care providers’ experiences with fracture management by skeletal traction; a qualitative study from Malawi

Abstract

The use of long-term skeletal traction has a devastating impact on the patients and families, and causes major frustrations to health workers involved with fracture management in a low-resource setting. Implications for Rehabilitation As stated by various health care providers, there is a need to improve trauma care, strengthen rehabilitation services and educate more rehabilitation staff so they can take up the different roles and functions required in treatment and rehabilitation after injuries and other debilitating conditions. In the current situation, sufficient pain relief for patients is required. This should go hand in hand with the empowerment of patients so as to fulfill their rights to quality health services. For health care providers, multidisciplinary teamwork, enhanced specialized education and skills, improved access to adequate equipment and developing standardized procedures appear essential in order to improve fracture management. With injuries representing a growing portion of the global burden of disease, and in the changing demographic panorama with aging populations in Africa and the world at large, injury prevention, trauma care- and rehabilitation need a stronger focus in public health globally.

Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi

“…As far as we know, this is the first study comparing quality of life and functional status in femoral shaft fracture patients treated with ST or IMN. Haug et al (2017) looked at quality ST vs. IMN EQ5D score 0.03 (-0.004 to 0.1) -0.14 (-0.27 to -0.02) -0.07 (-0.14 to -0.0001) -0.08 (-0.15 to -0.01) 0.001 (-0.05 to 0.05) p-value 0.1 0.03 0.05 0.04 1 SMFA FI -1.0 (-2.5 to 0.6) 8.7 (2.6 to 15) 8.4 (2.6 to 14) 7.9 (1.7 to 14) -2. (-5.8 to 1.7) p-value 0.2 0.01 0.01 0.01 0.3 SMFA BI -0.5 (-1.9 to 0.9) 9.2 (2.4 to 16) 7.7 (1.2 to 14) 6.7 (-0.3 to 14) -1.2 (-5.4 to 2.9) p-value 0.5 0.01 0.02 0.1 0.6 IMN vs. successful ST EQ5D score 0.03 (-0.002 to 0.1) -0.09 (-0.2 to 0.06) -0.07(-0.2 to 0.03) -0.05 (-0.14 to 0.03) -0.0001 (-0.05 to 0.05) p-value 0.1 0.2 0.2 0.2 1 SMFA FI -1.1 (-2.6 to 0.5) 8.5 (1.8 to 15) 7.6 (0.4 to 15) 7.2 (0.4 to 14) -2.4 (-6.3 to 1.5) p-value 0.2 0.01 0.04 0.04 0.2 SMFA BI -0.9 (-2.2 to 0.4) 8.8 (0.9 to 17) 5.5 (-2.5 to 14) 4.1(-3.6 to 12) -1.2 (-5.6 to 3.1) p-value 0.2 0.03 0.2 0.3 0.6 of life in femoral shaft fracture patients treated with skeletal traction and found that patients had both physical and psychological pain as well as emotional distress due to prolonged hospitalization and the associated negative economic impact on their families.…”

“Life is at a standstill” Quality of life after lower extremity trauma in Malawi

“…Patients treated with modern principles of fracture care can ambulate without pain soon after surgery [26]. With a severe under capacity for trauma surgery at KCH, patients were receiving conservative management for many injuries that are no longer treated in this way in most middle and high income countries [27]. A modest scale up of orthopedic trauma services could help reduce this burden in the future [28,23].…”

Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey

“…This can have a profound negative effect on a family's social and economic situation and even the economic development of the whole country. 17 …”