Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries

Young, Sven; Lie, Stein Atle; Hallan, Geir; Zirkle, Lewis G.; Engesæter, Lars B.; Havelin, Leif Ivar

doi:10.3109/17453674.2011.636680

Cited by 67 publications

(33 citation statements)

References 27 publications

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“…When the results of this study were compared to results from the SOSD one year before [21] an increase in the follow-up rate from 18.1 % (95 % CI: 17.7– 18.5) in 2010 to 23.1 % (95 % CI: 22.7–23.5) in 2011 was observed. Despite this 27.6 % increase in the follow-up rate, the infection rates in the SOSD have not risen notably.…”

Section: Discussionmentioning

confidence: 74%

“…The findings that the changes in infection rates are small despite a fairly large increase in follow-up might support the observation many surgeons in low-income countries have made; that a large proportion of the patients who have specific complaints do return for follow-up, whereas patients with no complaints do not return, due, among other things, to the high cost of transport [23]. In the previous article mentioned above, we looked at the effect of the low follow-up rate in the SOSD on the infection rates [21]. In that article the statistical model suggested that the data in the SOSD might support this, as countries registering more than 5 % follow-up had very little difference in infection rates, and no increase in infection rates was found with increasing follow-up rates over 5 %.…”

Section: Discussionmentioning

confidence: 86%

“…However, this might be necessary to accept if a large body of important information from poor countries is not to be kept out of the literature. In our above-mentioned earlier article validating the data in the SOSD in late 2010, we reported a follow-up rate of 18.1 % [21]. In that article we argued the case that the whole database can be used to estimate risk of infection based on the assumption that patients who have not returned for follow-up do not have infection.…”

Section: Discussionmentioning

confidence: 87%

“…There are now over 46,000 registered IM nail operations in this database, making it possibly the largest available database on orthopedic trauma care in LMIC. Despite a fairly limited follow-up rate (18.1 % in 2010), validation of the data in the SOSD has suggested that it is reliable and can be used for further research [21]. The aim of the present study was to use the data in the SOSD to investigate whether the follow-up and infection rates are changing, and to identify risk factors for infection after IM nail operations in LMIC.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

et al. 2012

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BackgroundThe fields of surgery and trauma care have largely been neglected in the global health discussion. As a result the idea that surgery is not safe or cost effective in resource-limited settings has gone unchallenged. The SIGN Online Surgical Database (SOSD) is now one of the largest databases on trauma surgery in low- and middle-income countries (LMIC). We wished to examine infection rates and risk factors for infection after IM nail operations in LMIC using this data.MethodsThe SOSD contained 46,722 IM nail surgeries in 58 different LMIC; 46,113 IM nail operations were included for analysis.ResultsThe overall follow-up rate was 23.1 %. The overall infection rate was 1.0 %, 0.7 % for humerus, 0.8 % for femur, and 1.5 % for tibia fractures. If only nails with registered follow-up (n = 10,684) were included in analyses, infection rates were 2.9 % for humerus, 3.2 % for femur, and 6.9 % for tibia fractures. Prophylactic antibiotics reduced the risk of infection by 29 %. Operations for non-union had a doubled risk of infection. Risk of infection was reduced with increasing income level of the country.ConclusionsThe overall infection rates were low, and well within acceptable levels, suggesting that it is safe to do IM nailing in low-income countries. The fact that operations for non-union have twice the risk of infection compared to primary fracture surgery further supports the use of IM nailing as the primary treatment for femur fractures in LMIC.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

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“…All operations performed using this IM nail are registered in the SIGN online surgical database (Young et al. 2011). …”

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confidence: 99%

The impact of the increasing burden of trauma in Malawi on orthopedic trauma service priorities at Kamuzu Central Hospital

et al. 2016

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Background and purpose — The burden of road traffic injuries globally is rising rapidly, and has a huge effect on health systems and development in low- and middle-income countries. Malawi is a small low-income country in southeastern Africa with a population of 16.7 million and a gross national income per capita of only 250 USD. The impact of the rising burden of trauma is very apparent to healthcare workers on the ground, but there are very few data showing this development.Patients and methods — The annual number of femoral fracture patients admitted to Kamuzu Central Hospital (KCH) in the Capital of Malawi, Lilongwe, from 2009 to 2014 was retrieved from the KCH trauma database. Linear regression curve estimation was used to project the growth in the burden of femoral fractures and the number of operations performed for femoral fractures over the same time period.Results — 992 patients with femoral fractures (26% of all admissions for fractures) presented at KCH from 2009 through 2014. In this period, there was a 132% increase in the annual number of femoral fractures admitted to KCH. In the same time period, the total number of operations more than doubled, but there was no increase in the number of operations performed for femoral fractures. Overall, there was a 7% mortality rate for patients with femoral fractures.Interpretation — The burden of femoral fractures in Malawi is rising rapidly, and the surgical resources available cannot keep up with this development. Limited funds for orthopedic trauma care in Malawi should be invested in central training hospitals, to develop a sustainable number of orthopedic surgeons and improve current infrastructure and equipment. The centralization of orthopedic surgical care delivery at the central training hospitals will lead to better access to surgical care and early return of patients to local district hospitals for rehabilitation, thus increasing surgical throughput and efficiency in a more cost-effective manner, with the goal of expanding the future orthopedic surgical workforce to meet the national need.

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Trauma of the Hip and Femoral Shaft

Gosselin¹,

Quasem²,

Zirkle

2014

Global Orthopedics

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Low infection rates after 34,361 intramedullary nail operations in 55 low- and middle-income countries

Cited by 67 publications

References 27 publications

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low‐ and Middle‐income Countries

The impact of the increasing burden of trauma in Malawi on orthopedic trauma service priorities at Kamuzu Central Hospital

Trauma of the Hip and Femoral Shaft

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