No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Wichlas, Florian; Hofmann, Valeska; Moursy, Mohamed; Strada, Gino; Deininger, Christian

doi:10.1007/s00402-020-03747-2

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…Kilonzo et al reported that 92.3% of unstable ankle fractures managed conservatively resulted in complications compared with 37.5% of operatively managed unstable fractures. Four papers did not define the presence or absence of complications other than infection at follow-up [19,20,22,28].…”

Section: Closed Fracturesmentioning

confidence: 99%

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Davies

Pennington

Dhadwal³

et al. 2022

Eur J Orthop Surg Traumatol

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Purpose Ankle fractures may cause disability and socioeconomic challenges, even when managed in a high-resource setting. The outcomes of ankle fractures in sub-Saharan Africa are not widely reported. We present a systematic review of the patient-reported outcomes and complications of patients treated for ankle fractures in sub-Saharan Africa. Methods Medline, Embase, Google Scholar and the Cochrane Central Register of Controlled Trials were searched, utilising MeSH headings and Boolean search strategies. Ten papers were included. Data included patient demographics, surgical and non-surgical management, patient-reported outcome measures and evidence of complications. Results A total of 555 patients with ankle fractures were included, 471 of whom were followed up (range 6 weeks–73 months). A heterogenous mix of low-quality observational studies and two methodologically poor-quality randomised trials demonstrated mixed outcomes. A preference for surgical management was found within the published studies with 87% of closed fractures being treated operatively. A total of five different outcome scoring systems were used. Most studies included in this review were published by well-resourced organisations and as such are not representative of the actual clinical practice taking place. Conclusion The literature surrounding the clinical outcomes of ankle fractures in sub-Saharan Africa is sparse. There appears to be a preference for surgical fixation in the published literature and considering the limitations in surgical resources across sub-Saharan Africa this may not be representative of real-life care in the region.

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Section: Closed Fracturesmentioning

confidence: 99%

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Davies

Pennington

Dhadwal³

et al. 2022

Eur J Orthop Surg Traumatol

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“…Our results are consistent with previous studies that found that hospitals in these countries still face widespread deficiencies in trauma capacity, 39 and limited implant availability may be a key contributor. 40 However, these differences in preferred treatment could be because of lack of access to equipment and/or inadequate dissemination of knowledge, as intramedullary nailing has become an increasingly available method of fracture fixation in lowresource settings 41 and has been shown to be cost-effective 42,43 with improved early functional recovery and lower risk of malunion in LMICs. 44 Respondents reported not having sufficient experience with the procedures, not having the necessary equipment, or a combination of both, but our survey was not designed to detect whether one reason was more predominant than the other.…”

Section: Discussionmentioning

confidence: 99%

Open tibial shaft fractures: treatment patterns in sub-Saharan Africa

2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objective: Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented.Methods: A survey was distributed to orthopaedic service providers across sub-Saharan Africa. Information gathered included surgeon and practice setting demographics and treatment preferences for open tibial shaft fractures across 3 domains: initial debridement, antibiotic administration, and fracture stabilization. Responses were grouped according to country income level and were compared between LMICs and upper middle-income countries (UMICs).Results: Responses from 261 survey participants from 31 countries were analyzed, with 80% of respondents practicing in LMICs. Most respondents were male practicing orthopaedic surgeons at a tertiary referral hospital. For all respondents, initial debridement occurred most frequently in the operating room (OR) within the first 24 hours, but LMIC surgeons more frequently reported delays due to equipment availability, treatment cost, and OR availability. Compared with their UMIC counterparts, LMIC surgeons less frequently confirmed tetanus vaccination status and more frequently used extended courses of postoperative antibiotics. LMIC surgeons reported lower rates of using internal fixation, particularly for high-grade and late-presenting fractures.Conclusions: This study describes management characteristics of open tibial shaft fractures in sub-Saharan Africa. Notably, there were reported differences in wound management, antibiotic administration, and fracture stabilization between LMICs and UMICs. These findings suggest opportunities for standardization where evidence is available and further research where it is lacking.

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“…This study was developed is an NGO hospital located in Goderich, Freetown, Sierra Leone, active since 2001 where all the patients are treated free of charge, the hospital is equipped with 85 beds, divided in an intensive care unit with eight beds, an operating theatre with three operating rooms, six wards, an outpatient department, a dressing room, an X-ray room, a physiotherapy room, and a casting room [ 8 , 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…In many LMIC, hospital resources are sometimes dependent on non-governmental and humanitarian organizations (NGO) and the most commonly used or available osteosynthesis materials in low-resourced settings include external fixators, conventional non-locking plates and intramedullary nails [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

Perdomo-Lizarraga,

Andrade-Arellano,

Necchi

et al. 2024

International Orthopaedics (SICOT)

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Purpose Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach. Material and Methods This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated. Results A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57). Conclusions Both options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

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No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Cited by 4 publications

References 29 publications

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review

Open tibial shaft fractures: treatment patterns in sub-Saharan Africa

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

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