The Malawi Orthopaedic Association/AO Alliance guidelines and standards for open fracture management in Malawi: a national consensus statement

Abstract

BackgroundOpen fractures are common injuries in Malawi that pose a large burden on the healthcare system and result in long-term disability.AimEstablishing a multiprofessional agreement on the management of open fractures in Malawi from a consensus meeting. MethodsAO Alliance convened a consensus meeting to build an agreement on the management of open fractures in Malawi. Eighteen members from different professions and various regions of Malawi participated in a 1-day consensus meeting on 7 September 2019. Prior to the meeting the British Orthopaedic Audit Standards for Trauma (BOAST) for open fractures, as well as relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on open fracture management, followed by an open discussion meeting. At the 1-day consensus meeting panel members developed statements for each standard and guideline. Panel members then voted to accept or reject the statements.ResultsSubstantial agreement (no rejections) was reached for all 17 guidelines and the associated terminology was agreed on. These guidelines were then presented to the members of the Malawi Orthopaedic Association (MOA) at their annual general meeting on 28 September 2019 and all participants agreed to adopt them.ConclusionsThese MOA/AO Alliance guidelines aim to set a standard for open fracture management that can be regularly measured and audited in Malawi to improve care for these patients.

Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning

“…In HICs, the creation of major trauma networks has aided fracture care management [ 24 , 25 ] and there is potential to develop a trauma network system in Malawi and similar LMICs along similar lines. The introduction of guidelines has strengthened open fracture care in the UK [ 25 ] and a recent initiative has established locally approved guidelines for the care and referral of open fractures in Malawi [ 26 ].…”

Development and use of clinical vignettes to assess injury care quality in Northern Malawi

“…Third, both prompt administration of antibiotics and documented examination of neurovascular status are key features of the Malawi Orthopaedic Association (MOA) guidelines for management of open fracture [37]. Few participants gave antibiotics, or checked for distal neurological or vascular compromise, which are potentially simple examination techniques to identify need for urgent intervention.…”

Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines

“…Compliance with the Malawi Orthopaedic Association/ Arbeitsgemeinschaft fur Osteosynthesefragen Alliance open fracture guidelines 26 …”

“…Some studies have shown that adherence to national guidance can reduce healthcare utilisation for severe open tibia fractures in the UK 24 , 25 . Recently, open fractures guidelines have been developed in Malawi via a consensus meeting 26 as resources such as computed tomography and specialised orthoplastic theatre lists are often not available in Malawi.…”

“…• A hospital management protocol for all open fractures will be implemented at first and second level healthcare facilities based on the 17 Malawi Orthopaedic Association/AO (Arbeitsgemeinschaft für Osteosynthesefragen) Alliance guidelines26 . This protocol will include administering early antibiotics, photographing the wound and performing debridement in theatre with adequate anaesthesia• A national educational course for clinical officers on the open fractures guidelines • Improved documentation of each guideline by using standard proformas for open fracture management • Transferring grade III open fractures to central hospitals as soon as possible and keeping wound open for grade IIIB and IIIC injuries…”