Use of external fixators in developing countries: a short socioeconomic analysis

Abstract

The use of external fixators (EFs) dates back to 377 BC Hippocrates’ time, and it has a wide range of orthopaedic applications. External fixator has expanded its use in the management of fractures and other musculoskeletal conditions. It is widely used all over the world to manage complex musculoskeletal injuries. It has many advantages as compared to internal fixation in some trauma scenarios. However, the cost of the external fixators presents a dilemma to the healthcare system in developing countries. The goals of this review article are to explain the importance of EFs in developing countries in managing fractures, to determine the problems encountered at present during external fixation by developing countries, to identify solutions that could be used to address these issues, expand the use of external fixation into other domains of treatment, the impact of COVID-19 pandemic on fracture management based on existing literature. In conclusion, EFs are very expensive, researches have been conducted to overcome these barriers in developing countries. However, there are limitations in implementing in developing countries. It is important to have affordable and clinically acceptable EFs available in developing countries.

Reuse of Orthopaedic Equipment

“…A recent review found that the greatest barriers to sustainable change for environmentally friendly practices in orthopaedics were “lack of appropriate infrastructure” and “lack of knowledge or training.” 16 Indeed, there are no universal protocols for evaluating whether equipment is suitable for reuse, nor evidence suggesting the number of times specific items can be safely reused 43,59,98,99 . In addition, there is limited equipment and trained personnel for reprocessing orthopaedic equipment, particularly in LMICs 74,87,100,101 .…”

“…External fixators have garnered particular attention for their substantial cost-saving potential 37,43 . Researchers implemented an external fixator reuse program in which components were inspected by a trained nurse, and if no obvious signs of wear were found, sterilized and reused up to 3 times; this resulted in a 32% decrease in mean unit cost, from $4,067 to $2,791 44 .…”

A Review of Tibial Shaft Fracture Fixation Methods

“…A prospective radiographic study of functional outcomes of tibial shaft fractures demonstrated a return to a state of health no different from scores of the UK population as a whole in regard to mobility, self-care, return to activities, and anxiety [65]. It does come at a cost, however, as a TSF is twice as expensive as an Ilizarov frame [53,67]. On the contrary, the TSF allows continuity of the device, reduced risk of infection, early mobilization, restoration of the primary defect caused by bone loss, easy and accurate application, and increased versatility than a monolateral fixator [53,65,66].…”

Biomechanical Stiffness and Strength of New Versus Reused Stainless Steel Uniplanar Tibial External Fixator Constructs in a Low-Resource Setting

“…15 Recycling external fixator components is often economical. 16 In developing countries, even locally manufactured external fixator stocks are often depleted and many patients cannot afford commercial devices. A common practice is to reuse, with the patient's consent, the non-implantable components (outriggers) of previously used external fixators, thus greatly reducing the cost of treatment.…”