Systems issues limiting acute fracture care delivery at a tertiary care hospital in Northern Tanzania.

Autor:	Morgan-Asiedu PK; Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America., Fryhofer GW; Department of Orthopaedic Surgery, University of Pennsylvania, Market Street, United States of America., Hardaker WM; Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, United States., Premkumar A; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, United States., Shin M; Department of Cardiothoracic Surgery, University of Pennsylvania, Market Street, United States., Ramesh S; Life Sciences and Management Program, University of Pennsylvania, Philadelphia, United States of America., Pean C; Harvard Orthopaedic Trauma Initiative, Brigham and Women´s Hospital, Massachusetts General Hospital., Jusabani MA; Kilimanjaro Christian Medical University College, Sokoine Rd, Moshi, Tanzania., Temu R; Kilimanjaro Christian Medical University College, Sokoine Rd, Moshi, Tanzania., Massawe H; Kilimanjaro Christian Medical University College, Sokoine Rd, Moshi, Tanzania., Sheth NP; Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, Spruce Street, Philadelphia, United States of America.
Jazyk:	angličtina
Zdroj:	The Pan African medical journal [Pan Afr Med J] 2024 May 29; Vol. 48, pp. 29. Date of Electronic Publication: 2024 May 29 (Print Publication: 2024).
DOI:	10.11604/pamj.2024.48.29.41286
Abstrakt:	Introduction: sub-Saharan Africa experiences a significant musculoskeletal trauma burden. Among patients who receive surgical treatment, there have been no reports as to how often surgical care is determined to be "adequate" or, if "inadequate", then what hospital and orthopaedic specialty-specific systems limitations might be prohibitive. Methods: data from patients presenting to the orthopaedic trauma service at a tertiary care center in sub-Saharan Africa were prospectively collected over a 6-week period and then retrospectively reviewed to determine whether the surgical treatment was "adequate" (or otherwise, "inadequate") according to the principle of restoring length, alignment, and rotation. Exclusion criteria included insufficient clinical information; isolated spinal injury; infection; cases involving only removal of hardware; soft-tissue procedures; tumor cases; and medical (non-surgical) conditions. Results: 112 cases were included for analysis. Surgery was indicated in 106 of 112 cases (94.6%), and of those, surgery was performed in 62 cases (58.4%). Among patients who underwent surgery with available post-operative imaging (n=56), surgical treatment was "inadequate" in 24 cases (42.9%). The most common reasons treatment was deemed "inadequate" included unavailability of appropriate implants (n=16), unavailability of intraoperative fluoroscopy (n=10) and incomplete intraoperative evaluation of injury (n=5). Conclusion: several systems limitations prevent the delivery of adequate surgical treatment in patients with acute orthopaedic traumatic injuries, including lack of intraoperative fluoroscopy and lack of implant availability. This study will serve as a useful baseline for ongoing efforts seeking to improve orthopaedic specialty resource availability and facilitate more effective fracture care in this region. Competing Interests: The authors declare no competing interests. (Copyright: Papa Kwadwo Morgan-Asiedu et al.)
Databáze:	MEDLINE
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