From the Department of Orthopaedic Surgery, The Warren Alpert School of Medicine at Brown University, Ontario, RI (Dr. Dworkin), Harvard Global Orthopaedics Collaborative, Boston, MA (Dr. Dworkin). AO Alliance, Davos, Switzerland (Mr. Harrison, Mr. Chidothi, Mr. Mbowuwa, and Dr. Martin); Countess of Chester Hospital NHS Foundation Trust, London (Mr. Harrison and Mr. Chidothi); Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding); Department Harvard Medical School, Program in Global Surgery and Social Change, Global Health and Social Medicine, Boston, MA (Dr. Agarwal-Harding), Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi (Ms. Chokotho).
J Am Acad Orthop Surg Glob Res Rev. 2024 Mar 26;8(4). doi: 10.5435/JAAOSGlobal-D-23-00282. eCollection 2024 Apr 1.
Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi.
We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi.
Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery.
The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.
在中低收入国家，对于桡骨远端骨折（DRF）的负担或管理知之甚少。本研究旨在描述马拉维 DRF 的治疗情况。
我们回顾性地分析了在马拉维四家公立医院的矫形外科部门就诊的所有骨折患者的病历。
共有 1440 名患者（14.5%）患有 DRF。平均年龄为 40 岁，888 名（62.0%）为男性。对 122 名患者（9.5%）进行了手术。在伊丽莎白女王医院就诊的患者、跌倒后就诊的患者以及最初由矫形登记员或矫形临床医生评估的患者，接受手术治疗的可能性较低。相比之下，开放性损伤接受手术治疗的可能性最大。
马拉维骨折登记处患者最常见的肌肉骨骼损伤是桡骨远端骨折。这些受影响最大的年轻成年男性患者可能受益于手术治疗；然而，大多数患者都接受了非手术治疗。在以农业为主的社会中，缺乏手术固定和保守随访可能会对长期功能产生影响。需要进行基于结果的研究，以帮助指导管理决策并规范患者护理和转诊方案。
