From the Virginia Commonwealth University, Richmond, VA (Mr. Cassidy and Mr. Yeramosu); the Harvard Global Orthopaedics Collaborative, Boston, MA (Mr. Cassidy, Mr. Yeramosu, Dr. Wu, and Dr. Agarwal-Harding); the Department of Surgery, Queen Elizabeth Central Hospital, Blantyre, Malawi (Mr. Mbomuwa and Mr. Chidothi); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA (Dr. Wu); the AO Alliance Foundation, Davos, Switzerland (Dr. Martin and Dr. Harrison); the Countess of Chester Hospital NHS Trust, Chester, United Kingdom (Dr. Harrison); the Malawi University of Science and Technology, Limbe, Malawi (Dr. Chokotho); and the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding).
J Am Acad Orthop Surg Glob Res Rev. 2024 Jul 16;8(7). doi: 10.5435/JAAOSGlobal-D-24-00026. eCollection 2024 Jul 1.
Pediatric fractures are common in Malawi, and surgical care, when needed, remains inaccessible to many. Understanding which children in Malawi receive surgery or nonsurgical treatment would help set priorities for trauma system development.
We used multivariate logistic regression to evaluate associations between surgical treatment and age, sex, school enrollment, injury mechanism, fracture type, open fracture, referral status, hospital of presentation, delayed presentation (≥2 days), healthcare provider, and inpatient vs outpatient treatment.
From 2016 to 2020, 10,400 pediatric fractures were recorded in the Malawi Fracture Registry. Fractures were most commonly of the wrist (26%), forearm (17%), and elbow (14%). Surgical fixation was performed on 4.0% of patients, and 24 (13.0%) open fractures were treated nonsurgically, without débridement or fixation. Fractures of the proximal and diaphyseal humerus (odds ratio [OR], 3.72; 95% confidence interval [CI], 2.36 to 5.87), knee (OR, 3.16; 95% CI, 1.68 to 5.95), and ankle (OR, 2.63; 95% CI, 1.49 to 4.63) had highest odds of surgery. Odds of surgical treatment were lower for children referred from another facility (OR, 0.62; 95% CI, 0.49 to 0.77).
Most Malawian children with fractures are treated nonsurgically, including many who may benefit from surgery. There is a need to increase surgical capacity, optimize referral patterns, and standardize fracture management in Malawi.
在马拉维，儿童骨折很常见，但许多儿童仍无法获得所需的手术治疗。了解哪些马拉维儿童接受了手术或非手术治疗，将有助于为创伤系统的发展确定优先事项。
我们使用多变量逻辑回归来评估手术治疗与年龄、性别、入学情况、损伤机制、骨折类型、开放性骨折、转诊情况、就诊医院、延迟就诊（≥2 天）、医疗服务提供者以及住院或门诊治疗之间的关联。
2016 年至 2020 年期间，马拉维骨折登记处共记录了 10400 例儿童骨折。最常见的骨折部位是手腕（26%）、前臂（17%）和肘部（14%）。对 4.0%的患者进行了手术固定，24 例（13.0%）开放性骨折未进行清创或固定的非手术治疗。肱骨近端和骨干（优势比 [OR]，3.72；95%置信区间 [CI]，2.36 至 5.87）、膝关节（OR，3.16；95% CI，1.68 至 5.95）和踝关节（OR，2.63；95% CI，1.49 至 4.63）骨折手术的可能性最高。从其他医疗机构转诊的儿童接受手术治疗的可能性较低（OR，0.62；95% CI，0.49 至 0.77）。
马拉维大多数骨折患儿均接受非手术治疗，包括许多可能受益于手术的患儿。马拉维需要增加手术能力，优化转诊模式，并规范骨折管理。
