Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America.
Department of Orthopaedic Surgery, University of Pennsylvania, Market Street, United States of America.
Pan Afr Med J. 2024 May 29;48:29. doi: 10.11604/pamj.2024.48.29.41286. eCollection 2024.
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.
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.
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).
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.
撒哈拉以南非洲地区面临着巨大的肌肉骨骼创伤负担。在接受手术治疗的患者中，尚未有报道说明手术治疗被认为是“充分”的频率，或者如果是“不充分”的，那么哪些医院和矫形专科的具体系统限制可能是不可逾越的。
在撒哈拉以南非洲地区的一家三级护理中心的矫形创伤服务中，前瞻性地收集了 6 周内就诊的患者数据，然后进行回顾性审查，以确定根据恢复长度、对线和旋转的原则，手术治疗是否“充分”（或者否则，“不充分”）。排除标准包括临床信息不足；单纯脊柱损伤；感染；仅涉及去除内固定物的病例；软组织手术；肿瘤病例；以及医疗（非手术）情况。
共纳入 112 例进行分析。112 例中有 106 例（94.6%）需要手术，其中 62 例（58.4%）进行了手术。在接受术后影像学检查的手术患者中（n=56），24 例（42.9%）手术治疗不充分。治疗被认为“不充分”的最常见原因包括缺乏合适的植入物（n=16）、术中缺乏透视（n=10）和术中对损伤评估不完整（n=5）。
在急性骨科创伤性损伤患者中，存在几种系统限制，包括术中缺乏透视和植入物缺乏，这会妨碍提供充分的手术治疗。本研究将为正在努力改善矫形专科资源可用性和促进该地区更有效的骨折护理的持续努力提供有用的基线。
