Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.

Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.

<h4>Importance</h4>Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements.<h4>Objective</h4>To use the analysis...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Alexander Thomas Schade, Foster Mbowuwa, Paul Chidothi, Peter MacPherson, Simon Matthew Graham, Claude Martin, William James Harrison, Linda Chokotho
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2021
Materias:
Medicine
R
Science
Q
Acceso en línea:https://doaj.org/article/9ce56c421ea74d59b4d68748d02edddc
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:9ce56c421ea74d59b4d68748d02edddc
record_format dspace
spelling oai:doaj.org-article:9ce56c421ea74d59b4d68748d02edddc2021-12-02T20:18:46ZEpidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.1932-620310.1371/journal.pone.0255052https://doaj.org/article/9ce56c421ea74d59b4d68748d02edddc2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255052https://doaj.org/toc/1932-6203<h4>Importance</h4>Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements.<h4>Objective</h4>To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings.<h4>Design</h4>Multicentre prospective registry study.<h4>Setting</h4>Two large referral centres and two district hospitals in Malawi.<h4>Participants</h4>All patients with a fracture (confirmed by radiographs)-including patients with multiple fractures-were eligible to be included in the registry.<h4>Exposure</h4>All fractures that presented to two urban central and two rural district hospitals in Malawi over a 3.5-year period (September 2016 to March 2020).<h4>Main outcome(s) and measure(s)</h4>Demographics, characteristics of injuries, and treatment outcomes were collected on all eligible participants.<h4>Results</h4>Between September 2016 and March 2020, 23,734 patients were enrolled with a median age of 15 years (interquartile range: 10-35 years); 68.7% were male. The most common injuries were radius/ulna fractures (n = 8,682, 36.8%), tibia/fibula fractures (n = 4,036, 17.0%), humerus fractures (n = 3,527, 14.9%) and femoral fractures (n = 2,355, 9.9%). The majority of fractures (n = 21,729, 91.6%) were treated by orthopaedic clinical officers; 88% (20,885/2,849) of fractures were treated non-operatively, and 62.7% were treated and sent home on the same day. Open fractures (OR:53.19, CI:39.68-72.09), distal femoral fractures (OR:2.59, CI:1.78-3.78), patella (OR:10.31, CI:7.04-15.07), supracondylar humeral fractures (OR:3.10, CI:2.38-4.05), ankle fractures (OR:2.97, CI:2.26-3.92) and tibial plateau fractures (OR:2.08, CI:1.47-2.95) were more likely to be treated operatively compared to distal radius fractures.<h4>Conclusions and relevance</h4>The current model of fracture care in Malawi is such that trained orthopaedic surgeons manage fractures operatively in urban referral centres whereas orthopaedic clinical officers mainly manage fractures non-operatively in both district and referral centres. We recommend that orthopaedic surgeons should supervise orthopaedic clinical officers to manage non operative injuries in central and district hospitals. There is need for further studies to assess the clinical and patient reported outcomes of these fracture cases, managed both operatively and non-operatively.Alexander Thomas SchadeFoster MbowuwaPaul ChidothiPeter MacPhersonSimon Matthew GrahamClaude MartinWilliam James HarrisonLinda ChokothoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255052 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Alexander Thomas Schade
Foster Mbowuwa
Paul Chidothi
Peter MacPherson
Simon Matthew Graham
Claude Martin
William James Harrison
Linda Chokotho
Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
description <h4>Importance</h4>Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements.<h4>Objective</h4>To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings.<h4>Design</h4>Multicentre prospective registry study.<h4>Setting</h4>Two large referral centres and two district hospitals in Malawi.<h4>Participants</h4>All patients with a fracture (confirmed by radiographs)-including patients with multiple fractures-were eligible to be included in the registry.<h4>Exposure</h4>All fractures that presented to two urban central and two rural district hospitals in Malawi over a 3.5-year period (September 2016 to March 2020).<h4>Main outcome(s) and measure(s)</h4>Demographics, characteristics of injuries, and treatment outcomes were collected on all eligible participants.<h4>Results</h4>Between September 2016 and March 2020, 23,734 patients were enrolled with a median age of 15 years (interquartile range: 10-35 years); 68.7% were male. The most common injuries were radius/ulna fractures (n = 8,682, 36.8%), tibia/fibula fractures (n = 4,036, 17.0%), humerus fractures (n = 3,527, 14.9%) and femoral fractures (n = 2,355, 9.9%). The majority of fractures (n = 21,729, 91.6%) were treated by orthopaedic clinical officers; 88% (20,885/2,849) of fractures were treated non-operatively, and 62.7% were treated and sent home on the same day. Open fractures (OR:53.19, CI:39.68-72.09), distal femoral fractures (OR:2.59, CI:1.78-3.78), patella (OR:10.31, CI:7.04-15.07), supracondylar humeral fractures (OR:3.10, CI:2.38-4.05), ankle fractures (OR:2.97, CI:2.26-3.92) and tibial plateau fractures (OR:2.08, CI:1.47-2.95) were more likely to be treated operatively compared to distal radius fractures.<h4>Conclusions and relevance</h4>The current model of fracture care in Malawi is such that trained orthopaedic surgeons manage fractures operatively in urban referral centres whereas orthopaedic clinical officers mainly manage fractures non-operatively in both district and referral centres. We recommend that orthopaedic surgeons should supervise orthopaedic clinical officers to manage non operative injuries in central and district hospitals. There is need for further studies to assess the clinical and patient reported outcomes of these fracture cases, managed both operatively and non-operatively.
format article
author Alexander Thomas Schade
Foster Mbowuwa
Paul Chidothi
Peter MacPherson
Simon Matthew Graham
Claude Martin
William James Harrison
Linda Chokotho
author_facet Alexander Thomas Schade
Foster Mbowuwa
Paul Chidothi
Peter MacPherson
Simon Matthew Graham
Claude Martin
William James Harrison
Linda Chokotho
author_sort Alexander Thomas Schade
title Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
title_short Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
title_full Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
title_fullStr Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
title_full_unstemmed Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning.
title_sort epidemiology of fractures and their treatment in malawi: results of a multicentre prospective registry study to guide orthopaedic care planning.
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/9ce56c421ea74d59b4d68748d02edddc
work_keys_str_mv AT alexanderthomasschade epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT fostermbowuwa epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT paulchidothi epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT petermacpherson epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT simonmatthewgraham epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT claudemartin epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT williamjamesharrison epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
AT lindachokotho epidemiologyoffracturesandtheirtreatmentinmalawiresultsofamulticentreprospectiveregistrystudytoguideorthopaediccareplanning
_version_ 1718374243292413952

Ejemplares similares