Global Relevance of Literature on Trauma

Background The developing world contains more than of the world's population, and has the largest burden of musculoskeletal disease. Published studies provide crucial information that can influence healthcare policies. Presumably much information regarding burden in the developing world would arise from authors from developing countries. However, the extent of participation of authors from the developing world in widely read orthopaedic journals is unclear.

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Representation of Developing Countries in Orthopaedic Journals: A Survey of Four Influential Orthopaedic Journals

Aluede

Phillips

Bleyer

et al. 2012

“…This skewed resource allocation is particularly pronounced in the orthopaedic literature where increased global musculoskeletal disease and trauma in the developing world have not been met with a concomitant increase in attention or funding [2,17,30]. Research is a way to contribute lasting change in a lowresource setting and is as important as research performed in a high-resource setting.…”

Section: Introductionmentioning

confidence: 99%

What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

Elliott

Sonshine

Akhavan

et al. 2015

Background Research addressing the burden of musculoskeletal disease in low-and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low-and middle-income countries. Purpose We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. Materials Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. Results We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to This study was supported by private donations to the Institute for Global Orthopaedics and Traumatology (IGOT, San Francisco, CA, USA). No authors received payment or in-kind benefit for this study, nor are any authors members of a company that provided funding to IGOT. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. Conclusions The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process ba...

“…The SIGN organization, its implants, and the many surgeons in low and middle-income countries now using their techniques and equipment have effectively and dramatically changed the treatment paradigm for long-bone fractures and serve as an example of successful disruptive innovation [6]. In the developing world where resources are limited, traditional clinical research using standard followup and clinical outcomes is extraordinarily difficult, if not impossible, and research in these countries is severely underrepresented in the literature [9]. Although logistically challenging, it is worth critically examining the outcomes of the SIGN nail thus far.…”

Section: Introductionmentioning

confidence: 99%

Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment

Carsen

Park

Simon

et al. 2015

Background The burden of orthopaedic trauma in the developing world is substantial and disproportionate. SIGN Fracture Care International is a nonprofit organization that has developed and made available to surgeons in resourcelimited settings an intramedullary interlocking nail for use in the treatment of femoral and tibial fractures. Instrumentation also is donated with the nail. A prospectively populated database collects information on all procedures performed using this nail. Given the challenging settings and numerous surgeons with varied experience, it is important to document adequate alignment and union using the device. Questions/purposes The primary aim of this research was to assess the adequacy of operative reduction of closed diaphyseal femur fractures using the SIGN interlocking intramedullary nail based on radiographic images available in the SIGN database. The secondary aims were to assess correlations between postoperative alignment and several associated variables, including fracture location in the diaphysis, degree of fracture site comminution, and time to surgery. The tertiary aim was to assess the functionality of the SIGN database for radiographic analyses. Methods A review of the prospectively populated SIGN database was performed for patients with a diaphyseal femur fracture treated with the SIGN nail, which at the time of the study totaled 32,362 patients. After study size calculations, a random number generator was used to select 500 femur fractures for analysis. Exclusion criteria included open fractures and those without radiographs during the early postoperative period. The following information was recorded: location of the fracture in the diaphysis; fracture classification (AO/Orthopaedic Trauma Association [OTA] classification); degree of comminution (Winquist and Hansen classification); time from injury to surgery; and patient demographics. Measurements of alignment were obtained from the AP and lateral radiographs with malalignment defined as deformity in either the sagittal or coronal plane greater than 5°. Measurements were made manually by the four study authors using onscreen protractor software and interobserver reliability was assessed. Results The frequency of malalignment greater than 5°o bserved on postoperative radiographs was 51 of 501 (10%; 95% CI, 6.5-11.5), and malalignment greater than Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® 10°occurred in eight of 501 (1.6%) of the femurs treated with this nail. Fracture location in the proximal or distal diaphysis was strongly correlated with risk of malalignment, with an odds ratio (OR) of 3.7 (95% CI, 1.5-9.3) for distal versus middle diaphyseal fractures and an OR of 4.7 (95% CI, 1.9-11.5) for proximal versus middle fractures (p \ 0.001). Time from injury to surgery greater than 4 weeks also was strongly correlated with risk of malalignment (p \ 0.001). Inherent fracture stability, based on fracture site comminution as per the Winquist and Hansen clas...