Open Fracture Management in Low‐Resource Settings: A Medical Training Experience in Cambodian Hospitals

Tajsic, Nenad B.; Sambath, Puon; Nguon, Sophy; Sokh, Vannara; Chheang, Virak; Landsem, Gaute; Zaletel, Ivan; Husum, Hans

doi:10.1007/s00268-017-4245-7

Cited by 5 publications

(14 citation statements)

References 27 publications

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“…804023.17). 4 Testing results showed that the chemical composition of the pins was similar to authentic stainless steel of type SS316/SS316L which is used for medical instruments and fixation screws. The new external fixator frame was accepted and approved by the Secretary of State for Health at the national workshop in Phnom Penh (Cambodia) on June 31, 2011.…”

Section: Introductionmentioning

confidence: 92%

“…The challenge is therefore to find methods for limb salvage surgery which are feasible in low-resource settings. 4 In most developed countries, larger hospitals typically have multi-disciplinary teams for lower limb reconstruction, including orthopedic surgeons, plastic surgeons, and infectious disease specialists. Those special skills are not available in Cambodian hospitals for the time being.…”

Section: Introductionmentioning

confidence: 99%

“…Patients were able to adjust the support by a Velcro strap. 4 Intervention 2: Clinical Training and Supervision Based on their skills and location of practice, three surgeons (two doctors and one paramedic) were selected to reach the top of the reconstructive ladder in open fracture management. 5 None of the pre-selected surgeons and paramedic had been engaged in limb salvage surgery before.…”

Section: Introductionmentioning

confidence: 99%

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Norwegian Open Fracture Management System: Outcomes After 10 Years Working in Low-Resource Settings in Cambodian Hospitals

Tajsic

Sørbye

Nguon

et al. 2022

Prehosp. Disaster med.

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Introduction: The treatment of open lower limb fractures represents a major challenge for any trauma surgeon, and this even more so in resource-limited areas. The aim of the study is to describe the intervention, report the treatment plan, and observe the effectiveness of the Norwegian Open Fracture Management System in saving lower limbs in rural settings. Materials and Methods: A retrospective and prospective interventional study was carried out in the period 2011 through 2017 in six rural hospitals in Cambodia. The fractures were managed with locally produced external fixators and orthosis developed in 2007. Based on skills and living locations, two local surgeons and one paramedic without reconstructive surgery experience were selected to reach the top of the reconstructive ladder and perform limb salvage surgeries. This study evaluated 56 fractures using the Ganga Hospital Open Injury Score (GHOIS) for Gustilo-Anderson Type IIIA and Type IIIB open fracture classification groups. Results: The primary success rate in open tibia fractures was 64.3% (95% CI, 50.3 - 76.3). The average treatment time to complete healing for all of the patients was 39.6 weeks (95% CI, 34.8 - 44.4). A percentage of 23.2% (95% CI, 13.4 - 36.7) experienced a deep infection. Fifteen of the patients had to undergo soft tissue reconstruction and 22 flaps were performed. Due to non-union, a total of 15 bone grafts were performed. All of the 56 patients in the study gained limb salvage and went back to work. Conclusion: The given fracture management program proves that low-resource countries are able to produce essential surgical tools at high quality and low price. Treatment with external fixation and functional bracing, combined with high-level training of local surgeons, demonstrates that a skilled surgical team can perform advanced limb salvage surgery in low-resource settings.

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Norwegian Open Fracture Management System: Outcomes After 10 Years Working in Low-Resource Settings in Cambodian Hospitals

Tajsic

Sørbye

Nguon

et al. 2022

Prehosp. Disaster med.

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“…One study in India reported improved burn management skills, including decreased antibiotic use and earlier excision and grafting [29], while a similar study in Zambia did not report significant changes to burn management protocols or consequent patient outcomes [62]. Carey et al [55] reported on the completion of 93.3% flaps with a 78.1% aversion rate of amputations, while Tajsic et al [13] indicated a 70% primary healing rate of open fractures after orthopedic trauma courses. Participants of the Uganda Sustainable Trauma Orthopedic Program reported a subjective improvement for patients with orthopedic trauma [58].…”

Section: Course Effectivenessmentioning

confidence: 99%

Trauma Training Courses and Programs in Low‐ and Lower Middle‐Income Countries: A Scoping Review

et al. 2021

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Background Injury is the leading cause of morbidity and mortality in low- and lower middle-income countries (LMICs). Trauma training is a cost-effective way to improve injury outcomes. Several trauma programs have been implemented in LMICs; however, their scope and effectiveness remain unclear. In this review, we sought to describe and assess the current state of trauma training in LMICs. Methods We searched MEDLINE, Embase, Global Health, Cochrane Library, and ProQuest Dissertations & Theses Global for trauma training courses in LMICs. An additional gray literature search was conducted on university, governmental, and non- governmental organizations’ websites to identify trauma-related postgraduate medical education (PGME) opportunities. Results Most studies occurred in sub-Saharan Africa and participants were primarily physicians/surgeons, medical students/residents, and nurses. General and surgical trauma management courses were most common, followed by orthopedic trauma or plastic surgery trauma/burn care courses. 32/45 studies reported on participant knowledge and skills, 27 of which had minimal follow-up. Of the four studies commenting on cost of courses, only one demonstrated cost-effectiveness. Three articles evaluated post-course effects on patient outcomes, two of which failed to demonstrate significant improvements. Overall, 43.0% of LMICs have PGME programs with defined trauma competency requirements. Conclusions Current studies on trauma training in LMICs do not clearly demonstrate sustainability, cost-effectiveness, nor improved outcomes. Trauma training programs should be in response to a need, championed locally, and work within a cohesive system to demonstrate concrete benefits. We recommend standardized and contextualized trauma training with recertifications in LMICs for lasting and improved trauma care.

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“…The articles in this collection cover a spectrum of topics ranging from specific techniques in the operating room to national policy. These include: details of operative care (fracture care in Cambodia) [1], hospital-wide programs to improve trauma care in Malawi [2], quality improvement (safe surgery checklist in Cambodia) [3], innovative measures to improve access to surgery through use of patient navigators in Haiti [4] and a nationwide surgical plan in Ethiopia [5].…”

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confidence: 99%

Advancing Global Surgery: Moving Beyond Identifying Problems to Finding Solutions

Charles

Mock

2017

World j. surg.

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Open Fracture Management in Low‐Resource Settings: A Medical Training Experience in Cambodian Hospitals

Abstract: This study demonstrates that the capacity building of reconstructive surgery in low-resource settings by local doctors and paramedics is clearly a reasonable option that may substantially reduce amputation of the limbs.

Cited by 5 publications

References 27 publications

Norwegian Open Fracture Management System: Outcomes After 10 Years Working in Low-Resource Settings in Cambodian Hospitals

Norwegian Open Fracture Management System: Outcomes After 10 Years Working in Low-Resource Settings in Cambodian Hospitals

Trauma Training Courses and Programs in Low‐ and Lower Middle‐Income Countries: A Scoping Review

Advancing Global Surgery: Moving Beyond Identifying Problems to Finding Solutions

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