Orthopedic trauma surgeon in Sierra Leone: how to keep one’s head over water

Wichlas, Florian; Tsitsilonis, Serafeim; Guanti, Michela Delli; Strada, Gino; Deininger, Christian

doi:10.1007/s00402-019-03171-1

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…In this study, we report briefly on intraoperative mortality. Rates are comparable across the different lead providers and similar to other observational data from LMICs17–21 and some humanitarian organisations (including other MSF operational centres),4 22 23 while higher than other humanitarian organisations 24 25. Such data must be interpreted cautiously as they should ideally be adjusted more fully for case-mix and severity.…”

Section: Discussionsupporting

confidence: 69%

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

et al. 2020

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ObjectiveTo describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload.DesignDescriptive analysis using 10 years (2008–2017) of routine case-level data linked with routine programme-level data from surgical projects run exclusively by Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB).SettingProjects were in contexts of natural disaster (ND, entire expatriate team deployed by MSF-OCB), active conflict (AC) and stable healthcare gaps (HG). In AC and HG settings, MSF-OCB support pre-existing local facilities. Hospital facilities ranged from basic health centres with surgical capabilities to tertiary referral centres.ParticipantsThe full dataset included 178 814 surgical cases. These were categorised by most senior anaesthetic provider for the project, according to qualification: specialist physician anaesthesiologists, qualified nurse anaesthetists and uncertified anaesthesia providers.Primary outcome measureVolume and nature of surgical workload of different anaesthesia providers.ResultsFull routine data were available for 173 084 cases (96.8%): 2518 in ND, 42 225 in AC, 126 936 in HG. Anaesthesia was predominantly led by physician anaesthesiologists (100% in ND, 66% in AC and HG), then nurse anaesthetists (19% in AC and HG) or uncertified anaesthesia providers (15% in AC and HG). Across all settings and provider groups, patients were mostly healthy young adults (median age range 24–27 years), with predominantly females in HG contexts, and males in AC contexts. Overall intra-operative mortality was 0.2%.ConclusionOur findings contribute to existing knowledge of the nature of anaesthetic provision in humanitarian settings, while demonstrating the value of high-quality, routine data collection at scale in this sector. Further evaluation of perioperative outcomes associated with different models of humanitarian anaesthetic provision is required.

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Section: Discussionsupporting

confidence: 69%

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

et al. 2020

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“…Furthermore, these implants need a power drive to be used and, although not absolutely necessary, an image intensifier. In LIC, K-wires have been showed to be extremely valuable for treatment of hand, foot, and paediatric fractures [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Even when electric power drills are not available, practicable external fixator systems exist. The fact that 35.24% of the fractures are open fractures [ 9 ] makes these implants indispensable. Additionally, external fixators are reusable and the angle stability permits treatment even in weak bone.…”

Section: Discussionmentioning

confidence: 99%

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Off-label use of orthopedical trauma implants in a low-income country

Wichlas

Hofmann

Strada³

et al. 2021

International Orthopaedics (SICOT)

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Purpose Lack of resources, severe injuries, and logistical flaws force surgeons in low-income countries (LIC) to improvise during surgery and use implants “off-label.” These off-label treatments are specific for the work of trauma surgeons in non-governmental (NGO) hospitals in LIC. The aim of this study is to show the need of off-label surgery in an environment of low resources by means of typical examples. Methods Off-label treated fractures, the implant used instead, and the reason for off-label treatment were investigated in 367 injuries over a three month period in an NGO hospital in Sierra Leone. Results Twenty-seven fractures were treated off-label with mostly K-wires (88.89%) and external fixators (51.85%). Three reasons for off-label use could be defined: no suitable implants (N = 14), the condition of soft tissues that did not allow internal osteosyntheses (N = 10), and implants not ready for surgery due to logistic flaws (N = 3). The implants needed were mostly locking plates. Conclusion Surgeons in similar settings must use K-wires and external fixators to treat complex fractures. Using implants off-label can help surgeons to treat fractures otherwise left untreated.

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“…This planning can be achieved by CT scans and 3D reconstruction. In LIC, CT and 3D reconstruction are often not accessible [ 11 ]. Without CT scans, the use of plates for complex reconstruction is impossible as approaches must be planned, and instabilities defined.…”

Section: Introductionmentioning

confidence: 99%

Off-Label Treatment for Severe Craniomaxillofacial Fractures in Low-Income Countries—A Novel Operation Method with the External Face Fixator

Deininger

Hofmann

Necchi³

et al. 2022

JCM

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Introduction: Craniomaxillofacial fractures (CMF) are common in low-income countries (LIC). Due to limited resources, treatment of these fractures usually consists of interdental wiring or immobilization with a Barton bandage to maintain the reduction by permanent occlusion. These non-surgical treatment methods often lead to unsatisfactory results, such as a disturbed dental occlusion and lockjaw. The aim of this study is to present an off-label treatment option for CMF by applying a hand fixator as external face fixator (EFF) and to demonstrate the surgical method in detail. Materials and Methods: The feasibility and postoperative outcomes of this new off-label operation technique were evaluated by analyzing patients with CMF (n = 13) treated at an NGO hospital in Sierra Leone between 2015 and 2019. Results: The application of the EFF was feasible. The biggest advantage compared to the conventional non-operative methods was, that a dynamic occlusion was still possible during the 6 weeks healing period. Hence, patients could eat and drink almost normally and perform dental hygiene with the EFF in place. We did not discover pintrack infections or other complications. Three patients developed an oronasal fistula due to traumatic a palatal bone loss of about 7–8 mm which was treated by a palatal mucoperiosteal flap 15–20 days after the first operation. Discussion and Conclusions: In LIC, where plate osteosynthesis for CMF cannot be performed due to limited resources the application of an EFF is a promising alternative for a better outcome and an improved quality of life for the patients.

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Orthopedic trauma surgeon in Sierra Leone: how to keep one’s head over water

Cited by 6 publications

References 19 publications

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

Off-label use of orthopedical trauma implants in a low-income country

Off-Label Treatment for Severe Craniomaxillofacial Fractures in Low-Income Countries—A Novel Operation Method with the External Face Fixator

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