Understanding and Addressing the Global Need for Orthopaedic Trauma Care

IntroductionLow/middle-income countries (LMICs) have a growing need for trauma and orthopaedic (T&O) surgical interventions but lack surgical resources. Part of this is due to the high amount of road traffic accidents in LMICs. We aimed to develop recommendations for an essential list of equipment for three different levels of care providers.MethodsThe Delphi method was used to achieve consensus on essential and desirable T&O equipment for LMICs. Twenty experts with T&O experience from LMICs underwent two rounds of questionnaires. Feedback was given after each round of questionnaires. The first round of questionnaire consisted of 45 items graded on a Likert scale with the second round consisting of 50 items. We used an electronic questionnaire to collect our data for three different levels of care: non-operative-based provider, specialist provider with operative fracture care and tertiary provider with operative fracture care and orthopaedics.ResultsAfter two rounds of questionnaires, recommendations for each level of care in LMICs included 4 essential equipment items for non-operative-based providers; 27 essential equipment items for specialist providers with operative fracture care and 46 essential equipment items for tertiary providers with operative fracture care and orthopaedic care.ConclusionThese recommendations can facilitate in planning of appropriate equipment required in an institution which in turn has the potential to improve the capacity and quality of T&O care in LMICs. The essential equipment lists provided here can help direct where funding for equipment should be targeted. Our recommendations can help with planning and organising national T&O care in LMICs to achieve appropriate capacity at all relevant levels of care.

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“…3 Injuries are mainly from road traffic accidents, and disproportionately affect the young population. 4 …”

Section: Introductionmentioning

confidence: 99%

“… 6 If all-cause injury mortality can be reduced to the level in high-income countries, 50 million disability-adjusted life years and $786 billion could be saved annually. 4 …”

Section: Introductionmentioning

confidence: 99%

Essential fracture and orthopaedic equipment lists in low resource settings: consensus derived by survey of experts in Africa

et al. 2018

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“…Infectious disease has long been a specialty of medicine associated with overseas collaboration, treating diseases, such as AIDS, malaria, and tuberculosis (9–12). Access to surgery is being increasingly recognized as a global health issue, as the poorest countries in the world—representing a third of the global population—only account for a small percentage of operations performed annually (13, 14). Despite these staggering statistics, academic models of collaboration in surgical fields lag behind their counterparts in medicine.…”

Section: Background and Rationalementioning

confidence: 99%

“…Adding to the challenge is that no all-encompassing innovation will be universally adaptable. Rather, each initiative will need to be unique and malleable to fit the needs and locations being addressed (14). Given the need for increased global orthopedic presence without a consensus on effective strategies, IGOT serves an important purpose in both the orthopedic and public health communities.…”

Section: Background and Rationalementioning

confidence: 99%

The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery

Conway

Coughlin

Caldwell

et al. 2017

Front. Public Health

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In 2006, surgeons at the University of California, San Francisco (UCSF) established the Institute for Global Orthopedics and Traumatology (IGOT), an initiative within the department of orthopedic surgery. The principal aim of IGOT is to create long-term, sustainable solutions to the growing burden of musculoskeletal injury in low- and middle-income countries (LMICs) through academic partnership. IGOT currently has relationships with teaching hospitals in Ghana, Malawi, Tanzania, Nicaragua, and Nepal. The organizational structure of IGOT is built on four pillars: Global Surgical Education (GSE), Global Knowledge Exchange (GKE), Global Research Initiative (GRI), and Global Leadership and Advocacy. GSE focuses on increasing surgical knowledge and technical proficiency through hands-on educational courses. The GKE facilitates the mutual exchange of surgeons and trainees among IGOT and its partners. This includes a global resident elective that allows UCSF residents to complete an international rotation at one of IGOT’s partner sites. The GRI strives to build research capacity and sponsor high-quality clinical research projects that address questions relevant to local partners. The fourth pillar, Global Leadership and Advocacy aims to increase awareness of the global impact of musculoskeletal injury through national and international courses and events, such as the Bay Area Global Health Film Festival. At the core of each tenet is the collaboration among IGOT and its international partners. Over the last decade, IGOT has experienced tremendous growth and maturation in its partnership model based on cumulative experience and the needs of its partners.

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“… 6 The need for and strategies to address global orthopaedic trauma care have been described. 4 , 7 8 9 10 Although musculoskeletal tumors are rare, there still exists a great need for surgical care of these conditions. Barriers to surgical care in low-income and middle-income countries include structural aspects of health care, cultural beliefs and attitudes, and financial barriers.…”

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confidence: 99%

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

2020

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Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.

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Understanding and Addressing the Global Need for Orthopaedic Trauma Care

Cited by 57 publications

References 93 publications

Essential fracture and orthopaedic equipment lists in low resource settings: consensus derived by survey of experts in Africa

Essential fracture and orthopaedic equipment lists in low resource settings: consensus derived by survey of experts in Africa

The Institute for Global Orthopedics and Traumatology: A Model for Academic Collaboration in Orthopedic Surgery

Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls

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