Analysis of Outpatient Trauma Referrals in a Sub-Saharan African Orthopedic Center
The purpose of this study was to characterize the orthopedic trauma workload in the Bedford Orthopaedic Centre (BOC), an orthopedic referral hospital in rural South Africa.
Demographic data, injury data, and information about initial management were collected for two 6-week periods during both 2008 and 2009 from patients seen in the BOC outpatient department. Two primary outcomes were evaluated: (1) the interval between the initial outside evaluation and the BOC consultation and (2) the presence of established infection at the time of consultation. Secondary outcomes included assessments of the initial management at the referring facility.
Most patients were adult men. Almost half were referred from within a radius of 10 km, but more than one-third came from facilities in excess of 50 km away. The most frequent mode of transport was ambulance followed by taxi-van. Fractures accounted for most of the injuries. Motor vehicle accidents and assaults were more prevalent among adults than among children, for whom falls accounted for a large proportion of injuries. Referral was delayed more than 72 h in 41.4% of patients. Established infections were indentified in 12.2%. Deficiencies detected during prehospital care were common.
The burden of orthopedic trauma in this rural referral center is sufficient to justify the manpower and resources needed for a major orthopedic trauma center. Because most of the injuries were fractures, efforts should be aimed at improving fracture care. Differences in the mode of injury and in the anatomical sites involved between adults and children highlight the need for focused preventive measures. Reducing both delays in referral and deficiencies in initial management might well reduce the cost and complexity of the definitive treatment required.
- Spiegel D, Gosselin R, Coughlin R et al (2008) Topics in global public health. Clin Orthop Rel Res 466:2377–2384 CrossRef
- Meel BL (2004) Incidence and patterns of violent and/or traumatic deaths between 1993 and 1999 in the Transkei region of South Africa. J Trauma 57:125–129 CrossRef
- Meel BL (2003) Mortality of children in the Transkei Region of South Africa. Am J Forensic Med Pathol 24:141–147 CrossRef
- Meel BL (2007) Trends in firearm-related deaths in the Transkei region of South Africa. Am J Forensic Med Pathol 28:86–90 CrossRef
- Meel BL (2004) Pre-hospital and hospital traumatic deaths in the former homeland of Transkei, South Africa. J Clin Forensic Med 11:6–11 CrossRef
- Meel BL (2007) Trends in fatal motor vehicle accidents in Transkei region of South Africa. Med Sci Law 47:64–68 CrossRef
- Millar TMS, McConnachie CCP (2007) Orthopaedic trauma workload in the former homeland of the Transkei, South Africa. Injury 38:147–149 CrossRef
- Mock C, Cherian M (2008) The global burden of musculoskeletal injuries. Clin Orthop Rel Res 466:2306–2316 CrossRef
- Surgical Care at the District Hospital, World Health Organization (2003) http://www.who.int/surgery/publications/en/SCDH.pdf
- Oloruntoba D, Dormans J (2003) Orthopaedics in the developing world: present and future concerns. J Am Acad Orthop Surg 11:75–76
- Ostermann P, Henry S, Seligson D (1993) The role of local antibiotic therapy in the management of compound fractures. Clin Orthop Rel Res 205:102–111
- Patzakis M, Dorr L, Ivler D et al (1975) The early management of open fractures: a prospective study of one hundred and forty patients. J Bone Joint Surg Am 57:1065–1070
- Quanash R, Abantanga F, Donkor P (2008) Trauma training for nonorthopaedic doctors in low- and middle-income countries. Clin Orthop Rel Res 466:2403–2412 CrossRef
- Analysis of Outpatient Trauma Referrals in a Sub-Saharan African Orthopedic Center
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World Journal of Surgery
Volume 35, Issue 5 , pp 956-961
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- 1. Institute for Global Orthopaedics and Traumatology, Department of Orthopedic Surgery, San Francisco General Hospital, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
- 2. Bedford Orthopaedic Centre, Private Bag X5103, Mthatha, 5100, Republic of South Africa