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



A prospective interventional study has been carried out on the teaching effect and sustainability of low-cost trauma training program in open tibia fracture management for health workers.

Materials and methods

In 2007, an external fixator and a patella-bearing orthosis were developed at a rural workshop in Cambodia. From 2010 to 2016, a core group of nine Cambodian health workers was trained in open fracture management by Norwegian senior surgeons, using the locally made fixator and brace. The training outcome was also assessed by a questionnaire comprising of assertions regarding theoretical understanding, technical skills and self-confidence in understanding the biomechanical properties of locally made external fixator and its application; the use of handmade orthosis and principle in covering of soft-tissue defects.


The students managed 23 cases with the new technique with a primary healing rate of 70% (95% CI 48.1–85.5). A significant increase in self-reported technical skills, understanding, and self-confidence was reported.


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.

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We express our thanks for the support given by the Norwegian Ministry of Foreign Affairs, the Trauma Care Foundation in Cambodia, Director Tor Ingebrigtsen University Hospital of Northern Norway and Stefan Tajsic for technical assistance in preparation of figures and tables. The study has been carried out in cooperation with the District Office of Health, and Military Hospital, Region 5, Battambang, Cambodia.

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Correspondence to Nenad B. Tajsic.

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Tajsic, N.B., Sambath, P., Nguon, S. et al. Open Fracture Management in Low-Resource Settings: A Medical Training Experience in Cambodian Hospitals. World J Surg 41, 2981–2989 (2017) doi:10.1007/s00268-017-4245-7

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