Epidemiology and Management of Pediatric Fractures in Malawi

被引:0
作者
Cassidy, Benjamin P. [1 ,2 ]
Yeramosu, Teja [1 ,2 ]
Mbomuwa, Foster J. [3 ]
Chidothi, Paul [3 ]
Wu, Hao-Hua [2 ,4 ]
Martin Jr, Claude [5 ]
Harrison, William James [5 ,6 ]
Chokotho, Linda [7 ]
Agarwal-Harding, Kiran J. [2 ,8 ]
机构
[1] Virginia Commonwealth Univ, Richmond, VA USA
[2] Harvard Global Orthopaed Collaborat, Boston, MA USA
[3] Queen Elizabeth Cent Hosp, Dept Surg, Blantyre, Malawi
[4] Massachusetts Gen Hosp, Dept Orthopaed Surg, Boston, MA USA
[5] AO Alliance Fdn, Davos, Switzerland
[6] Countess Chester Hosp NHS Trust, Chester, England
[7] Malawi Univ Sci & Technol, Limbe, Malawi
[8] Harvard Med Sch, BethIsrael Deaconess Med Ctr, Dept Orthopaed Surg, Boston, MA USA
来源
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS | 2024年 / 8卷 / 07期
关键词
INJURIES; CHILDREN; HUMERUS; RISK;
D O I
10.5435/JAAOSGlobal-D-24-00026
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Pediatric fractures are common in Malawi, and surgical care, when needed, remains inaccessible to many. Understanding which children in Malawi receive surgery or nonsurgical treatment would help set priorities for trauma system development. Methods: We used multivariate logistic regression to evaluate associations between surgical treatment and age, sex, school enrollment, injury mechanism, fracture type, open fracture, referral status, hospital of presentation, delayed presentation (>= 2 days), healthcare provider, and inpatient vs outpatient treatment. Results: From 2016 to 2020, 10,400 pediatric fractures were recorded in the Malawi Fracture Registry. Fractures were most commonly of the wrist (26%), forearm (17%), and elbow (14%). Surgical fixation was performed on 4.0% of patients, and 24 (13.0%) open fractures were treated nonsurgically, without debridement or fixation. Fractures of the proximal and diaphyseal humerus (odds ratio [OR], 3.72; 95% confidence interval [CI], 2.36 to 5.87), knee (OR, 3.16; 95% CI, 1.68 to 5.95), and ankle (OR, 2.63; 95% CI, 1.49 to 4.63) had highest odds of surgery. Odds of surgical treatment were lower for children referred from another facility (OR, 0.62; 95% CI, 0.49 to 0.77). Conclusions: Most Malawian children with fractures are treated nonsurgically, including many who may benefit from surgery. There is a need to increase surgical capacity, optimize referral patterns, and standardize fracture management in Malawi.
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页数:14
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