Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi

Overview

Journal J Am Acad Orthop Surg Glob Res Rev

Specialty Orthopedics

Date 2024 Mar 26

PMID 38530958

Authors

Myles Dworkin

William James Harrison

Paul Chidothi

Foster Mbowuwa

Claude Martin Jr

Kiran Agarwal-Harding

Linda Chokotho

Affiliations

Soon will be listed here.

Abstract

Background: Little is known about the burden or management of distal radius fractures (DRFs) in low- and middle-income countries. The purpose of this study was to describe the care of DRFs in Malawi.

Methods: We retrospectively reviewed a registry of all patients with fractures who presented to the orthopaedic departments at four public hospitals in Malawi.

Results: Totally, 1,440 patients (14.5%) were with a DRF. Average age was 40, and 888 (62.0%) were male. Surgery was done for 122 patients (9.5%). Patients presenting to Queen Elizabeth Hospital, patients presenting after a fall, and patients initially evaluated by an orthopaedic registrar or orthopaedic clinical officer had lower odds of receiving surgical treatment. Meanwhile, open injuries had the greatest odds of receiving surgery.

Conclusion: The most common musculoskeletal injury among patients in the Malawi Fracture Registry was fractures of the distal radius. These most affected young adult male patients may benefit from surgery; however, the majority were managed nonsurgically. Lack of access to surgical fixation and conservative follow-up may have long-term functional consequences in a predominantly agrarian society. Outcomes-based research is needed to help guide management decisions and standardize patient care and referral protocols.

References

Wadsten M, Buttazzoni G, Sjoden G, Kadum B, Sayed-Noor A . Influence of Cortical Comminution and Intra-articular Involvement in Distal Radius Fractures on Clinical Outcome: A Prospective Multicenter Study. J Wrist Surg. 2017; 6(4):285-293. PMC: 5658209. DOI: 10.1055/s-0037-1601577. View

Spiegel D, Nduaguba A, Cherian M, Monono M, Kelley E . Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries. World J Surg. 2015; 39(6):1421-32. DOI: 10.1007/s00268-015-2971-2. View

Schade A, Mbowuwa F, Chidothi P, MacPherson P, Graham S, Martin Jr C . Epidemiology of fractures and their treatment in Malawi: Results of a multicentre prospective registry study to guide orthopaedic care planning. PLoS One. 2021; 16(8):e0255052. PMC: 8336825. DOI: 10.1371/journal.pone.0255052. View

Agarwal-Harding K, Chokotho L, Young S, Mkandawire N, Chawinga M, Losina E . Assessing the capacity of Malawi's district and central hospitals to manage traumatic diaphyseal femoral fractures in adults. PLoS One. 2019; 14(11):e0225254. PMC: 6867700. DOI: 10.1371/journal.pone.0225254. View

Mackenney P, McQueen M, Elton R . Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006; 88(9):1944-51. DOI: 10.2106/JBJS.D.02520. View

Atiase Y, Quarde A . A call to action for osteoporosis research in sub-saharan Africa. Ghana Med J. 2020; 54(1):58-67. PMC: 7445704. DOI: 10.4314/gmj.v54i1.9. View

Lofman O, Hallberg I, Berglund K, Wahlstrom O, Kartous L, Rosenqvist A . Women with low-energy fracture should be investigated for osteoporosis. Acta Orthop. 2008; 78(6):813-21. DOI: 10.1080/17453670710014608. View

Shrime M, Dare A, Alkire B, ONeill K, Meara J . Catastrophic expenditure to pay for surgery worldwide: a modelling study. Lancet Glob Health. 2015; 3 Suppl 2:S38-44. PMC: 4428601. DOI: 10.1016/S2214-109X(15)70085-9. View

Azad A, Kang H, Alluri R, Vakhshori V, Kay H, Ghiassi A . Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups. J Wrist Surg. 2019; 8(4):305-311. PMC: 6685779. DOI: 10.1055/s-0039-1685205. View

10.

Rundgren J, Bojan A, Navarro C, Enocson A . Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord. 2020; 21(1):88. PMC: 7007648. DOI: 10.1186/s12891-020-3097-8. View

11.

Brogren E, Hofer M, Petranek M, Wagner P, Dahlin L, Atroshi I . Relationship between distal radius fracture malunion and arm-related disability: a prospective population-based cohort study with 1-year follow-up. BMC Musculoskelet Disord. 2011; 12:9. PMC: 3032765. DOI: 10.1186/1471-2474-12-9. View

12.

Manning Smith R, Cambiano V, Colbourn T, Collins J, Graham M, Jewell B . Estimating the health burden of road traffic injuries in Malawi using an individual-based model. Inj Epidemiol. 2022; 9(1):21. PMC: 9275162. DOI: 10.1186/s40621-022-00386-6. View

13.

Agarwal-Harding K, Chokotho L, Mkandawire N, Martin Jr C, Losina E, Katz J . Risk Factors for Delayed Presentation Among Patients with Musculoskeletal Injuries in Malawi. J Bone Joint Surg Am. 2019; 101(10):920-931. PMC: 6530973. DOI: 10.2106/JBJS.18.00516. View

14.

Hevonkorpi T, Launonen A, Huttunen T, Kannus P, Niemi S, Mattila V . Incidence of distal radius fracture surgery in Finns aged 50 years or more between 1998 and 2016 - too many patients are yet operated on?. BMC Musculoskelet Disord. 2018; 19(1):70. PMC: 5834887. DOI: 10.1186/s12891-018-1983-0. View

15.

Nellans K, Kowalski E, Chung K . The epidemiology of distal radius fractures. Hand Clin. 2012; 28(2):113-25. PMC: 3345129. DOI: 10.1016/j.hcl.2012.02.001. View

16.

Gregson C, Cassim B, Micklesfield L, Lukhele M, Ferrand R, Ward K . Fragility fractures in sub-Saharan Africa: time to break the myth. Lancet Glob Health. 2018; 7(1):e26-e27. DOI: 10.1016/S2214-109X(18)30412-1. View

17.

Mulwafu W, Chokotho L, Mkandawire N, Pandit H, Deckelbaum D, Lavy C . Trauma care in Malawi: A call to action. Malawi Med J. 2017; 29(2):198-202. PMC: 5610296. DOI: 10.4314/mmj.v29i2.23. View

18.

Oyen J, Brudvik C, Gjesdal C, Tell G, Lie S, Hove L . Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am. 2011; 93(4):348-56. DOI: 10.2106/JBJS.J.00303. View

19.

Jung H, Park H, Kim J, Yoon J, Jeon I . Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures. J Korean Med Sci. 2016; 31(6):972-5. PMC: 4853678. DOI: 10.3346/jkms.2016.31.6.972. View

20.

Niempoog S, Sukkarnkosol S, Boontanapibul K . Prevalence of Osteoporosis in Patients with Distal Radius Fracture from Low-Energy Trauma. Malays Orthop J. 2020; 13(3):15-20. PMC: 6915318. DOI: 10.5704/MOJ.1911.003. View