Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi
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Myles Dworkin1, William James Harrison, Paul Chidothi
1From the Department of Orthopaedic Surgery, The Warren Alpert School of Medicine at Brown University, Ontario, RI (Dr. Dworkin), Harvard Global Orthopaedics Collaborative, Boston, MA (Dr. Dworkin). AO Alliance, Davos, Switzerland (Mr. Harrison, Mr. Chidothi, Mr. Mbowuwa, and Dr. Martin); Countess of Chester Hospital NHS Foundation Trust, London (Mr. Harrison and Mr. Chidothi); Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Dr. Agarwal-Harding); Department Harvard Medical School, Program in Global Surgery and Social Change, Global Health and Social Medicine, Boston, MA (Dr. Agarwal-Harding), Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi (Ms. Chokotho).
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.
