High morbidity and mortality after lower extremity injuries in Malawi: A prospective cohort study of 905 patients. (March 2017)

• Record Type: Journal Article
• Authors: Chagomerana, Maganizo B.; Tomlinson, Jared; Young, Sven; Hosseinipour, Mina C.; Banza, Leonard; Lee, Clara N.
• Is Part Of: International journal of surgery. Volume 39(2017)
• Page Start: 23
• Page End: 29
• Publication Date: 2017-03
• Subjects: Lower extremity injury -- Leg injury -- Leg trauma -- Global surgery -- Orthopedic injury; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.01.047
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Introduction: A lower extremity injury can be a devastating event in low-income countries due to limited access to surgical care. Its incidence, treatment patterns, and outcomes, however, have not been well-described. Methods: We prospectively enrolled all patients admitted with lower extremity trauma to a tertiary hospital in Lilongwe, Malawi between October 2010 and September 2011. Patients with a lower extremity injury but primarily admitted for unrelated reasons were excluded. The outcomes were deaths, complications, and length of hospital stay. Results: Of the 905 patients eligible for analysis, 696 (77%) were males. Most patients had femur fractures (46%), and most were treated non-operatively (70%). Overall mortality rate was 3.9%. For adult patients with femur fractures, mortality was higher in patients treated with traction (9.0%) than for those treated with surgery (1.3%). The total complication rate was 15%, with adjusted odds of developing a complication higher in patients with concurrent head injury (OR = 2.8; 95% CI: 1.3–6.0), and patients who had an operative treatment (OR = 2; 95% CI: 1.2–1.9). The median length of stay was 16 days (IQR: 6–27) and was greatest among patients with femur fractures. Conclusion: Lower extremity injuries resulted in substantial mortality and morbidity in this low-income country. Mortality was particularly high among patients with femur fractures who did not have surgery. Modern orthopedic trauma surgery is greatly needed in low-income countries. Highlights: Mortality in patients with femur fractures was highest in those treated non-operatively. Young men were injured more often and most severely. Patients treated operatively stayed longer in the hospital. Lower extremity injury was a common cause of admission among trauma patients.