Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 21
Study of the Epidemiology and Treatment
of Fractures in Rural North-East of
Democratic Republic of Congo
Ahuka Ona Longombe, M. Mbusa, K. Diyo, M. Kakule, K. Kasindi
and M. Duani
Abstract
Fractures are a very common occurrence in rural tropical areas. Young males are
the group most frequetly affected, and suboptimal management at the time of a
fracture can have serious consequences on a patient’s subsequent development and
productivity. Most fractures can be treated conservatively with surgery being needed
in only a few extreme cases. Paramedical personnel can be of great help in the nonsurgical
treatment of fractures such as plaster casting and traction.
Osteoarticular surgery (traumatology and orthopedics) is one of the surgical specialities
which requires particular attention because future physical function will
depend on adequate appropriate care immediately available to patients. In rural
Africa, the struggle for survival does not allow one to be physically handicapped for
that would reduce the potential of the entire family to support themselves. Primary
care in orthopedics-traumatology must constitute an important part in primary health
care in general. Is it really necessary to have a surgeon (whether he be a generalist,
traumatologist or orthopaedist) treat an uncomplicated fracture of the tibia?
In several rural regions, patients acquire physical handicaps simply due to inadequate
primary care at the time of the trauma. 1 It is in this context that we have
undertaken this study, which will examine the epidemiology and treatment of fractures
found in the rural African area. The purpose of the study will be to (1) gather
data on the epidemiology and treatment of fractures found in our area and (2) clarify
appropriate interventions which prevent or diminish useless handicaps.
Patients and Methods
This study is prospective, from February 1995 to November 1996—a total of 22
months. It was carried out at the Evangelical Medical Centre of Nyankunde, DRC,
which is a 250-bed reference situated in North-East. The facility has a good
Orthopedics-Traumatology service led by a General Surgeon (AOL) and assisted by
an experienced team of paramedical personnel.
This study includes all the patients consulted on our service during the specified
period.We excluded all patients having fractures of the vertebral column (which
require specific therapeutic interventions) as well as luxations. Only patients having
fractures confirmed by radiography were retained. All traction and casting not re-
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.