Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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192 Surgery and Healing in the Developing World
quiring delicate orthopedic manipulation were done by nurses. We had a total of
193 patients representing 216 fractures in our study.
Results
The analysis of our study population gave the following results.
Distribution According to Sex
Men are thus more commonly affected than women, and this is probably due to
their lifestyle and work.
Distribution According to Age
Causes of Fractures
Falls and motor vehicle accidents represent the two biggest causes of fracture in
our area. The latter is probably due to the poor condition of roads, as well as transportation
in nonmaintained vehicles that are overloaded with passengers. In the
other category, we put pathological fractures (4 cases), animal bites (3 cases), work
accidents (3 cases) and fractures in the newborn at the time of delivery.
Site of Fractures
There were 193 patients treated on our service, and they accounted for a total of
216 fractures, as 12 of the patients had 3 or 4 fractures. The four most commonly
fractured bones are the femur, tibia, fibula and humerus.
Foci of Open Fractures
Twenty-four patients out of 193 (or 12.44%) presented with open fractures, as
shown in Table 4. The tibia-fibula represents the most common open fracture site,
because of the lack of protection by soft tissues.
Methods of Treatment
The most commonly used therapeutic modalities in our area were plaster casting
alone, traction followed by plaster casting, and rest with analgesics (a total of 82.9%
of the cases). The other methods of treatment were relatively rare. Surgical treatment
(osteosynthesis), the placement of an external fixator of an external fixator,
and delicate reduction of fractures were done by the surgeon (AOL). The other
types of treatment were performed by nurses (plaster casting and traction).
Discussion
Males represent the sex most often stricken by fractures (66.84% of our cases).
This causes a disruption in the life of the African family where men still represent
the primary source of income. The 16-60 years old age group represents 59.02% of
our fractures. This age range is the time in which there is greatest professional activity,
and hence injuries sustained during this time have great consequences on the
survival of the family and that of the community in general.Only 6.44% of our
patients are beyond 60 years old as compared to the study found in Stiffman 2 who
had found that 33% of his patients with fractures were at least 60 years old. Our
data indicate that fractures affect a much younger and more active population in our
area. The femur (19.44%), humerus (16.67%), and the radius and ulna (7.41%)
were the most fractured bones in our study. This finding agrees with that of Rooser 3
and Hoaglund and Duthie 4 who found bones cited above to be the most commonly
found sites of fractures.