Pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is one of the leading complaints in emergency departments (EDs). Despite the important and the advantages of pain control, still patients do not receive appropriate attention. The objective of this study was to assess pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. A descriptive Cross-sectional study design (Hospital based) was used.  Total of 250 patients aged 18 – 60 years old with fractures of long bones were recruited from March to June 2008. Structured questionnaires and observation guide were used to collect data. Verbal rating scale was used, to determine the intensity of pain. The study shows that there is no documentation for pain assessment or reassessment at Emergency Department. Slightly above half (54%; 135/250) of patients were not given analgesics. The commonest analgesic given was diclofenac sodium (46%). There was no patient given opioids (pethedine/ morphine). The rate of analgesics administration or splinting before and after admission did not differ between sexes (P=0.314 vs P= 0.230) and (P=0.314 vs P= 0.114), respectively. Almost half (47.0%) of them spent >20 min to 1 hour before the administration of analgesics. After administration of analgesia 76% of the patients continued to have severe to moderate pain. A large proportion (62.4%; N=156/250) of the patients scored their pain as severe. Of these, 28 (17.9%) patients received analgesia within 20 min, 42 (26.9%) after 30-60 min and 73 (46.8%) were not given analgesics at all. In conclusion pain at Moi Orthopaedic Institute is under treated. It is important that this is addressed properly to minimize pains among patients attending hospitals for fracture management

Prevalence and risk factors of acute kidney injury in polytrauma patients at Muhimbili Orthopedic Institute, Tanzania

Background Polytrauma can lead to multi-organ dysfunction in addition to the local injuries. Acute kidney injury (AKI) is one of the most common causes and contributors to the high morbidity and mortality. Prevalence of acute kidney injury in trauma patients is as reported to be as high as 40.3%. Early detection and management leads to better outcomes. The prevalence of AKI among polytrauma patients remains unknown in our setting. Methodology A cross-sectional study involving all adults with polytrauma who presented at the emergency department at Muhimbili Orthopedic Institute (MOI) was designed. A score of ≥18 on the New Injury Severity Score (NISS) screening tool was used to identify polytrauma patients. The Kidney Disease Improving Global Outcomes (KDIGO) criteria was used to identify patient with polytrauma who developed acute kidney injury. Descriptive statistics were then obtained followed by hypothesis testing between variables with the chi squared test. Logistic regression models were used to determine factors associated with acute kidney injury. Results More than half (56.4%) of the patients were between 26 and 40 years and 92.3% of the polytrauma patients were males. Almost 2/5th (38.5%) of the polytrauma patients had acute kidney injury – half of these had stage 1 AKI, 33.3% had stage 2 AKI and the remaining 16.7% had stage 3 AKI. On multivariate logistic regression, it was found that patients who were older than 45 years (OR 8.53, CI 1.65–43.89, p = 0.01) and those patients with Systemic Inflammatory Response Syndrome (SIRS) (OR 21.83, CI 1.66–286.2, p = 0.019) had higher risk of acute kidney injury. Conclusion There is high prevalence of AKI among polytrauma patients. Elderly patients and those with SIRS were seen to have higher likelihood of AKI

Pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage and is one of the leading complaints in emergency departments (EDs). Despite the important and the advantages of pain control, still patients do not receive appropriate attention. The objective of this study was to assess pain management among adult patients with fractures of long bones at Muhimbili Orthopaedic Institute in Dar es Salaam, Tanzania. A descriptive Cross-sectional study design (Hospital based) was used. Total of 250 patients aged 18 – 60 years old with fractures of long bones were recruited from March to June 2008. Structured questionnaires and observation guide were used to collect data. Verbal rating scale was used, to determine the intensity of pain. The study shows that there is no documentation for pain assessment or reassessment at Emergency Department. Slightly above half (54%; 135/250) of patients were not given analgesics. The commonest analgesic given was diclofenac sodium (46%). There was no patient given opioids (pethedine/ morphine). The rate of analgesics administration or splinting before and after admission did not differ between sexes (P=0.314 vs P= 0.230) and (P=0.314 vs P= 0.114), respectively. Almost half (47.0%) of them spent >20 min to 1 hour before the administration of analgesics. After administration of analgesia 76% of the patients continued to have severe to moderate pain. A large proportion (62.4%; N=156/250) of the patients scored their pain as severe. Of these, 28 (17.9%) patients received analgesia within 20 min, 42 (26.9%) after 30-60 min and 73 (46.8%) were not given analgesics at all. In conclusion pain at Moi Orthopaedic Institute is under treated. It is important that this is addressed properly to minimize pains among patients attending hospitals for fracture management

Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Sothern Africa

Background Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the “Principles of Foot and Ankle Surgery” course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as “Poor”, “Below average”, “Average”, “Good” and “Excellent”, which was converted into a value from 1–5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann–Whitney) test, and significance was considered to be p < 0.05. Results Six courses in total were held between 2018 and 2020. Three in the UK and three in the COSECSA region. There were 78 participants in the three UK courses and 96 in the three courses run in the COSECSA region. Hundred percent of the UK participants and 97% of the COSECSA participants completed the feedback. Male to female ratio was 4:1 for the UK courses and 10:1 for the COSECSA Courses. In both regions all the participants responded that they would recommend the course to their colleagues. Among the COSECSA participants 91% reported that the course was pitched at the right level, which is similar to the 89% of the UK participants (p = 0.28). Conclusion The BOFAS Principles of Foot and Ankle Surgery course design provides core knowledge, with an emphasis on clinical examination techniques of the foot and ankle, while at the same time, caters for the anticipated difference in the local clinical case mix and resources. This study establishes that by attending the course surgical trainees can achieve their learning goals in foot and ankle surgery with the same high quality qualitative and quantitative feedback in both regions. This would improve their clinical practice and confidence. The multifaceted approach adopted in this course blending didactic teaching, small group discussions, interactive sessions, case-based discussions, cadaveric surgical skills training printed educational materials and feedback helped fulfil these educational objectives. Working in partnership with local expert orthopaedic surgeons from a number of Sub-Saharan countries, was key to adapting the course to local pathology and the COSECSA setting

Evaluation of an E-Learning Course for Clubfoot Treatment in Tanzania: A Multicenter Study

In total, 80% of clubfoot cases occur in low- and middle-income countries, where lack of clinical knowledge of the Ponseti method of treatment presents as a major barrier to treatment. This study aims to determine the effectiveness of an electronic learning course to teach clinicians in Tanzania Ponseti method theory. A total of 30 clinicians were recruited from clinics with high referral rates for clubfoot patients and invited to 1 of 3 training sites: Mbeya (n = 15), Zanzibar (n = 10), and Mwanza (n = 5). Baseline knowledge, measured through a pretest, was compared to performance on a posttest after e-learning course completion. Scores for Mbeya and Zanzibar participants improved from 44 ± 12.5 to 69.8 ± 16.5 ( P  < .0001) and 44.3 ± 14.0 to 67.9 ± 21.4 ( P  = .01), respectively. Our results suggest that an e-learning course may be an effective method of disseminating Ponseti method theory in Tanzania. Successful implementation requires an understanding of the device availability and technology literacy of the users

Feasibility of delivering foot and ankle surgical courses in a partnership in Eastern, Central and Southern Africa

Background Foot and ankle pathology if not treated appropriately and in a timely manner can adversely affect both disability and quality adjusted life years. More so in the low- and middle-income countries where ambulation is the predominant means of getting around for the majority of the population in order to earn a livelihood. This has necessitated the equipping of the new generation of orthopaedic surgeons with the expertise and skills set to manage these conditions. To address this need, surgeons from the British Orthopaedic Foot & Ankle Society (BOFAS) and College of Surgeons of Eastern, Central and Southern Africa (COSECSA) transferred the “Principles of Foot and Ankle Surgery” course to an African regional setting. The course was offered to surgical trainees from 14-member countries of the COSECSA region and previously in the UK. The faculty was drawn from practicing surgeons experienced in both surgical education and foot and ankle surgery. The course comprises didactic lectures, case-based discussions in small groups, patient evaluations and guided surgical dissections on human cadavers. It was offered free to all participants. The feasibility of the course was evaluated using the model defined by Bowen considering the eight facets of acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited efficacy. At the end of the course participants were expected to give verbal subjective feedback and objective feedback using a cloud based digital feedback questionnaire. The course content was evaluated by the participants as “Poor”, “Below average”, “Average”, “Good” and “Excellent”, which was converted into a value from 1–5 for analysis. The non-parametric categorical data was analysed using the Two-sample Wilcoxon rank-sum (Mann–Whitney) test, and significance was considered to be p < 0.05. Results Six courses in total were held between 2018 and 2020. Three in the UK and three in the COSECSA region. There were 78 participants in the three UK courses and 96 in the three courses run in the COSECSA region. Hundred percent of the UK participants and 97% of the COSECSA participants completed the feedback. Male to female ratio was 4:1 for the UK courses and 10:1 for the COSECSA Courses. In both regions all the participants responded that they would recommend the course to their colleagues. Among the COSECSA participants 91% reported that the course was pitched at the right level, which is similar to the 89% of the UK participants (p = 0.28). Conclusion The BOFAS Principles of Foot and Ankle Surgery course design provides core knowledge, with an emphasis on clinical examination techniques of the foot and ankle, while at the same time, caters for the anticipated difference in the local clinical case mix and resources. This study establishes that by attending the course surgical trainees can achieve their learning goals in foot and ankle surgery with the same high quality qualitative and quantitative feedback in both regions. This would improve their clinical practice and confidence. The multifaceted approach adopted in this course blending didactic teaching, small group discussions, interactive sessions, case-based discussions, cadaveric surgical skills training printed educational materials and feedback helped fulfil these educational objectives. Working in partnership with local expert orthopaedic surgeons from a number of Sub-Saharan countries, was key to adapting the course to local pathology and the COSECSA setting

Incidence of hip fracture in southeastern Norway: A study of 1,730 cervical and trochanteric fractures

The incidence of hip fracture has been studied extensively, but there is still some doubt whether the age-specific incidence is increasing. The proportion of trochanteric fractures has varied and has also been said to be increasing. We studied data on 1,730 prospectively registered cases from 1998–2003 and computed age- and gender-specific incidence rates for intracapsular and trochanteric fractures. The incidence of hip fracture for women over 50 years was 1,263 and for men 452 per 100,000. The proportion of trochanteric fractures was 38% for women and 41% for men. There was no significant difference in the proportion of trochanteric fractures either between or within the genders, and the proportion did not exceed 50% in any age group. These findings confirm the high incidence of hip fracture in Norway but do not indicate any increase. The proportion of trochanteric fractures also seems to be stable