RESUMO
INTRODUCTION: There exists substantial variability in the management of pelvic ring injuries among pelvic trauma surgeons. The objective of this study was to perform a comprehensive survey on the management of pelvic ring injuries among an international group of pelvic trauma surgeons to determine areas of agreement and disagreement. METHODS: A 45-item questionnaire was developed using an online survey platform and distributed to 30 international pelvic trauma surgeons. The survey consisted of general questions on the acute management of pelvic ring injuries and questions regarding 5 cases: Lateral compression (LC) type 1 injury, LC-3, Anterior-posterior compression (APC) type 3 injury, a combined vertical shear (VS) injury through the sacrum, and VS injury through sacroiliac joint. Respondents were shown blinded anteroposterior pelvis radiographs and axial computed tomography (CT) images for each case and asked if the injury needed fixation, the type of fixation, the order of fixation, and postoperative weight-bearing status. The Kappa statistic was calculated to assess agreement between respondents for each question. RESULTS: Nineteen out of 30 pelvic trauma surgeons completed the survey. Respondents practiced in Brazil (n = 1), Germany (n = 1), India (n = 1), Italy (n = 1) United Kingdom (n = 1), and the United States (n = 14). Of the 45 questions in this survey, 38 (84%) had minimal to no agreement among the respondents. There was moderate agreement, for performing lumbopelvic fixation when indicated, for anterior and posterior fixation of the LC-3 injury, and on forgoing EUA or stress X-rays for the APC-3 injury. There was strong agreement for open reduction and internal fixation of the anterior pelvic ring in the APC-3 injury and the VS injury through the SI joint. In contrast, LC-1 injury and combined VS pelvic ring injury through the sacrum had no areas of moderate to strong agreement. DISCUSSION: This study identified specific areas of pelvic ring injury management with minimal to no agreement among pelvic trauma surgeons. Future research should target these areas with a lack of agreement to decrease practice variability and improve patient outcomes.
Assuntos
Fraturas Ósseas , Ossos Pélvicos , Cirurgiões , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Estudos Retrospectivos , Inquéritos e QuestionáriosRESUMO
Musculoskeletal disorders and injuries represent a substantial proportion of the global burden of disease. This burden is particularly prevalent in low and middle-income countries that already have insufficient health-care resources. The purpose of this paper is to highlight the vision, the history, the implementation, and the challenges in establishing an orthopaedic surgical mission in a developing nation to help address the epidemic of musculoskeletal trauma.Scalpel At The Cross (SATC) is a nonprofit Christian orthopaedic surgical mission organization that sends teams of 10 to 20 members to Pucallpa, Peru, a rural town in the Amazon, to evaluate patients with musculoskeletal conditions, many that require surgery. The organization employs 4 full-time staff members and has included over 400 medical volunteers in 32 surgical campaigns since 2005. SATC has provided approximately 8.1 million U.S. dollars in total medical care, while investing approximately 2.2 million U.S. dollars in implementation and overhead.Given the projected increase in trauma in low and middle-income countries, the SATC model may be increasingly relevant as a possible blueprint for other medical professionals to take on similar endeavors. This paper also highlights the importance of continued research into the effectiveness of various organizational models to advance surgical services in these countries.
Assuntos
Missões Médicas/organização & administração , Doenças Musculoesqueléticas/cirurgia , Sistema Musculoesquelético/lesões , Sistema Musculoesquelético/cirurgia , Procedimentos Ortopédicos , Ortopedia , Missões Religiosas/organização & administração , Expedições , Humanos , Peru , Serviços de Saúde Rural , Fatores de TempoRESUMO
BACKGROUND: We describe a follow-up program for patients undergoing surgical procedures with documented results from short-term surgical mission trips to the developing world. The surgical procedures were all performed at a government hospital in Pucallpa, Peru, a remote city in the Amazon. METHODS: Between July 2007 and January 2012, ten surgical mission trips were completed with a mean time of six days on location and a mean number of 2.3 surgeons (range, two to five surgeons) per trip. A Peruvian general surgeon conducted postoperative visits at time intervals of two to four weeks, five to sixteen weeks, four to seven months, and eight to twelve months. Each visit included the completion of a patient outcome form, radiographs, and functional range-of-motion photographs. Patient demographic characteristics; type of surgical procedure; completed follow-up; complications including infection, malunion, or nonunion; and clinical results were analyzed. RESULTS: Of the 127 patients eligible for analysis, twenty-three patients were lost to follow-up, leaving a follow-up rate of 81.9% (104 of 127 patients). Patients were predominantly male (63.5%) and had a mean age of 37.0 years (range, ten months to 93.4 years). The mean length of follow-up was 11.8 months, with a mean number of 3.7 postoperative encounters. Orthopaedic trauma fixation was the predominant surgical procedure (57%), with forty-two procedures (40%) being open reduction and internal fixation. In the 104 patients, successful wound-healing occurred in 101 (97%) and 100 (96%) had a functional outcome deemed to be good or fair by the in-country physician. The infection rate was 2.9% (three patients), with 97% (fifty-seven of fifty-nine) of fractures united. There was one nerve injury in a pediatric patient treated for supracondylar humeral malunion, and two cases of prominent implant necessitating removal. The mean direct cost of the follow-up program was $20,041 in U.S. dollars per year. CONCLUSIONS: It is possible to develop a sustainable surgical patient follow-up program with robust results and to achieve acceptable outcomes for orthopaedic conditions, even in an austere medical environment.