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Schade, Alexander, Sabawo, Maureen, Nyamulani, Nohakhelha, Mpanga, Chikumbutso Clara, Ngoie, Leonard Banza, Metcalfe, Andrew John, Lalloo, David 
ORCID: https://orcid.org/0000-0001-7680-2200, Madan, Jason J, Harrison, William James and MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613
(2023)
'Functional outcomes and quality of life at 1-year follow-up after an open tibia fracture in Malawi: a multicentre, prospective cohort study'. Lancet Global Health, Vol 11, Issue 10, e1609-e1618.
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PIIS2214109X23003467.pdf - Published Version Available under License Creative Commons Attribution. Download (3MB) | Preview |
Abstract
Injuries are a major cause of disability globally and injury incidence is rapidly increasing, largely due to road traffic injuries in low-income and middle-income countries. Current estimates of the scale and consequences of disability from injury are largely based on modelling studies, with a scarcity of empirical evidence from severe injuries in low-income countries. We aimed to better understand the outcomes for individuals with open tibia fractures in Malawi. In this multicentre, prospective cohort study, adults (aged ≥18 years) with open tibia fractures were systematically recruited at six hospitals in Malawi (two tertiary hospitals and four district hospitals). Follow-up lasted at least 1 year, during which in-person follow-up reviews were done at 6 weeks, 3 months, 6 months, and 1 year post-injury. The primary outcome was function at 1 year post-injury, measured by the Short Musculoskeletal Functional Assessment (SMFA) score. Secondary outcomes included quality-adjusted life-years (QALYs; as determined via the European Quality of Life 5-Dimensions 3-Levels [EQ-5D-3L] survey) and fracture-related infection at 1 year post-injury. Multilevel regression models investigated associations between SMFA score, EQ-5D-3L, baseline factors, and orthopaedic management. Between Feb 12, 2021, and March 14, 2022, 287 participants were enrolled (median age 34 years [IQR 25-44]; 84% male). The most common mode of injury was road traffic injuries (194 [68%] of 287). Overall, 268 (93%) participants had debridement; of the 63 participants who were debrided in district hospitals, 47 (75%) had the procedure under local or no anaesthesia. Following substantial declines by 6 weeks after injury, function and quality of life had not recovered by 1 year post-injury for participants with Gustilo grade I-II fractures (posterior mean SMFA at 1 year: 10·5, 95% highest density interval [HDI]: 9·5-11·6; QALYs: 0·73, 95% HDI: 0·66-0·80) nor Gustilo grade III fractures (posterior mean SMFA at 1 year: 14·9, 95% HDI: 13·4-16·6; QALYs: 0·67, 95% HDI: 0·59-0·75). For all fracture grades, intramedullary nailing substantially improved function and quality of life at 1 year post-injury. Delayed definitive fixation after 5 days had 5-times greater odds of infection compared with early management within 2 days (adjusted odds ratio: 5·1, 95% CI 1·8-16·1; p=0·02). Adults with open tibia fractures in Malawi have poor function and quality of life in the 1 year following injury. Centralised orthopaedic surgical management, including early definitive fixation and intramedullary nailing for more severe injuries, might improve outcomes. Wellcome Trust. For the Chichewa translation of the abstract see Supplementary Materials section.
| Item Type: | Article | ||||
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| Subjects: | WE Musculoskeletal System > WE 800 Extremities > WE 850 Lower extremity. Hip. Leg. Foot. WE Musculoskeletal System > WE 800 Extremities > WE 870 Knee. Lower leg |
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| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW) |
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| Digital Object Identifer (DOI): | https://doi.org/10.1016/S2214-109X(23)00346-7 | ||||
| SWORD Depositor: | JISC Pubrouter | ||||
| Depositing User: | JISC Pubrouter | ||||
| Date Deposited: | 28 Sep 2023 12:04 | ||||
| Last Modified: | 12 Oct 2023 12:06 | ||||
| URI: | https://archive.lstmed.ac.uk/id/eprint/23185 |
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