Oscar Alvarado1, Miguel Trelles1,2, Katie Tayler-Smith3,4, Holdine Joseph1,5, Rodné Gesline1,5, Thélusma Eli Wilna1,5, Mohammad Karim Mohammad Omar1,6, Niaz Mohammad Faiz Mohammad1,6, John Muhima Mastaki1,7, Richard Chingumwa Buhu1,7, An Caluwaerts1,8, Lynette Dominguez1,2. 1. Médecins sans Frontières - Operational Centre Brussels (MSF-OCB), Brussels, Belgium. 2. MSF-OCB Surgery, Anaesthesia, Gynaecology, and Emergency Medicine Unit, Brussels, Belgium. 3. Médecins sans Frontières - Operational Centre Brussels (MSF-OCB), Brussels, Belgium. katietaylersmith@gmail.com. 4. MSF-OCB, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg. katietaylersmith@gmail.com. 5. Tabarre Referral Centre for Surgical and Orthopaedic Care, Port-au-Prince, Haiti. 6. Kunduz Trauma Centre, Kunduz, Afghanistan. 7. Masisi General Referral Hospital, North Kivu, Democratic Republic of the Congo. 8. MSF-OCB Infection Control Unit, Brussels, Belgium.
Abstract
PURPOSE: Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of context-specific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures--internal fixation--and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. METHODS: We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). RESULTS: The minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. CONCLUSIONS: In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.
PURPOSE: Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of context-specific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures--internal fixation--and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. METHODS: We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). RESULTS: The minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. CONCLUSIONS: In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.
Entities:
Keywords:
Internal fixation; Minimum standards; Natural disaster and conflict settings; Orthopaedic surgery
Authors: Thomas G Weiser; Scott E Regenbogen; Katherine D Thompson; Alex B Haynes; Stuart R Lipsitz; William R Berry; Atul A Gawande Journal: Lancet Date: 2008-06-24 Impact factor: 79.321
Authors: R Hoencamp; E C T H Tan; F Idenburg; A Ramasamy; T van Egmond; L P H Leenen; J F Hamming Journal: Eur J Trauma Emerg Surg Date: 2014-04-15 Impact factor: 3.693
Authors: Marie Jeanne Bertol; Rafael Van den Bergh; Miguel Trelles Centurion; Hyacinthe Kenslor Ralph D; Jean-Paul Basimuoneye Kahutsi; Abdul Qayeum Qasemy; Jacky Jean; Alberta Majuste; Theophile Kubuya Hangi; Samsoor Safi Journal: Int Orthop Date: 2014-07-20 Impact factor: 3.075