Global Surgery & Anesthesia
Fracture care in the SCDH manual
The sections on emergency management are good. It is somewhat disheartening to see traction or casting recommended for virtually all fractures in this manual. This makes it sound as though this is the correct or desirable treatment whereas we all know that surgical treatment is recommended for a high proportion of long bone fractures and is the norm in developed medical systems (with good reason). The only reason to recommend traction for femur fractures is that the system cannot afford surgery, even though it has been shown to be more cost-effective (http://www.ncbi.nlm.nih.gov/pubmed/19437019 see also discussion in http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=dcp2&part=A9770) Surgical treatment of fractures is available in many LMIC institutions now with good results. This text should be modified to imply that surgery is the treatment of choice but if it is not available then traction or casting should be undertaken as follows etc.
As long as it is implied that non-operative treatment is the correct treatment, we will never see surgical services supplied at the appropriate level.
Attached resource:
Nadine Semer
You make a really important point. We want to promote access to treatments which optimize patient outcomes. As you say, perhaps educating providers/administrators about best practices (which have been shown to be achievable in low resource areas), will help push demand for these services in areas where they are not yet available.
2:25 PM, 5 Apr 2010 | Permalink