Orthopaedic trauma surgery in high-need, resource-limited, urban settings: Port-auPrince, Haiti; and Port Harcourt, Nigeria
Patrick Hérard, Francois Boillot, Greg Elder
MSF, Paris, France
Contact: patrick.herard@paris.msf.org
Background
In 2005-2006, MSF started surgery programmes in Port-au-Prince, Haiti, and Port Harcourt,
Nigeria, to provide trauma surgery care in contexts of urban violence and limited medical
resources. In Port-au-Prince, MSF runs a 68-bed trauma centre at La Trinité Hospital, including
a burn unit, and a 40-bed surgical rehabilitation centre at Pacot Hospital. In Port Harcourt there
is a 70-bed trauma centre in Temé Hospital. Both programmes perform surgical treatment of
fractures with internal fixation for closed fractures. Reports on the use of internal fixation in
resource-limited settings are rare.
Methods
We analysed medical records from January 2007 to December 2008. We examined the number
of orthopaedic procedures, causes of injury, and profile of patients to evaluate surgical
outcomes and assess the challenges of providing trauma surgery care of acceptable quality.
Results
A total of 15 823 surgical procedures were performed; 4644 were orthopaedic. In Port-auPrince, 400-500 surgical procedures were performed every month; 25% were orthopaedic. In
Port Harcourt, almost half the 200 monthly procedures were orthopaedic. Average length of stay
in orthopaedic units was 8 days. A total of 1198 internal fixation procedures were performed on
closed fractures with an overall early infection rate of 2%. In 2008, 9019 surgical procedures
were performed, the most common were orthopaedic (2497; 27.7%) or visceral (440; 4.9%) with
some maxillofacial and neurosurgical (1-5%). Injuries due to violence (any type) made up 23.4%
(533) of the 2278 surgical patients in both programmes in 2008. Most (>50%) injuries resulted
from motor vehicle accidents. In 2008 the highest proportion of patients in both programmes
were males aged 19-49 years (12 990/27 263; 47.6%).
Conclusions
In Port-au-Prince and Port Harcourt, traumatic injury is a significant public-health issue.
Orthopaedic trauma surgery can provide social life-saving benefits by reducing disability and
returning people to work, especially young adult males, who are the most active in work
productivity. Internal fixation was successfully used with infection rates similar to those in
Europe and the USA in the 1980s, showing that advanced orthopaedic techniques are feasible
in resource-limited environments. The inclusion of burn cases may have weighted the analysis
for surgical case-load for Port-au-Prince. Although the programmes were set up in anticipation
of violent conflict, non-conflict related traumatic injuries predominated.