A broken leg that punches through the skin kills or maims thousands of people across Africa each year, yet no one knows how many of these open fractures occur or what treatment is available. This matters because open fractures are among the most devastating musculoskeletal injuries, with high rates of infection and amputation. They disproportionately affect people in poor regions, yet basic information about their frequency and the healthcare resources available to treat them is missing. Without this knowledge, hospitals and policymakers cannot plan effective care. If this research succeeds, it will produce the first systematic map of open fracture care across South Africa—detailing which hospitals have the equipment, staff, and facilities to treat these injuries. It will also count how many open fractures occur each year. Healthcare managers can then identify gaps in service readiness and allocate resources where they are most needed. A feasibility study will test whether a future nationwide clinical trial is possible, building local research capacity. The ultimate goal is to give clinicians and policymakers the evidence they need to reduce amputations and deaths from open fractures in low-resource settings.
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BACKGROUND Injuries are the leading cause of death in people aged between 10-49 years. More people die from injuries than from HIV, malaria, and tuberculosis combined. For every person who dies, up to 50 people survive but become disabled. Open fractures are amongst the most devastating type of MSK injury. An open fracture is a break of a bone where part of the bone comes out through the skin and can result in catastrophic consequences, including high rates of infection and amputation. They most commonly affect people living in poor regions around the world, such as countries in Africa. It is not known how many people in Africa sustain an open fracture, what healthcare services are available to treat them or how best to improve their recovery. Without this fundamental information, it is difficult to know how to improve the care of these complex injuries in resource limited settings. AIM To improve the outcomes of open fractures in low resource settings. LOCATION This project will be undertaken across multiple hospitals in South Africa. OBJECTIVES 1. Assess current healthcare resources (facilities, equipment, and people) that exist to treat open fractures 2. Determine the number of people affected by an open fracture across South Africa 3. Assess the feasibility to undertake a large-scale clinical study, with the goal of improving the recovery of patients who have experienced an open fracture in a low resource environment METHODS Objectives will be answered through four connect project work packages; Work Package 1. Define the healthcare resources available for the treatment of open fractures: I will describe the healthcare resources currently available to treat open fractures across South Africa. Work Package 2. Determine the size of the problem: I will work with a network of collaborating hospitals throughout South Africa to determine how commonly open fractures occur. Work Package 3: Implement a multi-hospital feasibility study: Through my network of collaborating hospitals, I will undertake a multi-hospital study to 'test' if it is possible to do large-scale research studies of patients suffering from an open fracture. IMPACT My research will impact the care of patients in three ways; 1. By understanding current treatment service availability, healthcare managers will be able to identify and fill gaps in service readiness. 2. By knowing the number and type of open fractures presenting to their healthcare centre, clinicians will be able to better allocate resources for open fracture management. 3. By 'testing' if it is possible to do a large-scale research study in open fracture care, clinicians will build the local research capacity and infrastructure for a future nationwide study to improve the care of patients suffering open fractures in low source settings. In summary, this project will provide key information to help local healthcare workers and policy makers plan future delivery of open fracture care. Without this work it is unlikely, given current limited evidence, that the care of these complex injuries in developing countries will improve.
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