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The Socioeconomic Implications of Isolated Tibial and Femoral Fractures from Road Traffic Injuries in Uganda

O’Hara, Nathan N., MHA1,a; Mugarura, Rodney, MMed2; Potter, Jeffrey, MD3; Stephens, Trina, MSc4; Rehavi, M. Marit, PhD5; Francois, Patrick, PhD5; Blachut, Piotr A., MD3; O’Brien, Peter J., MD3; Mezei, Alex, BA6; Beyeza, Tito, MMed2; Slobogean, Gerard P., MD, MPH, FRCS(C)1

doi: 10.2106/JBJS.17.00439
The Orthopaedic Forum
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Commentary

Background: The purpose of this study was to determine the socioeconomic implications of isolated tibial and femoral fractures caused by road traffic injuries in Uganda.

Methods: This prospective longitudinal study included adult patients who were admitted to Uganda’s national referral hospital with an isolated tibial or femoral fracture. The primary outcome was the time to recovery following injury. We assessed recovery using 4 domains: income, employment status, health-related quality of life (HRQoL) recovery, and school attendance of the patients’ dependents.

Results: The majority of the study participants (83%) were employed, and they were the main income earner for their household (74.0%) at the time of injury, earning a mean annual income of 2,375 U.S. dollars (USD). All of the patients had been admitted with the intention of surgical treatment; however, because of resource constraints, only 56% received operative treatment. By 2 years postinjury, only 63% of the participants had returned to work, and 34% had returned to their previous income level. Overall, the mean monthly income was 62% less than preinjury earnings, and participants had accumulated 1,069 USD in debt since the injury; 41% of the participants had regained HRQoL scores near their baseline, and 62% of school-aged dependents, enrolled at the time of injury, were in school at 2 years postinjury.

Conclusions: At 2 years postinjury, only 12% of our cohort of Ugandan patients who had sustained an isolated tibial or femoral fracture from a road traffic injury had recovered both economically and physically.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland

2Department of Orthopaedics, Makerere University, Kampala, Uganda

3Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada

4Faculty of Medicine, Queen’s University, Kingston, Ontario, Canada

5Vancouver School of Economics, University of British Columbia, Vancouver, British Columbia, Canada

6Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

aE-mail address for N.N. O’Hara: nohara@som.umaryland.edu

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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