title: High morbidity and mortality after lower extremity injuries in Malawi: A prospective cohort study of 905 patients.
abstract: BACKGROUND
  A lower extremity injury can be a devastating event in low-income countries due to limited access to surgical care. Its incidence, treatment patterns, and outcomes, however, have not been well-described.
  
  
  METHODS
  We prospectively enrolled all patients admitted with lower extremity trauma to a tertiary hospital in Lilongwe, Malawi between October 2010 and September 2011. Patients with a lower extremity injury but primarily admitted for unrelated reasons were excluded. The outcomes were deaths, complications, and length of hospital stay.
  
  
  RESULTS
  Of the 905 patients eligible for analysis, 696 (77%) were males. Most patients had femur fractures (46%), and most were treated non-operatively (70%). Overall mortality rate was 3.9%. For adult patients with femur fractures, mortality was higher in patients treated with traction (9.0%) than for those treated with surgery (1.3%). The total complication rate was 15%, with adjusted odds of developing a complication higher in patients with concurrent head injury (OR = 2.8; 95% CI: 1.3-6.0), and patients who had an operative treatment (OR = 2; 95% CI: 1.2-1.9). The median length of stay was 16 days (IQR: 6-27) and was greatest among patients with femur fractures.
  
  
  CONCLUSIONS
  Lower extremity injuries resulted in substantial mortality and morbidity in this low-income country. Mortality was particularly high among patients with femur fractures who did not have surgery. Modern orthopedic trauma surgery is greatly needed in low-income countries.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA. Electronic address: chago@email.unc.edu.
authors.forename: Maganizo B
authors.initials: MB
authors.lastname: Chagomerana
authors.affiliation: Department of Surgery, The University of North Carolina at Chapel Hill, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Tomlinson
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, P.O Box 149, Lilongwe, Malawi; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; The University of Malawi, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
authors.forename: Sven
authors.initials: S
authors.lastname: Young
authors.affiliation: UNC Project-Malawi, Kamuzu Central Hospital, Private Bag A-104, Lilongwe, Malawi.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, P.O Box 149, Lilongwe, Malawi; The University of Malawi, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
authors.forename: Leonard
authors.initials: L
authors.lastname: Banza
authors.affiliation: Department of Plastic Surgery, The Ohio State University, 915 Olentangy River Road Suite 2100, Columbus, OH 43212, USA.
authors.forename: Clara N
authors.initials: CN
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000401:mortality* / Q000628:therapy; D007902:Length of Stay; D035002:Lower Extremity / Q000293:injuries; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D012189:Retrospective Studies; D014143:Traction / Q000401:mortality; D016896:Treatment Outcome
keywords: Global surgery; Leg injury; Leg trauma; Lower extremity injury; Orthopedic injury