​What kinds of symptoms do patients experience before receiving treatment?

This procedure corrects a severe, poorly aligned fracture where the ends of affected bones are far apart. Such a fracture may occur anywhere in the body (leg, hip, arm, jaw, etc) usually as a result of trauma. Common symptoms include extreme pain, inability/difficulty in using limbs, and deformed limbs.

​What is the impact on patients’ lives of living with these conditions?

A non-union leads to chronic disability, pain, and inability to work.

What cultural or regional factors affect the treatment of these conditions?

Car/motorcycle taxi accidents are the number one cause. Work-related accidents and violence are others. The condition is more common largely because African roads (particularly Kenyan roads, where this procedure is approved) are among some of the most dangerous in the world.

What does the treatment process look like?

In general, an ORIF (open-reduction internal-fixation) procedure uses rods or plates to bring multiple parts of bone together and help them heal correctly.

What is the impact of this treatment on the patient’s life?

Curative. An ORIF fixes the broken bone, restoring it to complete function and enabling the patient to be able to work.

What potential side effects or risks come with this treatment?

This procedure has medium surgical risk but most trauma patients are young and tolerate the procedure well. Overall, the risk of surgery is less than the risks of the alternative (traction), or doing nothing. There is a risk of the metal becoming infected, which would require antibiotics and perhaps removal of the hardware and a second surgery.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are few quality orthopedic centers in developing countries. Often patients have received initial care for a fracture at another hospital and may have been placed in “traction.” This involves placing the affected limb in a cast under tension for prolonged periods to try to re-align the bones. Those who have funds try to make their way to a place like Kijabe Hospital. Most patients seen in Kijabe who are in need of an ORIF are patients who have been mismanaged in other hospitals. Usually, those hospitals lack adequate resources and expertise to treat them.

What are the alternatives to this treatment?

As mentioned, traction is an alternative for some — but not all — cases. And traction requires a patient to be in the hospital, immobile, for months — leading not only to lost wages but risk of bedsores, blood clots, and hospital-acquired infections.