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July 11, 2016Posted on

Fracture Care – A Neglected Area of Need

Every year, trauma kills over five million people – 32% more than the number of deaths resulting from HIV/AIDS, tuberculosis and malaria combined. The situation is worsening, as the World Health Organization (WHO) predicts that trauma will rise to third place on its list of health burdens by 2020, quietly making injury and fracture a global epidemic.

The increased use of motorized transport in LMICs, together with the fast pace of their economic growth, have led to an ever-rising number of injuries in countries with nascent trauma care systems. Even though the numbers are falling in developed countries, thanks to injury prevention and improved trauma care, the global rates of injury remain on an upward trend as the bulk of the world’s population resides in LMICs.

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For every person that dies from injury, many more will suffer a temporary or permanent disability. In LMICs, where it can often take days just to reach a hospital, injury often translates into dire consequences for patients and their families, as well as a huge burden to society because of limited treatment capacity, lack of orthopaedic surgeons and healthcare workers, and poor access to fracture care.

While closed head injuries and visceral injuries are the predominant cause of death, musculoskeletal injuries are a common source of morbidity. The effect of non-fatal injuries is likely much greater than that of fatal injuries. Up to 50% of those injured in LMICs receive no medical care, and a substantial number receive services at a primary health facility staffed by a non-physician care provider.

This profound capacity shortage needs to be recognized as a global crisis. We can begin to gradually address the disparities in global fracture burden through better global awareness and collaborative partnerships, as well as sustainable and adapted national training and education programmes led by local and national surgeons. In the meantime, the simple application of basic fracture treatment in resource-constrained countries can drive outcomes toward the levels in high-income countries.

Providing a full complement of trauma and fracture care services might well be currently beyond the means of most LMICs; but we can still design and deliver a core basket of goods and services that would materially help fracture care patients.

We recognize the problem is complex, but we are fully committed to making a difference in the care of patients who sustain musculoskeletal injuries in LMICs.

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Every patient sustaining a fracture in a low-income country should be able to access safe care, appropriate for their injury, and expect to return to normal, productive life.


Dr Jim Harrison, AOAF Director for Africa