The Open fracture National Evaluation (ONE) Study - South Africa: Improving outcomes in the care of open fractures in low resource settings

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.