Assessment of Long-Term Outcomes of Lower Limb Fractures Managed by Non-orthopaedic Specialist Surgeons in Rural Rwanda: A Pilot Feasibility Study

Abstract

Introduction Sub-Saharan Africa is disproportionately affected by injuries, and short-term morbidity and mortality are high in this context. Lower limb fractures (LLFs) are a common type of injury that can lead to severe disability with extensive negative social and economic consequences. However, little is known about the long-term outcomes of LLFs in sub-Saharan Africa. In this pilot study, we describe the feasibility of assessing epidemiological patterns of LLFs, the state of care, and long-term outcomes in rural Rwanda. Methods This study was conducted from July to December 2021. It consists of retrospective data collection from hospital charts and a cross-sectional, phone-based follow-up. Functional outcomes were assessed using the World Health Organization Disability Assessment Schedule (WHODAS; World Health Organization, Geneva, Switzerland) 2.0, and health-related quality of life (QoL) was assessed using a 36-Item Short Form Health Survey questionnaire (SF-36). Results Eighteen patients were included in the study, of which the majority were males (n=11, 61%), young adults (mean age 29, standard deviation (SD) 25), and without any previous comorbidities (n=16, 89%). Most patients had a single fracture, although nearly one-third presented with multi-trauma (n=5, 28%). The most common injury cause was falls (n=10, 56%). Fractures were most common in the femur/hip (n=10, 56%), and most fractures were closed (n=14, 78%) and non-comminuted (n=9, 50%). Disability was described as high, with a total mean WHODAS summary score of 80 (SD 29), whereas health-related QoL varied across the SF-36 domains, with "general health" being the lowest rated domain with a mean score of 30 (SD 25). Conclusion This study highlights the challenges of long-term follow-up after LLFs in a rural, low-resource setting but demonstrates that such a study is feasible if planned with contextual considerations. Self-perceived disability is high, and health-related QoL is low at long-term follow-up, which should be viewed in light of the fact that it primarily affects a young, previously healthy population.

Keywords: east africa; functional and clinical outcome; functional disability; health-related quality of life; long-term outcome; low- and middle-income country; lower extremity trauma.

Figure 1. Visualization of the recruitment process with the inclusion and exclusion of study participants.

CHW: Community health worker.

Figure 2. The distribution of WHODAS domain mean scores among the participants, ranging from one to five, representing “no disability” to “extreme disability.”

WHODAS: World Health Organization Disability Assessment Schedule.