1. CHALLENGES FACED BY GENERAL SURGEONS IN MANAGEMENT OF DIFFICULT PROXIMAL FEMUR FRACTURES IN RESOURCE LIMITED RURAL HOSPITALS
KISII LEVEL 5 HOSPITAL EXPERIENCE
DR. ODHIAMBO K - CONSULTANT SURGEON
DR. ONGARO N - ORTHOPEDIC SURGEON
DR. MAK’ANYENGO - ORTHOPEDIC SURGEON

2. HOSPITAL PROFILE
Referral facility for sub districts and district hospitals in Nyanza and South-west Rift.
Serves a population of 6 million.
Bed capacity of 405 with occupancy of 110%.
Has 2 surgical units- male and female with capacity of 100.
Trauma injuries account for 12% of all admissions.
Orthopedic cases account for 40 % of surgical bed occupancy.

3. MILESTONES
Open fractures have been managed by surgical toilet and skin traction.
Few cases benefited from external fixators with a challenge on availability, affordability and technical knowhow.
Proximal femur fractures were referred.
Occasional use of K nails was undertaken.

4. In view of these challenges, measures were undertaken to try and overcome them
Interlock IM SIGN project seminar at MTRH
On job training by local orthopedic surgeons
Availability of implants at low costs locally

5. Implementation challenges
These included:
Poor paramedical motivation
Low enthusiasm to learn new skills
Unavailability of theatre space
Lack of resident orthopedic surgeon
Shortage of anaesthetists and trained theatre nurses
Lack of equipments for operative fracture care
Anxiety in patients and staff in the success of the procedures

6. Case summary
Initially 2 patients with fracture neck of femur underwent Austin Moore hemiathroplasty successfully.

7. DIAGNOSIS
FREQUENCY
PROCEDURE
Fracture neck of femur 9
Hemiathroplasty
Intertrochanteric fracture 2
Dynamic hip screw
Bilateral fracture neck of femur 1
Bipolar hemiathroplasty
Segmental femur shaft fracture
Interlocking nail

8. Challenges – peri-operative
With minimum conditions having been met for operative management of proximal femur fractures, several challenges were encountered.
Difficult alignment of fractures due to delay in surgery and poor traction facilities.
Incomplete orthopaedic sets
Inadequate implant supply leading to improvisation
Lack of image intensifier thus open reduction
Lack of post anaesthetic care unit(PACU)
Poor follow up

9. RECOMMENDATION Independent orthopaedic wing Equipments and personnel
Training
Collaborations – KNH, MTRH, APDK, SIGN
Ministry of health- provision of implants

10. THANK YOU