Evaluation of knowledge of ortho-plastic approach in the management of post traumatic lower limb injuries in Kenyatta National Hospital.

Abstract

Background: Ortho-plastic management in post-traumatic lower limb injuries remains core in ensuring the best results are achieved for the patient. This has been shown to reduce complications and the rate of limb amputations. An Ortho-plastic approach also reduces healthcare costs and length of hospital stay. This approach is yet to be well implemented in our setting. This study aims to establish the understanding and the current Ortho-plastic management of patients with post-traumatic lower limb injuries. This is the first step in determining how to implement the Ortho-plastic approach. Study Objective: The aim of this study was to evaluate the understanding of Ortho-plastic approach in the management of post traumatic lower limb injuries. Materials and Methods: This was a descriptive cross sectional study which was carried out over a three month period. The sample size was 84 surgical residents. The study was conducted in all surgical wards of Kenyatta National Hospital and University of Nairobi, School of Medicine lecture theatres. A self-administered questionnaire was given to all the 84 surgical residents who were currently rotating or had rotated through the Orthopaedic and Plastic Surgery departments at KNH. Data were extracted and entered into an Ms excel sheet and encrypted for safety. The data were then analysed and percentage and proportions used to describe the data. Ethical approval was sought from the KNH-UON Ethics and Research Committee. Results: Eighty four (84) surgical residents were recruited into the study majority of whom were Orthopaedics Surgery residents 45(53.6%) followed by Plastic Surgery residents 17(20.2%), they were from second to fifth year of study. Eighty (80) had done at least three months orthopaedics rotation and 32 had done three months of plastic surgery rotation. Ninety point five percent (90.5%) of the residents had no knowledge of any Ortho-plastic protocol and there was no Ortho-plastic protocol in use at Kenyatta National Hospital. The most common indication for Ortho-plastic consultation was a compound fracture ready for reconstruction with a flap and Gustillo Anderson 3B compound fracture as stated by 66.7% of the residents. Only two out of six knowledge based questions of the Ortho-plastic approach were answered correct by more than 70% of the residents. Gustillo Anderson classification system was the most commonly used classification system for compound fractures as stated by 96% of the residents. The resident in Orthopaedics Surgery was the one who commonly classified and first debrided compound fractures. Plastic Surgery were commonly consulted for wounds that required flap closure. The greatest barriers to Ortho-plastic approach were availability of theatre space and lack of a protocol for Ortho-plastic collaboration. Conclusion: There is a gap in knowledge and practice of the Ortho-plastic approach in the management of lower limb injuries at KNH amongst the surgical residents of UON. There is also lack of a protocol for Ortho-plastic collaboration at KNH.