Date of Award

10-20-2006

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Trace Kershaw

Abstract

Trauma is the most common cause of mortality and disability among working aged adults in resource poor countries [1]. While injury prevention is crucial, epidemiologists and clinicians must also work to decrease mortality and disability that results from injury through cost-effective improvements in the entire system of trauma treatment. This review sought to determine if performing internal fixation using the Surgical Implant Generation Network (SIGN) intramedullary nail to treat femur and tibia fractures is feasible in rural Haiti; and which variables improve post-operative recovery, defined as weight bearing (WB) and range of motion (ROM). Sixty fractures, treated using the SIGN nail, were compared to 46 fractures that were treated prior to its advent. There was no significant difference between the groups based on OR time (p = 0.56) and LOS (p = 0.47). Within the SIGN group, a correlation was observed between weight bearing and age (p = 0.007), delays to surgery (p = 0.001), and polytrauma (p = 0.017). Age (p = 0.079) and delays to surgery (p = 0.010) were also found to influence knee range of motion. The low production cost of the SIGN nail and its design simplicity offer a potential solution to the multiple trauma fractures that frequently lead to disability in settings like Haiti. Its utility, in settings like Haiti, must be further studied. In addition, it is also essential that we continue to make efforts to improve post-trauma transport.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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