Global Orthopaedics - Our legacy for the future?
Background: The COVID-19 pandemic underscored global health disparities and the critical shortage of surgical services in low- and middle-income countries (LMICs). Approximately five billion individuals lack access to safe, timely surgical care, resulting in an estimated 20 million annual deaths and 77 million lost disability-adjusted life years (DALYs). Orthopedic conditions, including neglected trauma, infection, and pediatric pathologies, represent a significant portion of this unmet surgical need.
Objective: This review examines the current state of orthopedic service provision in LMICs, evaluates the economic and clinical barriers to care, and outlines strategies for sustainable surgical education, equipment procurement, and international collaboration.
Key Points: Surgical deficits in LMICs lead to profound morbidity, such as limb loss from delayed open fracture management. Economic projections suggest that achieving universal access requires 2.2 million additional healthcare workers, yet the cost is offset by preventing trillions in lost economic output. Effective service delivery models prioritize local capacity building through organizations like the College of Surgeons of East, Central and Southern Africa (COSECSA). Clinical practice in resource-limited settings necessitates adapting techniques, such as using percutaneous wires or specialized intramedullary systems like the SIGN nail, rather than high-cost, maintenance-heavy implants. Successful interventions emphasize "Train the Trainer" programs, virtual mentorship via mobile telecommunications, and the donation of robust, environment-specific equipment. Ethical considerations remain paramount, focusing on informed consent and the pillars of beneficence and non-maleficence within austere environments.
Conclusion: Addressing the global burden of musculoskeletal disease requires a shift from short-term surgical camps to sustainable, education-focused partnerships. Integrating technology for virtual support and prioritizing resource-appropriate surgical techniques are essential for improving orthopedic outcomes in LMICs.
