A Comparision of Clinical Diagnosis and Knee Arthroscopy Findings at Mulago Hospital

Background: Many patients present to the orthopaedic surgeon with complaints of knee pain. In many such cases making a diagnosis based on clinical examination is often difficulty and frequently inaccurate. This study sought to document the common findings at knee arthroscopy and how they compare with clinical impressions. Methods: A cross-sectional study of 34 patients undergoing diagnostic knee arthroscopy with undetermined diagnosis was conducted at Mulago Hospital. The preoperative clinical provisional diagnosis and the findings at arthroscopy were documented; compared and analysed. Results: The commonest clinical diagnosis was medial meniscal tear (21); while the most frequentinding at arthroscopy was osteochondral lesions (27). The highest correlations between clinical impressions and arthroscopic findings were in ACL tears and osteoarthritis. The overall accuracy of clinical examination was 87.2.Conclusion: Clinical examination is a useful tool in diagnosing knee pathologies. In Mulago; the accuracy of the clinical impressions as proved at arthroscopy is high

Orthopaedic Outreach Program in Uganda: A Strategy to Improve Inequality in Service Delivery between Rural and Urban Communities

Background: Musculoskeletal diseases are on the increase worldwide. Greater than 80of Ugandans live in rural areas; facing formidable barriers to specialized care. In 1991 the Orthopedics Outreach Program (OOP) was initiated as a plausible solution to the inequity of orthopedic care between the urban and rural disadvantaged populations. This investigation was conducted to evaluate the output; effectiveness; and barriers to access; of the OOP over 13 years. Methods: This was a retrospective analysis to quantify surgical output and effectiveness of the OOP using the outreach record and a cross-sectional analysis to assess access and efficacy of the program. Semi-structured and key informant interviews targeted to key actors involved in the OOP were conducted to provide a qualitative assessment of the program. Results: Sixty seven outreach visits were completed; 6;653 patients seen; and 1;071 surgeries performed; at a total cost of US$12;701.00. The cost per patient seen was US$1.91 and US$11.86 per surgery performed. Poverty was uniformly cited as barrier to access; others were; transportation; and lack of awareness. There was unanimous opinion on the worthiness and effectiveness of the OOP; but many operational issues and constraints were cited. Conclusion: The OOP may provide a short and medium term solution to equity and access for orthopedic care in Uganda. There is need to quantify the burden of specific orthopedics conditions. A follow-up analysis assessing operational efficacy and output from 2004 to date; under the African Medical and Research Foundation (AMREF) and Ministry of Health funding is recommended