Proximal femoral fractures. A perspective from developing countries.

The approach to hip fractures in the developing world has been reviewed to give perspective to the problem on a larger scale. Hip fracture treatment in the developing world is a paradigm for treatment of other orthopedic problems as well as for medical care in general. The most successful approach has been to use the resources as sparingly as possible so as to provide care for the greatest number of people. Reliance on simpler, more basic techniques of nonoperative treatment reduces the complication rate and seems to provide a safer, more cost-effective approach, but the nonunion rate may be 30%-70%. The situation in which technical development exceeds resources is not unique to the developing world, although it is perhaps more apparent there because of a lower resource level. The "developed" world faces the same dilemma, the only real difference perhaps being a higher minimum. Probably no society today can provide the medical care it is technically capable of producing for all of its members. When viewed from a world-wide scale, the task of providing high-technology medical care seems daunting indeed. Development of more sophisticated, expensive technology may not be the appropriate direction; a more fundamental or preventive approach might in the long run be the most effective.

Hinged cast and roller traction for fractured femur. A system of treatment for the Third World.

Hinged casts and roller traction were used in two developing countries to treat fractured femora, most of which were due to road traffic accidents or civil violence. This method of treatment, developed by Neufeld, is particularly useful in the Third World because it uses local materials, adapted in a hospital workshop, and circumvents the difficulties and complications of standard traction and of operative treatment. The results are reported from 11 patients treated in Uganda in 1979 and from 110 treated in the Dominican Republic in 1981 and 1982. All but one fracture united without complication or significant shortening after a brief period in hospital. The method was easily taught to hospital staff and is strongly recommended.