IN 2008, Ronnie Bunya lay motionless in Mengo Hospital for two weeks, following a car accident that left his femur broken. He had an operation which involved cutting through his flesh to the bones so that his femur could be rearranged and fastened with a metallic plate.
Bunya describes the pain as excruciating, but he was able to walk three days after the operation and was discharged after a month. He spent a year on crutches but is now able to walk without them.
A fracture is a crack or break that occurs in the bone. It can be complete or partial. When the bone breaks and remains in one place, it is a simple fracture. If the broken bone punctures the skin, it is called an open or compound fracture.
Fractures commonly occur during accidents or when one falls.
How does one tell they have a fracture? Dr. Mallon Nyati, a consultant orthopaedic surgeon at Mulago Hospital, says intense pain in the bones, inability to move, deformity or numbness in a certain part of the body are the common signs.
â€œMost casualties in Uganda, many of whom are men, are as a result of road accidents and their number is increasing by the day,â€ says Dr. Patrick Ssekimpi, an orthopaedic surgeon at Mulago Hospital.
He says boda bodas contribute to more than 90% of all the patients in the Mulago casualty ward. Other causes are domestic oriented, especially with children.
Using traditional crude methods can hinder quick recovery since their perpetrators do not have the scientific understanding of how to attend to a person with a fracture.
â€œIf the damage is not treated and monitored by a qualified orthopaedist, you stand a risk of deformity or prolonged healing,â€ explains Dr. Nyati.
The fracture can heal on its own even when unattended to, although this might lead to irregularities in bone development.
Much as we need to exercise and eat more foods rich in iron, calcium and Vitamin C for stronger bones, the strength of your bones does not necessarily protect you from a fracture.
Immobilisation (stopping the movement of the damaged part) should always be the first step. Strap the bruised area using a bandage and timber splints to stop further pain and tissue damage.
After administering first aid, rush the casualty to the nearest hospital where he may go through the basics including resuscitation before being handed over to the orthopaedic surgeons.
â€œVital checks, including the pulse rate, blood pressure and an x-ray to determine the type of fracture are carried out,â€ says Nyati.
Most fractures are treated using old, medical methods like the plast of Paris cast (commonly known as cement) and traction, which is, especially used among children because it is light.
Among adults, Plast of Paris is preferred because it maintains mobility.
However, surgical treatment is most ideal because movement is restored immediately.
It involves using metallic devices which are implanted in the patientâ€™s body to connect the broken bones.
The plates and screws used together or the nails, are inserted in the narrow cavity.
Because they are metallic, they are strong and hold the bones firmly together hence creating almost instant mobility.
The duration of healing is subject to oneâ€™s age. Children always heal faster, spending about six weeks, while adults need an average of three months.
The size of the broken bone, extent of the injury and how much you follow rehab instructions also determine how fast you will heal.
Big bones like the femur take longer periods. Sometimes the casts and braces are removed before complete healing to avoid joint stiffness.
â€œThe materials used in surgical donâ€™t have to be removed after surgery. The person feels at ease with them.
But in case there is an indication of discomfort, we can eliminate them,â€ says Ssekimpi.
Numbers and Resources
On average, 400 emergency cases report to Mulago Hospital every month due to fractures and a third of them are admitted. Ssekimpi says 150 chronic injuries are also treated every month. This brings the total to 600 patients every month.
Mulago has 11 orthopaedic surgeons, while the rest of the country has 30.
Most surgeons are in and around Kampala because other parts of the country, according to Ssekimpi, lack orthopaedic facilities.
Non-surgical treatment is hectic and time consuming for both the patient and surgeon, yet significantly cheaper than surgery.
For instance Bunyaâ€™s operation cost sh2m at Rubaga Hospital. Sometimes the extent of the fracture determines the type of treatment used.
â€œWhile the initial application of a cast costs sh150,000 at Mulagoâ€™s private ward, surgery on average costs sh2,000,000,â€ states Dr. Mallon Nyati.
Ssekimpi says surgery is free at Mulago public wing, although patients have to buy the metallic plates.
The implants, which comprise plates and screws, are sold in private hospitals at sh500,000. The plates for a hip replacement cost sh3m.
â€œHowever, we have affiliations with organisations in the US which donate implants to the hospital,â€ says Ssekimpi.
Broken bones- Fractures stopping men in their tracks