ORTHOPAEDIC TRAUMA IN NORTHERN MALAWI'S CENTRAL HOSPITAL: INJURY PATTERNS, OPERATIVE NEED, AND SERVICE CONSTRAINTS

Malawi has a high burden of traumatic injury but limited orthopaedic surgical capacity, particularly in the northern region where a single orthopaedic surgeon serves a population of over four million. This study aimed to describe the epidemiology of orthopaedic trauma in northern Malawi, assess operative demand, and evaluate how this demand is met by the existing orthopaedic service at Mzuzu Central Hospital (MZCH). Due to the absence of a reliable trauma registry, a retrospective review of multiple data sources was undertaken. These included all musculoskeletal radiographs performed in the Emergency Department over one-month, inpatient ward records, and theatre logbooks over the same period. Radiographs were reviewed to determine fracture patterns and anticipated best-practice management, according to locally agreed treatment algorithms. Inpatient workload, operative case mix, and anaesthetic practices were analysed descriptively. 936 non-spinal musculoskeletal radiographs were reviewed, of which 440 demonstrated fractures. Approximately 40% of injuries would have benefitted from surgical intervention. On average, 4.5 patients per day required surgery, compared with a theatre throughput of 3 patients-per-day. Adult trauma predominantly affected young males, with road traffic collisions, falls, and assault accounting for over 80% of injuries. Open fractures comprised 19% of adult operative cases, with nearly half of tibial shaft fractures being open. In children, upper limb fractures predominated. Overall, operative case mix broadly correlated with presenting injury patterns, although some fracture types - particularly adult forearm fractures - appeared to be under-treated surgically. Orthopaedic trauma places a substantial and unmet demand on surgical services in northern Malawi. Current operative capacity at MZCH is insufficient to meet the volume of injuries, particularly among economically productive adults. Addressing this gap will require targeted improvements in theatre capacity and data systems, alongside strengthened support and supervision of Orthopaedic Clinical Officers.