Fracture management challenges dissected

Hakim Hayat

The management of fracture forms a vital element of orthopaedic surgery and contributes towards a major trauma workload for the Department of Orthopaedic Surgery at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, according to Acting Director General of Medical and Health Services, Ministry of Health (MoH) Pengiran Dr Haji Mohd Khalifah bin Pengiran Haji Ismail.

This is in addition to ligament reconstruction surgery, joint replacement surgery and management of diabetic foot problems that the department covers.

Pengiran Dr Haji Mohd Khalifah said this as the guest of honour at the third National Fracture Management Workshop at Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah (PAPRSB) Institute of Health Sciences, Universiti Brunei Darussalam (UBD) yesterday.

A total of 200 doctors, paramedics, nurses and allied health professionals attended the workshop.

The Department of Orthopaedic Surgery receives over 20,000 patients per year, according to statistics from the Orthopaedic Society of Brunei Darussalam.

Over 2,000 patients were admitted to RIPAS Hospital and at least 400 surgeries were performed just for fracture fixation.

The society said that apart from the increasing number of road traffic accidents contributing to the trauma workload, there is also an increasing number of work-related injuries among labourers. Also worrying is the increasing number of falls and fragility among the elderly.

Acting Director General of Medical and Health Services, Ministry of Health Pengiran Dr Haji Mohd Khalifah bin Pengiran Haji Ismail delivers his speech. PHOTO: SIM YH

The workshop primarily targetted the accident and emergency doctors, general practitioners, nurses and other allied healthcare professionals such as physiotherapists, occupational therapists and paramedics.

The workshop saw lectures on the updated basic fracture management, and highlighted the common issues and challenges faced in the management of various types of fractures.

Interactive group discussions allowed the targetted audience to share their challenges when facing the management of an injured patient.

An Orthopaedic Society of Brunei Darussalam press release stated that it hopes to improve the quality of services provided by the MoH:

“Management of fracture forms a vital element of orthopaedic surgery. Fractures contribute a major trauma workload for the Department of Orthopaedic Surgery at RIPAS Hospital being a tertiary centre.

“The department has branched out to Suri Seri Begawan Hospital which acts as a secondary referral centre mainly for the Belait District population.

“The department also provides clinic services to Pengiran Isteri Hajjah Mariam Hospital in Temburong and Pengiran Muda Mahkota Pengiran Muda Haji Al-Muhtadee Billah Hospital in Tutong,”

The society noted that despite the large number of facture surgeries undertaken in a year, there is a large number of fractures that do not require surgery.

“These patients are normally seen first by the accident and emergency doctors of general practitioners in government or private peripheral health centres. Their role is to identify the injury or fracture and to make appropriate referrals directly to the Department of Orthopaedic Surgery.

“They could also request the appropriate investigation and initiate the first line of treatment, and then refer them to the Department of Orthopaedic Surgery for further management.

“Delay or missed referrals of certain unstable fractures or even inappropriate first line management can affect the outcome of the fracture healing.

“Any fracture can cause a great deal of loss to the patient individually in terms of health, income earnings, mobility, and a great burden to the patient’s carer or family. Looking at it from a larger perspective, a significant amount of loss to the nation as well, in terms of loss of productivity and efficiency at work.

“Therefore, the society aims to achieve swift diagnosis, appropriate management and early rehabilitation as this is key to a swift recovery.”

With the collaboration of UBD, the Orthopaedic Society of Brunei Darussalam said it will continue its mission to educate and train doctors, nurses and allied health professionals as well as medical students.