Injury results in the death of approximately 5.8 million people each year, as well as severe disability for survivors. A large proportion of these injuries are fractures or broken bones. Sierra Leone is a country in West Africa and is one of the world’s poorest countries with a very weak healthcare system. There are limited treatment options for patients who break the bones in their legs and many of them have to live with disability or die from their injuries.
This project aims to ensure that sufferers of lower limb trauma seek and receive appropriate, timely surgical care provided by trained and skilled healthcare providers, able to use sustainable and effective technologies to limit disability, suffering and to promote health and wellbeing of the community. There is a huge healthcare burden presented by lower limb fractures resulting from poor traffic infrastructure and the increase in the use of motorbikes. The majority of patients suffering these injuries are from the younger population. Currently patients would be hospitalised for a long period of time and current methods used in these hospitals are no longer used in high income countries. There is a desperate need to address this deficit in surgical provision, which is exacerbated by the increase in road traffic accidents.
This trial aims to examine the treatment of broken tibia (shin) bones in the main government hospital of Freetown, the capital of Sierra Leone. At present the treatment options for these fractures are casting with plaster of paris and skin traction. For many of these fractures, this treatment is less than ideal and often can result in prolonged hospital stay and poor function during and after treatment. Our trial will examine the outcomes for 20 patients who undergo treatment as usual (described above), and compare these with 20 patients who receive a surgical intervention known as Ilizarov frame fixation. This involves a surgical procedure where the 
fracture is held in place by metal pins and an external frame to hold the broken bone steady while it heals. We think the benefit of this will be that the patient can walk and will be discharged home from hospital quicker, have better bone healing and quality of life. A large part of the study will look to see if the frame can be put in safely in Connaught and what are the costs and benefits of the frame compared to the current treatment. We hope the results will contribute to the implementation of a cost-effective and sustainable fracture fixation service in the future.
Capacity building is a huge part of our projects. Alongside the treatment for patients, we will be running a training programme for healthcare workers (surgeons, nursing staff, physiotherapists) to manage the device in an outpatient setting, this will help to reduce the number of infections post treatment in the future. Furthermore, we will be running a research skills and trial delivery training programme to all researchers and staff involved. The hope is this will form the basis of research personnel for several future research projects.
The research was commissioned by the National Institute for Health Research using Official Development Assistance (ODA) funding.
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.