Students rethink fixing broken bones in rural Uganda

For those of us who have had the privilege to grow up in a country like Canada, the extensive healthcare system we have access to is easy to take for granted. But for many people in low income countries, such life-altering resources remain out of reach.

In May 2015, a group from UBC’s Biomedical Engineering Student Team (BEST) traveled to hospitals and universities in Uganda and Kenya as part of their International Medical Device Initiative in order to identify healthcare challenges they could begin to tackle.

The team came up with 30 proposals, one of which became the Femur Fracture Treatment Project (FFTP). The project is designed to improve the procedure for treating femur fractures, a serious injury all too common among boda boda drivers in Uganda, who make their living weaving through traffic on motorcycles with little to no protective equipment.

If tomorrow you were to break your thighbone, an orthopaedic surgeon at the hospital would perform a surgical procedure called an open reduction and internal fixation, reducing the fracture, then stabilizing the bone with a combination of rods, screws and plates.

For many people living with low incomes in places like Uganda, however, that procedure is not an option. While there, third-year mechanical engineer and FFTP co-lead Georgia Grzybowski was struck by the widespread use of an alternate procedure called skeletal traction for treating femur fractures.  

That treatment method — which is unheard-of in Canada — involves inserting pins into the bone, then attaching them to weights via pulleys to gradually ease the bone fragments back into place, reducing the fracture and allowing the bones to fuse. All told, the procedure requires a patient to spend three months in a hospital bed rigged up to the pulley system.

According to project co-lead Karla Rivera and BEST chief operating officer and captain Julie Kerr, the two main reasons why skeletal traction has remained the most common treatment for femur fractures in the developing world are cost and transportation. Traction can be paid in instalments, while surgery must be paid up front. Also, rural hospitals often are unable to perform the necessary surgeries and transportation to larger, urban hospitals can be difficult and expensive.

The potential complications of skeletal traction include pressure ulcers, infections, improper bone fusion and bedsores. There are also psychological side effects resulting from the extended amount of time patients must spend bed-bound and isolated while undergoing traction.

When developing a device to address these issues, the team had three goals — reduce time spent in the hospital, increase patient mobility and improve patient outcomes.

After six months of research, they began the design process, focusing on prototyping a device for stabilizing femur fractures after they are reduced.

The latest design is a rigid shell that the patient can wear with bars on the side that are attached to the pin in the femur used for reduction. The fracture can be sufficiently stabilized to promote bone growth, but the patient can be sent home on crutches while the bone fuses instead of being forced to remain bed bound.

By making it possible for the patient to be discharged a month earlier than they otherwise would, the team hopes to mitigate some of the adverse psychological effects of a long hospital stay.

Recognizing the work of the FFTP, the Rice University Institute for Global Health has invited the team to participate in the 2017 Global Health Design Competition on March 24. There, a panel of expert judges will assess the group’s design based on the potential it has to improve healthcare outcomes for its target patients.

Going forward, the goal of the FFTP team is to establish a collaborative partnership with Makerere University in Kampala to facilitate the joint development of their current prototype as well as the eventual development of a reduction device prototype. This will allow for constant feedback and input from the Uganda bioengineering students with direct access to the hospital wards where the technology will hopefully one day be implemented.

When trying to address international health challenges, Rivera emphasized how important it is not to operate in a vacuum and to pay close attention to the specific conditions in a particular location, which is why in-country partners like those they hope to gain at Makerere are so invaluable.

“I think this collaboration is going to be the key driver for the success of our project,” said Rivera.