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Background: Traumatic fractures are common in sub-Saharan Africa, a region with a shortfall of orthopaedic surgeons, and can result in morbidity if not appropriately managed. WhatsApp is an encrypted smartphone application and ubiquitous in sub-Saharan Africa. The objective of this study was to assess the use of WhatsApp as a mobile health platform to support fracture management by non-orthopaedic doctors in Cape Town, South Africa.Study Design: A WhatsApp orthopaedic referral group was created between non-orthopaedic doctors from community health clinics and the orthopaedic team from a first-level hospital to manage traumatic fractures. Non-orthopaedic doctors posted cases on the orthopaedic referral group and the orthopaedic team provided advice. Traumatic fracture data from January 1 to June 30, 2018 were analyzed and outcomes included response time, management advice, and treatment by facility level.Results: Seventy-two non-orthopaedic doctors posted 731 cases of traumatic fractures to the 5-member orthopaedic team. Six hundred and sixty-one (90%) cases were responded to within 1 hour. Three hundred and fifty-four (48%) patients were treated successfully by non-orthopaedic doctors at community health clinics, 288 (39%) were treated by the orthopaedic team at the first-level hospital, and 89 (12%) were referred directly to an orthopaedic subspecialist at a third-level hospital.Conclusions: The WhatsApp orthopaedic referral group provided a free telementoring platform for non-orthopaedic doctors to successfully manage traumatic fracture cases at community health clinics. This type of mobile health platform can be applicable to other resource-limited settings if disease burden is high and specialists are scarce. [ABSTRACT FROM AUTHOR]

Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level.Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts.Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2 ± 2.0 days at DH level and 7.6 ± 7.1 days for TH (p < 0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for tertiary level (p < 0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p < 0.05). Death rate was 0.4% vs 0.6% at district and tertiary hospitals respectively (p > 0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list.Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures.Level Of Evidence: Level III Retrospective cohort study. [ABSTRACT FROM AUTHOR]