{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T07:25:46Z","timestamp":1786951546018,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020137","name":"Johnson and Johnson Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020137","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low\u2010 and middle\u2010income countries (LMICs) account for 90% of all deaths from injury globally, yet health systems remain poorly equipped to manage the escalating trauma burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study describes the prevalence, causes, and surgical management of extremity fractures at Malawi's two high\u2010volume tertiary hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cross\u2010sectional observational study collected injury mechanism and injury type as well as operative data on all patients undergoing surgical management of upper and lower extremity fractures at Queen Elizabeth Central Hospital (QECH) and Lilongwe Institute of Orthopedics and Neurosurgery (LION) Trust Hospital between January 2023 and March 2025. Descriptive statistics characterized study data, and ordered logistic regression evaluated factors associated with injury severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Details were recorded for 5674 patients and operations, comprising 79% males. Motorcycle collisions accounted for 35% of injuries, followed by falls (18%) and pedestrian\u2010related road traffic collisions (15%). One quarter of patients presented with open fractures, with higher proportions at QECH than at LION (30% vs. 22%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001). The median time from admission to surgery was 7\u00a0days (interquartile range 1\u201318). Consultants performed 80% of surgeries at LION but only 16% at QECH (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights a critical and escalating operative trauma burden in Malawi, driven largely by road traffic injuries, particularly motorcycle taxis. The high prevalence of open fractures, surgical delays, and workforce disparities underscore the urgent need for coordinated health system reforms, including strengthening surgical infrastructure, expanding specialist training, and implementing evidence\u2010based road safety interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level IV, Prognostic Study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70475","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T12:15:36Z","timestamp":1783167336000},"page":"2480-2490","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the Burden of Operatively Managed Extremity Fractures in Malawi: A Tale of Two Tertiary Hospitals"],"prefix":"10.1002","volume":"50","author":[{"given":"Cornelius","family":"Mukuzunga","sequence":"first","affiliation":[{"name":"Kamuzu Central Hospital (KCH) and Lilongwe Institute of Orthopaedics and Neurosurgery (LION) Trust Hospital  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chikumbutso Clara","family":"Mpanga","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"},{"name":"Department of Surgery College of Medicine University of Malawi  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Chidothi","sequence":"additional","affiliation":[{"name":"Kamuzu Central Hospital (KCH) and Lilongwe Institute of Orthopaedics and Neurosurgery (LION) Trust Hospital  Lilongwe Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Kawonga","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Central Hospital  Blantyre Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9651-2590","authenticated-orcid":false,"given":"Faith","family":"Moyo","sequence":"additional","affiliation":[{"name":"Bradford University Hospital  Bradford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-1196","authenticated-orcid":false,"suffix":"Jr","given":"Claude","family":"Martin","sequence":"additional","affiliation":[{"name":"AO Alliance Foundation  Chur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"Harrison","sequence":"additional","affiliation":[{"name":"Countess of Chester NHS Foundation Trust  Chester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"Injuries and Violence","author":"World Health Organization","year":"2022"},{"key":"e_1_2_12_3_1","volume-title":"Sub\u2010Saharan Africa Leads Global HIV Decline: Progress made\u2014UNAIDS","author":"Institute for Health Metrics and Evaluation","year":"2024"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.54394\/CJQU6666"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.26502\/josm.511500198"},{"key":"e_1_2_12_6_1","volume-title":"Emergency and Trauma Care in Low\u2010 and Middle\u2010Income Countries","author":"World Health Organization","year":"2023"},{"issue":"5","key":"e_1_2_12_7_1","first-page":"1071","article-title":"Management of Open Fractures: An Update","volume":"42","author":"Mauffrey C.","year":"2018","journal-title":"International Orthopaedics"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2214\u2010109x(23)00346\u20107"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14217767"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1596\/36905"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.4314\/ecajs.v29i4.4"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v36i3.5"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255052"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/OI9.0000000000000062"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.163121"},{"key":"e_1_2_12_17_1","volume-title":"Global Status Report on Road Safety 2023","author":"World Health Organization","year":"2023"},{"issue":"11","key":"e_1_2_12_18_1","first-page":"e1420","article-title":"The Burden of Road Traffic Injuries in Africa: A 10\u2010Year Analysis","volume":"8","author":"Hyder A. 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