{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:17:45Z","timestamp":1787753865715,"version":"build-2784847793"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"\n \n \n \n \n \n \u27a2 Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The\n Lancet<\/jats:italic>\n Commission on Global Surgery.\n <\/jats:p>\n <\/jats:list-item>\n \n \u27a2 We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%).<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice.<\/jats:p>\n <\/jats:list-item>\n \n \u27a2 Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.26.00129","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T18:00:24Z","timestamp":1776103224000},"page":"792-798","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Hybrid Training Model for Open Fracture Management in Rwanda"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6483-5625","authenticated-orcid":false,"given":"Samhita","family":"Kadiyala","sequence":"first","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7536-3701","authenticated-orcid":false,"given":"Emily","family":"Powis","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3475-2692","authenticated-orcid":false,"given":"Alireza","family":"Mirahmadi","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1697-1672","authenticated-orcid":false,"given":"Carlos","family":"Mercado","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6037-2174","authenticated-orcid":false,"given":"Sion","family":"Yu","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-338X","authenticated-orcid":false,"given":"Suhas Rao","family":"Velichala","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5937-4523","authenticated-orcid":false,"given":"Alyssa","family":"Colannino","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5697-9051","authenticated-orcid":false,"given":"Isabella","family":"Hung","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00ebl B.","family":"Bikoroti","sequence":"additional","affiliation":[{"name":"University Teaching Hospital of Kigali, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9922-2062","authenticated-orcid":false,"given":"Olivier","family":"Kubwimana","sequence":"additional","affiliation":[{"name":"University Teaching Hospital of Kigali, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5022-6532","authenticated-orcid":false,"given":"Lambert R.","family":"Dusingizimana","sequence":"additional","affiliation":[{"name":"University Teaching Hospital of Kigali, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1326-6452","authenticated-orcid":false,"given":"Barnabas Tobi","family":"Alayande","sequence":"additional","affiliation":[{"name":"Centre for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8636-6473","authenticated-orcid":false,"given":"J.C. Allen","family":"Ingabire","sequence":"additional","affiliation":[{"name":"University Teaching Hospital of Kigali, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6445-1797","authenticated-orcid":false,"given":"Jean Claude","family":"Byiringiro","sequence":"additional","affiliation":[{"name":"University Teaching Hospital of Kigali, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8217-0593","authenticated-orcid":false,"given":"Edward K.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran J.","family":"Agarwal-Harding","sequence":"additional","affiliation":[{"name":"Harvard Global Orthopaedics Collaborative, Boston, Massachusetts"},{"name":"Beth Israel Deaconess Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"issue":"9","key":"bib1-20260603","doi-asserted-by":"crossref","first-page":"e580","DOI":"10.1016\/S2666-7568(21)00172-0","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"2","year":"2021","journal-title":"Lancet Healthy Longev."},{"issue":"2","key":"bib2-20260603","doi-asserted-by":"crossref","first-page":"e062","DOI":"10.1097\/OI9.0000000000000062","article-title":"The global burden of musculoskeletal injury in low and lower-middle income countries: A systematic literature review","volume":"3","author":"Cordero","year":"2020","journal-title":"OTA Int."},{"issue":"10","key":"bib3-20260603","doi-asserted-by":"crossref","first-page":"e1486","DOI":"10.1016\/S2214-109X(23)00367-4","article-title":"Outcomes of open tibial fracture surgery: beyond the operating room","volume":"11","author":"Gajewski","year":"2023","journal-title":"Lancet Glob Health."},{"key":"bib4-20260603","doi-asserted-by":"crossref","first-page":"204","DOI":"10.12688\/wellcomeopenres.18063.1","article-title":"\u201cDon\u2019t rush into thinking of walking again\u201d: Patient views of treatment and disability following an open tibia fracture in Malawi","volume":"7","author":"Schade","year":"2022","journal-title":"Wellcome Open Res."},{"issue":"2","key":"bib5-20260603","first-page":"218","article-title":"Current Strategies in the Prevention and Management of Infection in Open Fractures","volume":"7","author":"Roberts","year":"2025","journal-title":"J Orthop Sports Med."},{"issue":"8","key":"bib6-20260603","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s00402-019-03287-4","article-title":"General treatment principles for fracture-related infection: recommendations from an international expert group","volume":"140","author":"Metsemakers","year":"2020","journal-title":"Arch Orthop Trauma Surg."},{"issue":"1","key":"bib7-20260603","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.4102\/phcfm.v11i1.1908","article-title":"The physical, psychological and social impact of long bone fractures on adults: A review","volume":"11","author":"Singaram","year":"2019","journal-title":"Afr J Prim Health Care Fam Med."},{"issue":"1","key":"bib8-20260603","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.surg.2015.04.011","article-title":"Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development","volume":"158","author":"Meara","year":"2015","journal-title":"Surgery."},{"issue":"1","key":"bib9-20260603","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s00268-015-3258-3","article-title":"Vital Statistics: Estimating Injury Mortality in Kigali, Rwanda","volume":"40","author":"Kim","year":"2016","journal-title":"World J Surg."},{"issue":"9","key":"bib10-20260603","doi-asserted-by":"crossref","first-page":"e075117","DOI":"10.1136\/bmjopen-2023-075117","article-title":"Barriers to equitable access to quality trauma care in Rwanda: a qualitative study","volume":"13","author":"Nzasabimana","year":"2023","journal-title":"BMJ Open."},{"issue":"10","key":"bib11-20260603","doi-asserted-by":"crossref","first-page":"103661","DOI":"10.1016\/j.jsurg.2025.103661","article-title":"Rethinking Global Orthopedic Education: Centering Needs, Fostering Collaboration, and Building Networks","volume":"82","author":"Kadiyala","year":"2025","journal-title":"J Surg Educ."},{"issue":"20","key":"bib13-20260603","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.2106\/JBJS.24.01463","article-title":"Assessment of the Mechanical Performance of an Affordable External Fixator (AEFIX) Designed for Resource-Limited Settings","volume":"107","author":"Momenzadeh","year":"2025","journal-title":"J Bone Joint Surg Am."},{"key":"bib14-20260603","first-page":"151","article-title":"The utility of low-cost negative pressure wound therapy in Cameroon","volume":"48","author":"Amlani","year":"2024","journal-title":"Pan Afr Med J."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.26.00129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:20:17Z","timestamp":1787750417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.26.00129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":13,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.26.00129","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}