Major Orthopaedic Procedures: 17 Year Trends.

Objective: This study was aimed at determining the trends in the proportions of major orthopaedic procedures performed in the department of orthopaedics, Addis Ababa University in Ethiopia in the last two 'decades'. The factors contributing to the trends and their implications were also analysed..
Patients and Methods: this was a Retrospective study of major Orthopaedic procedures done between January 1988 and January 2005 at Addis Ababa University, Medical Faculty, Department of Orthopaedic Surgery, 'Tikur Anbessa' Hospital (Black lion Hospital). Medical records and operation logbooks (OR-registry) of 13,702 were reviewed. Minor and day case procedures were excluded from the study.
Results: On average, 806 major orthopaedic procedures were done annually. Males accounted for 74% of the cases. A total of 3,974 (29%) of procedure were in children. The mean age for adults was 34 years. Eighty percent of the procedures were elective with trauma being the indication in 65%. In 4,661(34%) the procedures were 'septic'. Open reduction and internal fixation (ORIF) and amputations were performed in 14.5% and 11.7% respectively. The commonest major procedure in children was postero-medial release (PMR) for clubfeet. Over the 'two decades', increasing trends in numbers of ORIF, bone biopsy, PMR for talipes and above knee amputations (AKA) were observed. In contrast, a decline in frequency of septic operations, closed manipulations and procedures to correct post polio deformities was registered.
Conclusion: Over the two past decades, a significant change in trends of major orthopaedic procedures occurred. The shift towards operative fixation of fractures demands importing expensive implants. The implication of such a change needs to be investigated further.