Partnering to Progress Access to Affordable Trauma Care in the Region

Trauma is a large driver of global mortality, causing more than 4.5M deaths per year, thereby surpassing the combined number of deaths by HIV, tuberculosis, and malaria worldwide. Annually, 15 million individuals suffer open fractures where access to adequate orthopaedic trauma care is frequently limited or financially burdensome. Inadequate management of open fractures leads to disability, livelihood loss, amputation, and even fatality. 

External fixation is one component required for adequate care of high-energy trauma. These devices help to stabilise open and/or complex fractures, and aid in the training of surgeons in trauma expertise. Regrettably, these essentials are frequently inaccessible in low-income nations, primarily due to prohibitively high costs and insufficient training opportunities.

One significant aspect of this collaboration is the assessment of the effectiveness of AEFIX, a novel and affordable clamp for external fixation, especially in resource-constrained settings. An external fixator is a versatile tool for managing open fractures. It involves inserting pins through the skin into the patient's bone and connecting them to rods via specialized clamps, creating a customizable frame stabilizing the fracture. The clamps constitute the most costly component, accounting for nearly 90% of the expenses for the system. AEFIX offers an affordable alternative, with a 100-fold cost save, costing $5 (compared to industry-standard clamps costing $500). It features a simple design conducive to local manufacturing and is currently undergoing mechanical testing.

In the coming year, the partners will conduct a randomized clinical trial of AEFIX in Jaffna. The key objective of this trial is to establish the non-inferiority of AEFIX compared to existing standard care. This is pivotal in healthcare research to confirm that a new treatment, like AEFIX, is as effective as established options, particularly given that it may offer additional advantages to both health systems and to individual patients such as increased affordability and accessibility. The outcomes of this research have the potential to establish AEFIX as a viable, cost-effective alternative in settings where medical resources are limited. This could transform access to quality trauma care in these regions and strengthen the collaborative efforts between the SingHealth Duke-NUS Global Health Institute and contributing partners. 

Research like this also strengthens the collaborative efforts between the SingHealth Duke-NUS Global Health Institute and the other project partners. The Medical School in Jaffna is currently in the process of becoming a Research Collaborating Centre to SDGHI and in the future SDGHI plans to expand our shared work on innovative affordable trauma care solutions.

“We are very excited to be setting out on this learning journey together with our partners. If proven safe and effective, this technology would offer additional advantages of increased affordability and accessibility to both patients and entire health systems. The evidence generated from our study could become a stepping stone in a transformational shift of increased access to quality trauma care.”

Jonas Karlström, Innovation Core Lead, SDGHI

For queries, reach out to Jonas Karlström at jkarlstrom@duke-nus.edu.sg. 

 

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References

1. Agarwal-Harding et al. J Bone Joint Surg Am. 2016.
2. GBD 2019 Fracture Collaborators. Lancet Healthy Longev. 2021.
3. Hofman et al. Am J Public Health. 2005 Jan;95(1):13-7.
4. Pouramin et al. OTA Int. 2019.