Management of Mangled Foot Injuries at the Moi Teaching and Referral Hospital Essay (Research Paper Sample)

Management of Mangled Foot Injuries at the Moi Teaching and Referral Hospital
By
Hillary Kiplangat
May, 2020
Management of Mangled Foot Injuries at the Moi Teaching and Referral Hospital
By
Hillary Kiplangat
SM/PGORTH/08/19
Submitted in Partial Fulfillment of the Requirements for the Award of a Master of Medicine Degree in Orthopedic Surgery (MMED-Orth)
College of Health Sciences
Moi University
DECLARATION
Declaration by Candidate
I, the undersigned, affirm that all the ideas that are presented in this proposal are based on my original work. Any reference to research carried out by other scholars or organizations have been cited and referenced accordingly. I also declare that this thesis proposal has not been published or submitted to any other learning institution for academic credit.
Hillary Kiplangat
Signature …………………………..Date ………………….
Declaration by Supervisors
This thesis proposal has been submitted for examination with our approval as university supervisors.
Supervisor 1
Signature …………………………..Date ………………….
Supervisor 2
Signature …………………………..Date ………………….
ABSTRACT
Background: A mangled foot injury (MFI) is a severe injury to the foot that affects an individual’s soft tissue, bone, muscles, tendons, and/or neurovascular structures. MFIs can result in disability and are associated with significant morbidity and mortality, especially in cases where diagnosis and treatment are delayed. MFIs also place a huge financial burden to victims and their families.
Objective: The proposed study aims at assessing not only the occurrence but also the management of MFIs at Kenya’s Moi Teaching and Referral Hospital. The study also aims at comparing six-month functional outcomes and health related quality of life (HRQoL) of patients who underwent salvage and amputation procedures for the treatment of MFIs.
Methods: The proposed study will be a prospective observational study. The researcher will conduct a census of all patients undergoing reconstructive surgeries, salvage procedures, and amputation for the treatment of MFIs at the Moi Teaching and Referral Hospital (MTRH) between 1st April 2021 and 31st March 2022. A structured data collection tool will be employed in the study. The tool will gather socio-demographic data including age, gender, education level, and occupation status. The tool will also collect clinical data such as cause of injury; defect site; degree of trauma; and management details regarding fixation, soft tissue coverage, and amputation. It will also measure and record participants’ length of hospital stay, postoperative complications, and mortality. The researcher will also utilize the Health Related Quality of Life (HRQoL), Short Musculoskeletal Functional Assessment (SMFA) and Foot Function Index questionnaires to measure six-month functional outcomes and HRQoL of the selected patients.
Outcomes: Findings from the proposed study will be valuable in identifying optimal treatment modalities for mangled feet injuries.
DEDICATION
The researcher wishes to dedicate the present thesis proposal to his family and friends.
ACKNOWLEDGMENTS
The researcher is grateful to God Almighty for the wisdom, strength, peace of mind, good health, and unending love, which were vital to the completion of the project. The researcher also wishes to express his gratitude to his research supervisors for not only imparting their knowledge and expertise to the study but also supporting and guiding him throughout the project. He also wishes to appreciate his friends and family for their emotional and financial support.
TABLE OF CONTENTS
TOC \o "1-3" \h \z \u DECLARATION PAGEREF _Toc49476988 \h iii
ABSTRACT PAGEREF _Toc49476989 \h v
DEDICATION PAGEREF _Toc49476990 \h vi
ACKNOWLEDGMENTS PAGEREF _Toc49476991 \h vii
TABLE OF CONTENTS PAGEREF _Toc49476992 \h viii
ABBREVIATIONS AND ACRONYMS PAGEREF _Toc49476993 \h x
OPERATIONAL DEFINITION OF TERMS PAGEREF _Toc49476994 \h xi
CHAPTER ONE: INTRODUCTION PAGEREF _Toc49476995 \h 1
1.1Background to the Problem PAGEREF _Toc49476996 \h 1
1.1.1Anatomy of the Foot and Ankle PAGEREF _Toc49476997 \h 1
1.1.2Mangled Foot Injuries PAGEREF _Toc49476998 \h 7
1.1.3Diagnosis of MFIs PAGEREF _Toc49476999 \h 7
1.1.4Management of MFIs PAGEREF _Toc49477000 \h 8
1.1.6 Outcomes and Complications PAGEREF _Toc49477001 \h 9
1.2Statement of the Problem PAGEREF _Toc49477002 \h 9
1.3Justification of the Study PAGEREF _Toc49477003 \h 10
1.4Research Questions PAGEREF _Toc49477004 \h 10
1.5Objectives of the Study PAGEREF _Toc49477005 \h 11
1.5.1General Objective PAGEREF _Toc49477006 \h 11
1.5.2Specific Objectives PAGEREF _Toc49477007 \h 11
1.6Scope and Delimitation of the Study PAGEREF _Toc49477008 \h 12
CHAPTER TWO: LITERATURE REVIEW PAGEREF _Toc49477009 \h 13
2.1 Introduction PAGEREF _Toc49477010 \h 13
2.2Distribution PAGEREF _Toc49477011 \h 13
2.3Mechanism of Injury PAGEREF _Toc49477012 \h 14
2.4Management PAGEREF _Toc49477013 \h 14
2.5Outcomes and Complications Associated with Diverse Management Protocols PAGEREF _Toc49477014 \h 15
2.6Factors and Comorbidities that Affect Healing PAGEREF _Toc49477015 \h 17
CHAPTER THREE: MATERIAL AND METHODS PAGEREF _Toc49477016 \h 18
3.1Introduction PAGEREF _Toc49477017 \h 18
3.2Study Design PAGEREF _Toc49477018 \h 18
3.3Study Site PAGEREF _Toc49477019 \h 18
3.4Target Population PAGEREF _Toc49477020 \h 19
3.5Inclusion Criteria PAGEREF _Toc49477021 \h 19
3.6Exclusion Criteria PAGEREF _Toc49477022 \h 19
3.7Sampling Procedures PAGEREF _Toc49477023 \h 20
3.8Data Collection Methods PAGEREF _Toc49477024 \h 20
3.9Data Management, Analysis, and Presentation PAGEREF _Toc49477025 \h 22
4.0Ethical Consideration PAGEREF _Toc49477026 \h 22
4.1Ethics PAGEREF _Toc49477027 \h 23
4.2Benefits to Subjects PAGEREF _Toc49477028 \h 23
4.3Informed Consent PAGEREF _Toc49477029 \h 23
4.4Privacy and Confidentiality PAGEREF _Toc49477030 \h 24
5.0References PAGEREF _Toc49477031 \h 25
6.0APPENDICES PAGEREF _Toc49477032 \h 28
Appendix 1: Mess Score PAGEREF _Toc49477033 \h 28
Appendix 2: Timeline of Activities PAGEREF _Toc49477034 \h 29
Appendix 3: Study’s Budget Estimate PAGEREF _Toc49477035 \h 30
Appendix 4: Consent Form PAGEREF _Toc49477036 \h 31
Appendix 5: Questionnaire PAGEREF _Toc49477037 \h 32
Appendix 6: Health Related Quality of Life Questionnaire PAGEREF _Toc49477038 \h 36
Appendix 7: Short Musculoskeletal Function Assessment Questionnaire PAGEREF _Toc49477039 \h 41
Appendix 8: Foot Function Index (FFI-R) Questionnaire PAGEREF _Toc49477040 \h 44
ABBREVIATIONS AND ACRONYMS
CTComputed Tomography
FFIFoot Function Index
HRQoLHealth Related Quality of Life
IRECInstitutional Research and Ethics Committee
NPWTNegative Pressure Wound Therapy
MESSMultiple Extremity Severity Score
MFIMangled Foot Injury
MRIMagnetic Resonance Imaging
MVAMotor Vehicle Accident
MTRHMoi Teaching and Referral Hospital
SMFAShort Musculoskeletal Functional Assessment
SPSSStatistical Package for Social Sciences
OPERATIONAL DEFINITION OF TERMS
Amputation: Refers to the intentional surgical removal of a limb or a body part to remove diseased tissue or relieve pain.
Foot: Refers to the lower extremity of the vertebrate leg that is in direct contact with the ground and is used for locomotion.
Mangled foot: Refers to an injury to at least three out of the four systems of a foot, which include soft tissue, bone, nerves, and vessels.
Salvage: Refers to attempts to rescue or save the remains of something.
Trauma: Refers to severe injury to the body, which is often caused by physical violence or an accident.
CHAPTER ONE: INTRODUCTION
1.1Background to the Problem
1.1.1Anatomy of the Foot and Ankle
The human foot is a firm platform that is responsible for supporting the body’s weight, providing balance, and absorbing shock. It allows individuals to stand upright and perform activities such as walking, running, and jumping (MacGregor & Byerly, 2020). The human foot is composed of bones, joints, muscles, tendons, ligaments, nerves, and blood vessels. It is divided into three parts, which include the hind-foot, the mid-foot, and the fore-foot (Figure 1). The hind-foot is the most posterior aspect of the foot that consists of the talus and the calcaneus. The mid-foot, on the other hand, consists of the navicular; cuboid; and medial, middle, and lateral cuneiforms. Finally, the fore-foot is composed of metatarsals, phalanges, and sesamoid bones (Fraser, Feger, & Hertel, 2016; MacGregor & Bye...