Introduction.

Background: Orthopedic trauma are among the common daily cause of misery, disability and death globally, improper initial management can lead to significant long term morbidity and potentially mortality. With the burden of musculoskeletal disease at the forefront of the health care worldwide, the world health organization (WHO) declared 2000-2010 the bone and joint decade (USBJD). The USBJD includes over 100 professional and patient organization. [1]

The focus on orthopedic health continued, with the WHO most recently declaring a decade of action for road safety 2011-2020’ recognizing that death and disability from traffic trauma is a major public issue worldwide [1, 2]

In low and middle income countries, falls and traffic injuries are the top causes of disease burden, higher than communicable diseases such as tuberculosis and HIV/AIDS. The upsurge in the number of vehicles per inhabitant will result in an anticipated 80% increase in injury mortality rates between 2010-2020. It has been predicted that by 2020, road traffic injuries will rank as high as third among causes of disability adjusted life years (DALYs) lost as it is currently estimated by WHO that injuries account for 12% of all DALYs lost, which includes a significant number of fractures. [3, 4]

Orthopedic trauma are commonly seen in traffic crashes and falls. In 2004 traffic crashes was identified by WHO as the ninth most common cause of death worldwide. As a major cause of trauma, traffic accidents are increasing at a fast rate in developing countries in which Tanzania is one among them due to rapid motorization. While low income countries already account for more than 85% of all road traffic deaths in the world. [5, 6, 7]

Injuries related to traffic accidents contributes significantly to the number of trauma admission at Bugando medical centre, causing disabilities and deaths among the patients admitted. Even though factors like fractures secondary to some pathologies, particularly osteomyelitis also contribute to a numerous number of patients being admitted commonly among children. [3, 8].

As a result of increased incidences of orthopedic trauma, this attachment field I did, aimed at learning different approaches and means on how different orthopedic trauma are managed. During my weeks attachment field at Bugando medical centre in September 2016, there were a total number of 86 patients admitted with orthopedic trauma; 37 had femur fractures, 30 had tibia and fibula fractures, 6 with hip dislocation, 6 had chronic osteomyelitis, 3 had fractures of radius and ulna, 3 had soft tissue injury and I with a cut wound.

Objectives of the field attachment program.
To practice on clerking, presenting and diagnosis formulation.
To learn on interpretation of different radiological films especially x-rays.
To learn on how to manage different orthopedic emergencies.
To learn on conservative and definitive management of different orthopedic trauma cases.
To learn on management of different orthopedic trauma complications.
To learn and understand different orthopedic instruments and their uses.
To observe, assist and perform as many procedures as possible.
Follow up of different orthopedic trauma cases during the surgical outpatient clinic day.

Background of the district attached to: Nyamagana district is one of the seven districts of the Mwanza region, it is bordered to the north by Ilemela district, to the east by Magu district, to the south by Misungwi district and to the west by the Mwanza bay of lake Victoria. Part of the regions capital, the city of Mwanza is within the Nyamagana district. The main activities are fishing and business.

Structure and organization of the district with emphasis on the department where student is deployed: The orthopedic department at Bugando medical centre which is located in the shores of lake Victoria in Mwanza city within the Nyamagana district, has a total number of two inpatient wards, male and female ward with a capacity of 45 and 32 beds respectively, it has a term of 5 orthopedic surgeons, 7 resident doctors, with variable number of intern doctors, 18 registered nurses, 2 enrolled nurses and 16 medical attendants divided into two firms (firms A and firms B).

Major activities and focus of the department: The department focuses on providing clinical services for patients in all age groups seeking care for orthopedic problems while maintaining quality educational programs for medical students and residents.

Among the major activities of the department include; correction of bone deformities particularly in children, repair of soft tissue injuries as well as repair as well of fractured bones and dislocations. But also has a task of provision of services, consultation and follow up to outpatients.

In accomplishment of all these activities each firm has two theatre days, two days for major ward round and one day for surgical outpatient clinic in a week. I was attached in firm B where Monday and Friday were theatre days, Tuesday and Thursday were for major ward rounds and Wednesday were for surgical outpatient clinic.