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Research Article | | Peer-Reviewed

Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records

Birhanu Ayana Deffa*,  Bahiru Bezabhi,  Samirawit Esayas
Published in Journal of Surgery (Volume 13, Issue 4)
Received: 27 May 2025     Accepted: 16 June 2025     Published: 10 July 2025
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Abstract

Background: Pediatric musculoskeletal surgical conditions pose a major public health challenge in Ethiopia, similar to other low-middle income countries. There is a dearth of information about a pattern of pediatric musculoskeletal surgical diseases. Understanding the burden of these disorders in children will inform capacity building efforts, resource allocation and training. This study aimed to assess the pattern and magnitude of pediatric orthopedic surgical disorders among patients admitted to Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods: Clinical records that included the admission and discharge registry data were retrospectively reviewed for pediatric orthopedic patients (0- 15 years) admitted at TASH between September2017 and August 2021. Data recorded were age, sex, diagnosis, treatment and discharge recommendations. Results: A total of 726 children were admitted to the pediatric orthopedic unit during the study period. Of these 482 (66.4%) were male and 244 (33.6%) were female. The most common diagnoses were trauma (n=278, 38.3%, infection (n=161, 22.2%), musculoskeletal tumors (n=95, 13.0%), and congenital anomalies (n=78, 11.0.3%). Conclusions: Findings demonstrate a wide spectrum and pattern of pediatric orthopedic conditions that require surgical admission at TASH. As the largest national specialized teaching and tertiary referral center in the country, these findings give insight into different types of musculoskeletal surgical disorders in children. This highlights the need to increase the capacity to care for specific musculoskeletal conditions in the pediatric population of Ethiopia.

Published in Journal of Surgery (Volume 13, Issue 4)
DOI 10.11648/j.js.20251304.11
Page(s) 69-76
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2025. Published by Science Publishing Group
Previous article
Keywords

Pediatric Musculoskeletal Conditions, Surgical Admission, Ethiopia, Children, Surgery, Musculoskeletal

1. Introduction
Musculoskeletal disorders are common causes of severe long-term morbidity affecting hundreds of millions of people around the world and create enormous economic and social impacts on individuals, society, and on health systems
[1]
. These disorders encompass a wide range of musculoskeletal pathologies from traumatic injury to congenital anomalies, developmental conditions, musculoskeletal infection, tumors, and neuromuscular disorders as well as inflammatory joint disease
[2]
. According to the Global Burden of Disease, musculoskeletal disorders are the biggest contributor to years lived with disability worldwide, with more than 90% of disability-adjusted life years lost occurring in low- and middle-income countries (LMICs)
[3]
. Despite the well understood lifelong consequences, little is known about the burden and pattern of musculoskeletal conditions in these countries
[4, 5]
. Existing surveys in LMICs have revealed that a significant proportion of the populations with musculoskeletal disorders lack access to basic surgical care
[6-9]
.
Moreover, disparities exist in available data for pediatric musculoskeletal disorders. Despite pediatric musculoskeletal disorders being common worldwide, most information describes the burden of the condition in adults, with little emphasis on pediatric populations presenting with musculoskeletal pathologies
[10-12]
. The vast majority of children with musculoskeletal disorders are in LMIC, given the high number of births and children representing up to 50% of the population and untreated conditions can result in long-term disability which can strain health system further
[11, 13, 14]
. The children's orthopedic surgery service is a relatively newly emerging surgical sub-specialty in most of the sub-Sahara region and there is a scarcity of reports on the prevalence of pediatric musculoskeletal disorders that require surgical care
[15]
. Population-based survey studies in sub-Saharan countries show that a large number of children experience musculoskeletal disorders and most lack access to safe, affordable, and timely surgical care
[14, 16-21]
.
Ethiopia is the second most populated country in Africa where half of the population is under 16 years of age and more than 80% of the total population lives in rural areas without access to tertiary-level surgical care. Many children with musculoskeletal disorders do not receive the surgical care they need due to inadequate infrastructure, service delivery systems, trained personnel, and poor awareness among the general population
[22]
.
There is limited literature about pediatric orthopedic surgical conditions affecting children in Ethiopia despite the high pediatric population. To date, no published data exist on the pattern of surgical admissions for children with musculoskeletal disorders despite a long history of providing pediatric orthopedic surgical services in Tikur Anbessa Specialized Hospital (TASH). The few available data focus mainly on adult orthopedics and general pediatric surgery, with little emphasis on children's orthopedic surgical disorders
[23-25]
. Whilst, studies on specific pathology have been reported, such as clubfoot and fractures, these do not reflect a diversity of the pediatric orthopedic surgical burden
[26, 27]
.
Assessing the epidemiology of pediatric orthopedic surgical admissions will provide insight into the spectrum of pathologies and their burden. This will be useful for long-term health care planning, appropriate resource allocation, providing appropriate care, and developing sub-specialty training programs and research. Therefore, the purpose of the study was to describe the pattern and extent of pediatric orthopedics surgical patients admitted to TASH.
2. Patient and Methods
We reviewed patient records for pediatric orthopedic patients (0-15 years of age) admitted to the TASH, department of orthopedic surgery, pediatric orthopedic surgery unit between September 2017 and August 2021.
TASH is a multi-departmental and multi-disciplinary tertiary teaching University Hospital located in the capital city of the country, Addis Ababa. It is the main public hospital giving service to children with musculoskeletal pathologies and receives referrals from all over the country for complex pediatric orthopedic conditions.
The pediatric orthopedic unit is under the Department of Orthopedic Surgery and was established as an independent unit in 2013. It has a ward with 30 beds that is run by one fellowship-trained pediatric orthopedic surgeon and three consultant general orthopedic surgeons.
The data were retrieved from the hospital's computerized admission and discharge registry to identify all pediatric orthopedic surgical conditions and performed procedures. Additionally, the OR logbook, patient documentation chart and digital x-ray findings were used to confirm the reliability of the data, and validate the data. The following data were extracted: demographic data, primary diagnosis, and surgical procedures. For the purpose of this study, the specific orthopedic surgical pathologies are classified into the following categories: congenital, developmental, infection, trauma, neuromuscular, tumor, and miscellaneous. All information was obtained and curated with a customized data collection form. Patients were excluded if incomplete data and patients with non-orthopedic cases. Two study investigators (SE & BB) independently reviewed the data collection forms to verify the accuracy of the data. Descriptive data analysis was undertaken using SPSS version 22. Continuous variables were expressed as a range (SD). Categorical variables were expressed as number (%).
Ethical consideration: Ethical approval for the study was obtained from the departmental ethics committee.
3. Results
There were a total of 782 patients admitted to the unit out of which 726 patients were included in the study and 56 were excluded due to incomplete data and children with non- orthopedic conditions during the study period. Among these 482 (66.4%) were male and 244 (33.6%) were female. The age ranged from 0 to 15 years with a mean age of 7.5 years (SD 4.1). The diagnosis of pathologies was grouped into seven major categories (Figure 1). The most common diagnostic categories were trauma (n= 278, 38.2%), infection (n=161, 22.1%) and musculoskeletal neoplasm (n=95, 13.0%).
The most prevalent fracture that required surgical treatment was a displaced supracondylar fracture of the humerus (Gartland 3) (n=77, 38%) followed by femur shaft fracture (n=74, 27%) and forearm fracture (n=25, 9%) (Table 1).
Osteomyelitis was the leading cause of admission within musculoskeletal infections (n = 75, 47%), followed by joint infection (n = 47, 29%) and cellulitis/pyomyoscitis (n=29, 18%). Almost all children with osteomyelitis presented in the chronic stage of the disease requiring radical surgical procedures aimed to eradicate infection and/or salvage damaged osseous and articular structures.
The majority of cases of musculoskeletal tumor were malignant tumors with delayed presentation (n= 95, 13%). A large number of these cases have visited traditional care like herbal medicine and bone setter treatment prior to admission.
Congenital anomalies were the fourth most common condition with 78 cases (11.0%. Of these, clubfoot was the most common diagnosis that required admission for surgical treatment. Clubfoot constituted 69.2% (n=54) of congenital anomalies.
Miscellaneous cases are conditions that could not fall within the categories previously outlined. There were a total of 54 cases (6.1%). These include osteogenesis imperfect, rickets, dysplasia, hemophilic arthropathy, hardware removal, contracture and acquired deformities.
Developmental orthopedic disorders in children constituted 40 (5.5%) admissions which included angular deformity of the limbs, developmental dysplasia of the hip, coxa vara, and Perthes disease.
There were a fewer number of neuromuscular cases 29 (4.1%). Of these, cerebral palsy was the leading cause of admission followed by residual brachial plexus palsy and arthrogryposis. A very few number of cases (n = 10, 1.2%) were in another form of neuromuscular conditions such as myelomeningocele, peripheral neuropathy and post-injection neuropathy.
Figure 1. Pattern of pediatric orthopedic surgical admission in TASH, Ethiopia.
Table 1. Distribution of pediatric orthopedics surgical conditions.

Category

Diagnosis

Number of cases

Percentage (%)

Trauma

278

38.2

Humeral fracture

7

2.5

Clavicle fracture

1

0.3

Supracondylar fracture

77

28

Condylar fracture

10

3.5

Montegia fracture-dislocation

3

1.0

Forearm fracture

25

9

Distal radial physeal injury

3

1.0

Hand fracture

2

0.7

Chronic elbow dislocation

7

2.5

Pelvic fracture

7

2.5

Chronic traumatic hip dislocation

2

0.7

Femur neck fracture

12

4.3

Femur fracture

74

27

Tibio-fibular fracture

23

8.2

Foot fracture

3

1.0

Soft tissue injury

4

1.4

Traumatic amputation

5

2

Polytrauma

13

5

Infection

161

22.1

Osteomyelitis

75

47

Septic arthritis

47

29

Tbc hip arthritis

4

2.5

Pyomyocitis/ Abscess

29

18

Surgical site infection

6

4

Tumor

95

13

Benign

22

23

Malignant

73

79

Congenital

78

11

Clubfoot

54

69

Polydactyl

4

5

Trigger finger

2

2.5

Macrodactyly

3

4

Congenital tibial pseudoarthrosis

4

5

Congenital synostosis of forearm

2

2.5

Club hand

2

2.5

Congenital Vertical Talus

3

4

Torticollis

1

1.2

Congenital elbow contracture

1

1.2

Fibula hemimeliac

1

1.2

Congenital posteromedial bowing of tibia

1

1.2

Miscellaneous

45

6.1

Acquired deformity

14

31

Hardware in-situ

10

22

Contractures

7

15.5

Dysplasia

3

7

others

11

24

Developmental

40

5.5

DDH

5

12.5

Coxa vara

2

5

Perthe’s disease

3

7.5

Angular deformities of knee

19

47.5

Madlung

2

5

Hallux valgus

2

5

Others

7

17.5

Neuromuscular

29

4.1

Cerebral palsy

10

34

Erbs palsy

7

24

Arthrogryposis

2

7

Peripheral neuropathy

8

27

Melomeningocele

2

7

Total

726

100%
4. Discussion
The pattern and burden of pediatric orthopedic surgical conditions within the general population in Ethiopia has yet to be measured and the results of this study showed a wide spectrum of children's musculoskeletal surgical disorders presenting to a national referral hospital. These findings can be considered reasonably representative of orthopedic surgical conditions that affect the pediatric population in Ethiopia, taking into account that Tikur Anbessa Specialized Hospital is the biggest tertiary referral hospital in the country from all over the region. The majority of patients fall into four major diagnostic categories: trauma, surgical infections, tumor and congenital anomalies respectively. These four diagnostic categories accounted for almost 85% of pediatric orthopedic surgical admissions.
Trauma and infection were responsible for the largest number of admissions, and these findings align with studies conducted in other sub-Saharan countries (Nigeria, Tanzania, and Gambia)
[28-30]
. However, reports from Zambia
[31]
revealed that congenital anomalies were the leading cause of admission followed by trauma and tumors. Spiegel et. al. in Nepal (32) found that congenital anomalies were the second common cause of admission after injuries.
Available evidence, along with these findings, underscore the major public health challenge posed by injuries worldwide
[2, 14, 33]
. The most common traumatic fracture was a supracondylar fracture of the humerus, followed by fracture of the femur and forearm. A similar pattern was reported in a previous study in our setting
[26]
. Additionally, a study from Kenya revealed that fractures of the distal metaphysis of the humerus were prevalent, which is consistent with our findings
[34]
.
Musculoskeletal surgical infections were the second most common diagnostic category requiring surgical admission. Comparable findings have been reported in many countries in the region
[28, 29, 31]
. Studies conducted in Gambia
[30]
and Burundi
[35]
found orthopedic surgical infection was a common cause of admission, and chronic osteomyelitis was the most prevalent surgical infection, consistent with our findings that highlight the burden of chronic osteomyelitis on the pediatric population. Based on this findings it is very imperative emphasize the need of health education, awareness creation among the general population and health professionals the importance of early medical-surgical management of musculoskeletal infections in children.
It is important to note that a considerable number of children with musculoskeletal tumors presented in the late stage of the disease, posing challenges for surgical management. Among musculoskeletal tumors, malignancies outnumbered benign cases and this finding align with reports from Zambia
[31]
and Gambia
[30]
where tumors were also common surgical conditions. In contrast, a study in Nigeria (28) revealed that tumors were the least cause of surgical admission. Our findings are likely due to our hospital being the only referral center for musculoskeletal tumors in the country. Currently, TASH is the only hospital providing reconstructive, radiation and chemotherapy services in Ethiopia.
The pattern of congenital anomalies in this study was similar to that reported from other LMICs and demonstrates that congenital orthopedic disorders are significant causes of disability
[15, 28, 31, 32]
. Among congenital anomalies, talipes equinovarus deformity (clubfoot) was the most common diagnosis that required surgical admission in this study. Interestingly, all surgical interventions for clubfoot were less extensive soft tissue procedures to treat recurrence or residual deformity after the introduction of Ponseti treatment
[27]
.
Clubfoot is the most common musculoskeletal congenital anomaly worldwide
[36]
. In Ethiopia, it is estimated that about 4,000- 5,000 infants are born with clubfoot each year. TASH primarily treats clubfoot using the conservative method (Ponseti method) since its adoption in 2005
[27]
. Prior to this, the most common procedure for children with clubfoot was a radical posteromedial release
[37]
. We have successfully treated older patients with clubfoot with the Ponseti treatment principle combined with limited surgical intervention, thereby avoiding traditional extensive surgical correction. However, significant numbers of older children and adolescents still present with untreated clubfoot deformity in Ethiopia
[38, 39]
. Currently the clubfoot services have been expanded all over the regions establishing more than sixty clubfoot clinics. The expansion of the services at early age will definitely help to decrease the number of neglected clubfoot cases and avoids the need for extensive surgical intervention.
This study is limited by its retrospective method and several considerations should be taken into account when interpreting the findings. The data were collected from the only specialized government institution where children with orthopedics problems are referred and receive optimal treatment options. While all necessary information was carefully recorded, the study’s reliance on data from a single facility limits its generalizability to the entire population of Ethiopia. Moreover, the retrospective nature of the study introduces inherent biases and limitations, such as incomplete or missing data, variations in data collection practices over time, and the inability to control for confounding variables. Additionally, the study's reliance on medical records may lead to inaccuracies or inconsistencies in reporting, as documentation practices can vary among healthcare providers. Furthermore, as a hospital-based study, it may not capture cases that were managed in other healthcare settings or those that did not seek medical attention. This could potentially underestimate the true prevalence and burden of pediatric orthopedic conditions in the broader population. Nevertheless, the study meticulously collected data from multiple sources to enhance the reliability and validity of the findings. The specialized setting also ensured access to specialized care and expertise, leading to accurate diagnoses and optimal treatment options for the study population.
5. Conclusions
The study revealed a wide spectrum of pediatric orthopedic conditions that require surgical management, posing a significant public health challenge in Ethiopia. Urgent action is needed to raise awareness and implement early intervention strategies. Expanding access to basic pediatric orthopedic services is crucial to reduce the need for complex surgical procedures and costly referrals. Advocating for nationwide expansion of pediatric surgical services is necessary to address the unmet surgical demand and ensure timely care for all children in Ethiopia.
Abbreviations

TASH

Tikur Anbessa Specialized Hospital
Acknowledgments
We would like to thank Department of Orthopedic Surgery and Tikur Anbessa Specialized Hospital for allowing me to Access the Data and perform the study. Our deepest gratitude to Sr Genet, the head nurse for pediatric orthopedic unit for keeping the computerized admission and discharge registry data and taking care of the patients. Special thanks go to Dr Tracey Smith for the critical revision of the Manuscript and comments.
Author Contributions
Bahiru Bezabhi: Conceptualization, Resources, Visualization
Samirawit Esayas: Data curation, Methodology, software, and Investigation
Birhanu Ayana: Supervision. Validation, Writing- Reviewing and Editing
Funding
This work is not supported by any external funding.
Data Availability Statement
The data supporting the outcome of this research work has been reported in this manuscript.
Conflicts of Interest
The author declares no conflicts of interest.
References
[1] Anthony D. Woolf, Bruce Pfleger. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization. 2003, 81(9), 646-656.
[2] Joshipura, M., Mock, C., Gosselin, R. A. Global Burden of Musculoskeletal Conditions. In: Gosselin, R., Spiegel, D., Foltz, M. (eds) Global Orthopedics. Springer, Cham. 2020, pp. 9-11.

https://doi.org/10.1007/978-3-030-13290-3_2

[3] Sebbag E, et al. The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database. Ann Rheum Dis. 2019, 0, 1–5.

https://doi.org/10.1136/annrheumdis-2019-215142

[4] Woolf AD, Akesson K. Understanding the burden of musculoskeletal conditions. The burden is huge and not reflected in national health priorities. BMJ. 2001, 322, 1079–80.

https://doi.org/10.1136/bmj.322.7294.1079

[5] John P. Dormans, MD, et al. Orthopaedics in the Developing World: Present and Future Concerns: J Am Acad Orthop Surg. 2001, 9, 289-296.

https://doi.org/10.5435/00124635-200109000-00002

[6] Atijosan O, Rischewski D, Simms V, Kuper H, Linganwa B, et al. A National Survey of Musculoskeletal Impairment in Rwanda: Prevalence, Causes and Service Implications. PLoS ONE. 2008, 3 (7), e2851.

https://doi.org/10.1371/journal.pone.0002851

[7] Ngoie LB, Dybvik E, Hallan G, Gjertsen JE, Mkandawire N, Varela C, et al. Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey. PLoS ONE. 2021, 16 (1), 1-15.

https://doi.org/10.1371/journal.pone.0243536

[8] Chawla S. S. et al. Musculoskeletal disease in Nepal: A countrywide cross-sectional survey on burden and surgical access: International Journal of Surgery. 2016, 34, 122-126.

https://doi.org/10.1016/j.ijsu.2016.08.522

[9] Elliott et al. The Burden of Musculoskeletal Disease in Sierra Leon: Clin Orthop Relat Res. 2015, 473,380–389.

https://doi.org/10.1007/s11999-014-4017-8

[10] Gunz et al. Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: a population-based study. BMC Musculoskeletal Disorders. 2012, 13(98), 1-7.

https://doi.org/10.1186/1471-2474-13-98

[11] Foster, H. E., Scott, C., Tiderius, C. J. et al. The paediatric global musculoskeletal task force - ‘towards better MSK health for all’. Pediatr Rheumatol. 2020, 18(60), 1-3.

https://doi.org/10.1186/s12969-020-00451-8

[12] Tan et al. Epidemiology of paediatric presentations with musculoskeletal problems in primary care. BMC Musculoskeletal Disorders. 2018, 19(40), 1-6.

https://doi.org/10.1186/s12891-018-1952-7

[13] Danzhen You, Jan Beise, Sinae Lee, Jennifer Requejo, Kathleen Strong; Demographic challenges and opportunities for child health programming in Africa and Asia. BMJ 2021, 372(19), 1-6.

https://doi.org/10.1136/bmj.n19

[14] Richard M. Schwend, The Burden of Pediatric Musculoskeletal Diseases Worldwide, Orthopedic Clinics of North America.2020, 51(2), 207-217.

https://doi.org/10.1016/j.ocl.201911.005

[15] Akinyoola A. L., Adegbehingbe O. O., Ogundele O. J.. Tanzania Journal of Health Research. 2008, 10(2), 68-72.

https://doi.org/10.4314/thrb.v10i2.14344

[16] Bhargava Mullapudi et al. Estimates of number of children and adolescents without access to surgical care: Bull World Health Organ. 2019, 97, 254–258.

https://doi.org/10.2471/BLT.18.216028

[17] Spiegel D. A., Nduaguba A., Cherian M. N., Monono M., Kelley E. T.: Deficiencies in the Availability of Essential Musculoskeletal Surgical Services at 883 Health Facilities in 24 Low- and Lower-Middle-Income Countries: World J Surg. 2015, 39 (6), 1421-1432.

https://doi.org/10.1007/s00268-015-2971-2

[18] Alves, K., Penny, N., Kobusingye, O. Et al. Paediatric musculoskeletal disease in Kumi District, Uganda: across-sectional survey. International Orthopaedics (SICOT). 2018 42, 1967–1973.

https://doi.org/10.1007/s00264-018-3915-x

[19] Atijosan et al. The Orthopaedic Needs of Children in Rwanda: Results from a National Survey and Orthopaedic Service Implications. J Pediatr Orthop. 2009, 29,948–951.

https://doi.org/10.1097/BPO.0b013e3181c18962

[20] Linder et al. Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method. BMC Musculoskeletal Disorders. 2021, 22(1), 1-10.

https://doi.org/10.1186/s12891-021-04942-x

[21] Ngoie et al. The unmet need for treatment of children with musculoskeletal impairment in Malawi: BMC Pediatrics. 2022, 22(67), 1-7.

https://doi.org/10.1186/s12887-022-03113-8

[22] Meshesha et al. Access to surgical care in Ethiopia: a cross-sectional retrospective data review. BMC Health Services Research. 2022, 22(973), 1-12.

https://doi.org/10.1186/s12913-022-08357-9

[23] Ahmed E, Chaka T. The pattern of orthopedic admissions in Tikur Anbessa University Hospital, Addis Ababa. Ethiop Med J. 2005, 43(2), 85-91.
[24] Derbew M, Elias A. The pattern of pediatrics surgical conditions in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. Ethiop Med J. 2006, 44(4), 331-338.
[25] Amezene Tadesse, Abay Gossaye, Milliard Derbew. Pediatrics surgical admissions and procedures: a five-year experience at tikur anbessa specialized hospital in addis ababa. Ethiop Med J. 2019, 57(2), 235-240.
[26] Admassie. D, Ayana. B, Girma. S. Childhood limb fracture at Tikur Anbessa Specialised Hospital (TASH), Addis Ababa, Ethiopia. East & Central African Journal of Surgery. 2015, 20 (1), 27-31.
[27] Mengistu G Mengesha, Birhanu Ayana, Mengestie M Belay, Wubalem Zewde, Peter J. Management of Idiopathic Clubfoot by Ponseti Method: Tikur Anbessa Specialized Hospital Five Year Experience: Ethiop Med J. 2020, 58, Supp. 3.
[28] Okenwa Wilfred O. Audit of Paediatric Orthopaedic Surgical Admissions in A Tertiary Health Centre in Enugu, Nigeria. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2019, 18(5), 72-76.

https://doi.org/10.9790/0853-1805017276

[29] Walsh R. B. et al. The spectrum and burden of in-patient paediatric musculoskeletal diseases in Northern Tanzania: paediatric and international child health. 2022, 42(1), 12–21.

https://doi.org/10.1080/20469047.2022.2062561

[30] Bickler SW, Kyambi J, Rode H. Pediatric surgery in sub-Saharan Africa. Pediatr Surg Int. 2001, 17,442–447.

https://doi.org/10.1007/s003830000516

[31] Makasa E, Munthali J. Patterns of Musculoskeletal Diseases seen in Zambian Children. Medical Journal of Zambia. 2009, 36(4), 171-177.
[32] Spiegel D. A. et al. Epidemiology of Surgical Admissions to a Children’s Disability Hospital in Nepal: World J Surg. 2010, 34,954–962.

https://doi.org/10.1007/s00268-010-0487-3

[33] Spiegel DA, Gosselin RA, Coughlin RR, Joshipura M, Browner BD, Dormans JP. The burden of musculoskeletal injury in low and middle-income countries: challenges and opportunities. JBJS. 2008, 90(4), 915-923.

https://doi.org/10.2106/JBJS.G.00637

[34] Ng’ang’a E, Mutiso V. M. Mwangi, J. C.: pattern of long bone fractures in a paediatric population at kenyatta national hospital. EAOJ. 2017, 11, 54-60.
[35] Gortan et al Epidemiology of Pediatric Surgical Conditions Observed in a First-Level Hospital in Burundi. Front. Pediatr. 2021, 9, 1-7.

https://doi.org/10.3389/fped.2021.681478

[36] Dobbs MB, Gurnett CA. Genetics of clubfoot. J Pediatr Orthop B. 2012, 21(1), 7–9.

https://doi.org/10.1097/BPB.0b013e328349927c

[37] Biruk Lambisso Wamisho,, Woubalem Zewde. Major Orthopaedic Procedures: 17 Year Trends. East and Central African Journal of Surgery. 2006, 11(1), 32-40.
[38] Ayana B, Peter K. Good results after ponseti treatment for neglected clubfoot in Ethiopia, Acta Orthopedica. 2014, 85 (6), 641-645.

https://doi.org/10.3109/17453674.2014.957085

[39] Drury G, Nunn TR, Dandena F, Smythe T, Lavy CBD. Treating Older Children with Clubfoot: Results of a Cross-Sectional Survey of Expert Practitioners. Int J Environ Res Public Health. 2023, 20(19), 1-14.

https://doi.org/10.3390/ijerph20196846

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    Deffa, B. A., Bezabhi, B., Esayas, S. (2025). Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records. Journal of Surgery, 13(4), 69-76. https://doi.org/10.11648/j.js.20251304.11

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    Deffa, B. A.; Bezabhi, B.; Esayas, S. Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records. J. Surg. 2025, 13(4), 69-76. doi: 10.11648/j.js.20251304.11

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    Deffa BA, Bezabhi B, Esayas S. Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records. J Surg. 2025;13(4):69-76. doi: 10.11648/j.js.20251304.11

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  • @article{10.11648/j.js.20251304.11,
  author = {Birhanu Ayana Deffa and Bahiru Bezabhi and Samirawit Esayas},
  title = {Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records
},
  journal = {Journal of Surgery},
  volume = {13},
  number = {4},
  pages = {69-76},
  doi = {10.11648/j.js.20251304.11},
  url = {https://doi.org/10.11648/j.js.20251304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20251304.11},
  abstract = {Background: Pediatric musculoskeletal surgical conditions pose a major public health challenge in Ethiopia, similar to other low-middle income countries. There is a dearth of information about a pattern of pediatric musculoskeletal surgical diseases. Understanding the burden of these disorders in children will inform capacity building efforts, resource allocation and training. This study aimed to assess the pattern and magnitude of pediatric orthopedic surgical disorders among patients admitted to Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods: Clinical records that included the admission and discharge registry data were retrospectively reviewed for pediatric orthopedic patients (0- 15 years) admitted at TASH between September2017 and August 2021. Data recorded were age, sex, diagnosis, treatment and discharge recommendations. Results: A total of 726 children were admitted to the pediatric orthopedic unit during the study period. Of these 482 (66.4%) were male and 244 (33.6%) were female. The most common diagnoses were trauma (n=278, 38.3%, infection (n=161, 22.2%), musculoskeletal tumors (n=95, 13.0%), and congenital anomalies (n=78, 11.0.3%). Conclusions: Findings demonstrate a wide spectrum and pattern of pediatric orthopedic conditions that require surgical admission at TASH. As the largest national specialized teaching and tertiary referral center in the country, these findings give insight into different types of musculoskeletal surgical disorders in children. This highlights the need to increase the capacity to care for specific musculoskeletal conditions in the pediatric population of Ethiopia.},
 year = {2025}
}

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  • TY  - JOUR
T1  - Pattern of Pediatric Musculoskeletal Surgical Admissions to a Tertiary Hospital in a Low-Income Country: A Retrospective Review of Medical Records

AU  - Birhanu Ayana Deffa
AU  - Bahiru Bezabhi
AU  - Samirawit Esayas
Y1  - 2025/07/10
PY  - 2025
N1  - https://doi.org/10.11648/j.js.20251304.11
DO  - 10.11648/j.js.20251304.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 69
EP  - 76
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20251304.11
AB  - Background: Pediatric musculoskeletal surgical conditions pose a major public health challenge in Ethiopia, similar to other low-middle income countries. There is a dearth of information about a pattern of pediatric musculoskeletal surgical diseases. Understanding the burden of these disorders in children will inform capacity building efforts, resource allocation and training. This study aimed to assess the pattern and magnitude of pediatric orthopedic surgical disorders among patients admitted to Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods: Clinical records that included the admission and discharge registry data were retrospectively reviewed for pediatric orthopedic patients (0- 15 years) admitted at TASH between September2017 and August 2021. Data recorded were age, sex, diagnosis, treatment and discharge recommendations. Results: A total of 726 children were admitted to the pediatric orthopedic unit during the study period. Of these 482 (66.4%) were male and 244 (33.6%) were female. The most common diagnoses were trauma (n=278, 38.3%, infection (n=161, 22.2%), musculoskeletal tumors (n=95, 13.0%), and congenital anomalies (n=78, 11.0.3%). Conclusions: Findings demonstrate a wide spectrum and pattern of pediatric orthopedic conditions that require surgical admission at TASH. As the largest national specialized teaching and tertiary referral center in the country, these findings give insight into different types of musculoskeletal surgical disorders in children. This highlights the need to increase the capacity to care for specific musculoskeletal conditions in the pediatric population of Ethiopia.
VL  - 13
IS  - 4
ER  -

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Author Information

  • Birhanu Ayana Deffa

    Department of Orthopedic and Trauma Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Biography: Birhanu Ayana is a consultant pediatric orthopedic surgeon at TASH, Associate professor of orthopedic surgery, Addis Ababa University, department of orthopedic and trauma surgery. He completed his pediatric orthopedic surgery fellowship from Christian medical college (CMC) Vellore, India, and his orthopedic surgery residency in Addis Ababa University, Addis Ababa, Ethiopia. He has also obsevership fellowship training in Sickids hospital, Toronto, Canada and Iowa university Hospital, Ponseti clubfoot center, USA. Dr. Ayana has significant contribution for the development of Ethiopian Clubfoot program. He has participated in Africa Clubfoot training manual project development as an Advisory group as well as faculty. In addition; he has authored and co-authored multiple publications on international and local journals. He currently serves as the pediatric orthopedic unit head at the department orthopedic surgery and medical Director of Ethiopian clubfoot Program (Hope walks Ethiopia).

    Research Fields: Birhanu Ayana: Pediatric musculoskeletal infection, Pediatric orthopedic trauma, Congenital musculoskeletal anomalies, Cerebral palsy, Orthopedic birth injury, Developmental hip disorders, Pedi-atric orthopedics service in resource limited setting

    Contact Email

    http://orcid.org/0009-0009-8483-1023

  • Bahiru Bezabhi

    Department of Orthopedic and Trauma Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Biography: Bahiru Bezabhi is a consultant orthopedic surgeon and assistant professor of orthopedic surgery at Addis Ababa University, depart-ment of orthopedic surgery, Tikur Anbesa Specialized Hospital. He obtained his medical degree in 1986 from Instituto Superior de Ciencias Medicas de Santiago de Cuba, CUBA. He completed his orthopedic surgery specialty from the same institution in1990. Dr Bahiru is a fellow of College of Surgeons of East, Central and Southern Africa (COSECSA). Dr. Bahiru has many years’ experi-ence practice in general orthopedic surgery and pediatric orthopedics surgery internationally and locally. In addition to clinical practice and academic activity Dr. Bahiru has served as Medical Director of Tikur Anbessa Specialized Hospital, Head, department of orthopedic surgery and President of Ethiopian Society of Orthopaedics and Traumatology. He has published articles in local and international journals. Currently, he is a Vice President of Ethiopian Paralympic Committee and Board Member of Ethiopian Medical Association.

    Research Fields: Bahiru bezabhi: Osteomyelitis in pediatrics, Pediatric orthopedic trauma, Congenital musculoskeletal anomalies, Long bone fracture in children, Delayed presenting pediatric orthopedic conditions

    http://orcid.org/0000-0002-1849-9554

  • Samirawit Esayas

    Department of Orthopedic and Trauma Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Biography: Samrawit Esayas is an Assistant Professor of Orthopedic Surgery and Traumatology. She completed her medical degree from Tikur Anbessa Specialized Hospital (TASH), College of Health Sciences (CHS), Addis Ababa University (AAU) in 2015 and finished her specialty training in Orthopedics and Traumatology from the same institution in 2021. She is also a fellow of College of Surgeons of East, Central and Southern Africa (COSECSA) by examination in 2022. She has participated in many research projects at Tikur Anbessa Hospital Orthopedics department. She currently works as a general orthopedic surgeon in the Pediatric Unit of Orthopedics department at TASH and as a lecturer for orthopedic residents and undergraduate students. In addition, she is a coordinator of 4th year residents and also participates in organizing trainings and Ethiopian Orthopedic Society meetings

    Research Fields: Samirawit Esayas: Lower extremity fracture in children, Elbow injury in pediatric, Developmental hip dysplasia of the hip, Delayed presenting clubfoot management outcome, Traditional bone setters associated disability in children, Pediatric musculoskeletal infections

    http://orcid.org/0009-0004-3959-7956

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