Public versus private surgical treatment of common orthopedic injuries in Zambia: A retrospective review

Abstract

Background: Trauma is a leading cause of disability and death in low- and middle-income countries, largely due to orthopedic injuries. In Zambia, public and private hospitals differ in medical resources, yet their orthopedic trauma care management and treatment outcomes have not been studied. Purpose: This study aims to characterize and compare orthopedic injury patterns, treatment methods, and postoperative outcomes between a public and a private hospital in Zambia to identify disparities and inform improvements in trauma care. Methods: This retrospective cohort study reviewed 512 orthopedic cases treated between 2021 and 2025 at Lusaka’s public University Teaching Hospital (UTH) and private St. John Paul II Orthopedic Hospital (SJPII). Data included demographics, injury types, treatment methods, and postoperative outcomes. Results: A total of 512 patients received orthopedic treatment in Zambia, with 258 managed at a public hospital (UTH) and 254 at a private hospital (SJPII). Femur, tibial shaft, and distal radius fractures were most common, with SJPII treating more complex fractures like bimalleolar ankle and acetabular fractures. Open reduction internal fixation (ORIF) was more common at UTH for femur (N=33 vs. 11), tibial shaft with fibula (N=27 vs. 6), and humerus fractures (N=13 vs. 10), while SJPII performed more ORIFs for bimalleolar ankle (N=32 vs. 7). SJPII favored intramedullary nailing for tibial shaft with fibula (N=30 vs. 6) and femur fractures (N=21 vs. 1) and conducted all hip replacements (N=17 vs. 0). UTH favored external fixation (N=16 vs. 4) and skeletal traction (N=4 vs. 0). Despite similar time to surgery between hospitals, complication rates were significantly higher at UTH (70.5% vs. 35.0%; p