ArticleInternational orthopaedics2026
Impact of fracture table availability and usability on surgical decision-making: a national cross-sectional survey of Nigerian orthopaedic surgeons.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate fracture table availability and functional usability in Nigerian orthopaedic practice and their influence on surgical decision-making, including referral practices, to inform strategies for improving access within existing surgical infrastructure.
methodsA nationwide cross-sectional survey was conducted among 77 orthopaedic surgeons across 46 hospitals in 25 Nigerian states, representing all six geopolitical zones and the Federal Capital Territory. Participants were recruited via a national WhatsApp group of practising orthopaedic surgeons, enabling broad geographic representation, although the sample was non-probability. A structured questionnaire captured respondent demographics, institutional characteristics, fracture table availability and functional usability, barriers to use, and qualitative suggestions for improving access. Quantitative data were analysed descriptively, with associations assessed using chi-square tests, interpreted cautiously in the context of potential structural dependencies. Open-ended responses underwent thematic qualitative analysis.
resultsSixty-one per cent of respondents reported the presence of fracture tables at their primary workplaces, with private hospitals showing the highest availability (85.7%). However, consistent usability was limited; only 19.1% of surgeons with access reported 'always' using the equipment when indicated, highlighting a gap between availability and functional readiness. Reported barriers included malfunction (34.0%), lack of perceived need (21.3%), and insufficient training (12.8%). While higher utilisation was associated with reported availability (p < 0.001), this relationship likely reflects underlying differences in institutional resources. Formal training was associated with increased self-reported confidence (p < 0.001). Notably, the availability of fracture tables alone was not clearly associated with reported changes in surgical planning, suggesting that broader contextual constraints may influence decision-making. Respondents proposed financing strategies, training initiatives, maintenance systems, and policy measures to improve access.
conclusionIn Nigeria, the presence of fracture tables does not necessarily translate to functional usability. Constraints related to maintenance, training, and institutional capacity limit effective use and may attenuate their influence on surgical decision-making. Strengthening orthopaedic care will require coordinated system-level interventions that prioritise not only the provision of equipment but also sustainability, workforce capacity, and context-appropriate surgical planning.
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