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ItemPrevalence and factors associated with limb length discrepancy following intramedullary nailing of femur shaft fractures in adults at Mulago National Referral Hospital(Makerere University, 2026)Background. Limb length discrepancy (LLD) is a recognized complication following intramedullary nailing (IMN) of femoral shaft fractures, with a reported global incidence of 20–43%. In sub-Saharan Africa, limited access to intraoperative imaging, and fracture tables heightens this risk. In Uganda, the burden of LLD following IMN remains poorly characterized, creating an evidence gap. Complications such as gait disturbance, early arthritis and psychological distress may occur in patients with LLD. Objectives. The objective of this study was to determine the prevalence of LLD and to identify the factors associated with LLD following IMN of femoral shaft fractures among adults at Mulago National Referral Hospital (MNRH), Kampala, Uganda. Methods. An analytical cross-sectional study was conducted at Mulago National Referral Hospital from October 2025 to February 2026. 101 consecutive adult patients (≥18 years) who had undergone IMN for femur shaft fractures were enrolled on their first post-operative day. Limb length was measured radiologically using CT-scanogram. LLD was categorized as mild LLD (<2 cm), moderate (2–5 cm), or severe (>5 cm). Ordinal logistic regression adjusted for clustering at the surgical team level was used for bivariate and multivariable analysis in STATA version 15. Results. The overall prevalence of LLD was 38.6% [95% CI (29.1,49.8)], 23.8%[95% CI (15.9,33.3)] had mild LLD and 14.8% [95% CI (8.6,23.3)] had moderate LLD; In multivariable ordinal logistic regression, greater trochanter nail entry (aOR 2.79, 95% CI 1.99,3.90, p<0.001), absence of pre-operative traction (aOR 3.96, 95% CI 3.04,5.17, p<0.001), comminuted fractures with (aOR 13.62, 95% CI 2.14,86.74, p=0.006), Fracture location (mid-third aOR 0.21; distal aOR 0.12, both p<0.001), Mid-thigh circumference (aOR 1.11, 95% CI 1.07,1.14, p<0.001),were independently associated with LLD. Surgical delay was strongly associated with worse LLD in bivariate analysis (OR 84.00, 95% CI 21.73,324.64, p<0.001) though model instability due to sparse data. precluded its inclusion in the final multivariable model. Conclusions. LLD is a complication following femur fractures after IMN at MNRH, affecting 38.6% of patients on the first post-operative day. Complex fracture patterns, absence of pre-operative traction, and greater trochanter nail entry were independently associated with LLD. Reducing time to surgery, standardizing pre-operative traction for all patients awaiting IMN, and improving access to intraoperative fluoroscopy are the most actionable interventions to reduce the LLD burden at this institution.
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ItemSkeletal-related events in multiple myeloma at Uganda Cancer Institute: prevalence, patterns, associated factors and overall survival(Makerere University, 2026)Background: Skeletal-related events are a major source of morbidity in multiple myeloma, yet their burden, anatomical distribution, and prognostic significance remain poorly characterized in sub-Saharan Africa, where patients typically present with advanced disease. Uganda Cancer Institute is the sole national oncology referral facility in Uganda, and its growing multiple myeloma caseload from 65 patients in 2021 to 117 in 2024 highlights an urgent need for locally derived evidence to guide clinical management. Objective: To determine the prevalence, patterns, and factors associated with skeletal-related events among multiple myeloma patients at Uganda Cancer Institute and to assess their two-year overall survival. Methods: A retrospective cohort study was conducted on 181 adults with confirmed multiple myeloma diagnosed at Uganda Cancer Institute between January 2021 and December 2023. Independent factors associated with skeletal-related event occurrence were identified using multivariable modified Poisson regression, reported as adjusted prevalence ratios (aPR) with 95% confidence intervals. Two-year overall survival was estimated using the Kaplan-Meier method, and independent predictors of mortality identified using Cox proportional hazards regression. Results: Skeletal-related events occurred in 71.8% of patients (n=130; 95% CI 65.2–78.4), with 60.8% already present at admission. Pathological fractures (60.8%) and spinal cord compression (37.6%) were the most frequent skeletal-related event types, both predominantly involving the thoracic and lumbar spine. Durie-Salmon Stage III disease (aPR 1.73, 95% CI 1.19–2.51, p=0.004) and HIV co-infection (aPR 1.32, 95% CI 1.10–1.58, p=0.003) were independently associated with skeletal-related event occurrence. Two-year survival was significantly lower in patients with skeletal-related events than without (33% vs 55%; log-rank p=0.022). On multivariable Cox regression, the skeletal-related event mortality association was attenuated after adjustment (aHR 1.45, p=0.276). Conclusion: Skeletal-related events are highly prevalent at Uganda Cancer Institute, affecting 71.8% of patients, driven by late-stage presentation, with advanced disease stage and HIV co-infection as independent associated factors. These findings highlight the need for earlier multiple myeloma diagnosis at lower health system levels, routine spinal imaging for patients presenting with back pain or neurological symptoms, and a national multidisciplinary guideline for multiple myeloma management in Uganda.
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ItemPrevalence of neglected long bone fractures and associated factors among patients with musculoskeletal trauma at Mulago National Referral Hospital(Makerere University, 2026)Background: Neglected long bone fractures, defined as fractures presenting more than four weeks after injury without prior definitive orthopaedic management, are a major cause of preventable disability in low- and middle-income countries. Their burden in Uganda is poorly quantified, and the patient and health-system factors driving prolonged neglect at the Mulago National Referral Hospital (MNRH) have not been systematically described. Objectives: To determine the prevalence of neglected long bone fractures among patients presenting with long bone fractures at Mulago National Referral Hospital (MNRH), and to identify factors associated with prolonged neglect among those patients. Methods: A hospital-based, cross-sectional analytical study with a nested screening component was conducted at the orthopaedic outpatient clinic and accident and emergency unit of MNRH. All long bone fracture patients presenting during the study period were screened and logged to provide the prevalence denominator. Patients meeting the criteria for neglect were enrolled consecutively until the target sample size of 105 was reached. Data were collected using a structured, pre-tested, bilingual (English/Luganda) questionnaire and a focused clinical and radiological assessment. The period prevalence was reported with a 95% confidence interval. Factors associated with prolonged neglect (≥90 days from injury to presentation) among neglected patients were examined using bivariate logistic regression for crude associations and Firth’s penalized logistic regression for the multivariable model, with the final model built by backward elimination. Results: During the study period, 843 patients with long bone fractures were evaluated, of whom105 had neglected fractures, giving a prevalence of 12.5%. The median duration of neglect was 62 days (IQR 38–150), with the majority (70.5%) delaying care for 1–3 months. Young adults experienced longer delays, with 38.9% presenting after 91–180 days, while children and the elderly presented earlier (30–90 days). Despite delays, all participants sought some form of care within the first 28 days, predominantly from traditional bone setters (73.3%), whereas only 26.7% visited local clinics. The tibia/fibula was the most commonly fractured bone (38.1%), with fractures occurring more frequently on the left side (63.8%), mainly in the distal segment (39.0%), and predominantly closed (90.5%). Multivariate analysis identified several factors independently associated with neglected fractures: male sex (AOR = 31.7, P=0.001), alcohol use (AOR = 11.8, P=0.007), residence >10 km from a health facility (AOR = 5.7, P=0.013), lack of prior medical advice (AOR = 6.4, P=0.007), and difficulty accessing orthopaedic care (AOR = 13.2, P=0.001). Conclusion: Neglected long bone fractures are common at MNRH and disproportionately affect young adult men. Prolonged neglect is driven jointly by behavioural factors and by structural and informational barriers within the health system, and universal early contact with traditional bone setters represents the single most promising point of intervention. Targeted public-health messaging, structured engagement with traditional bone setters, expansion of regional orthopaedic capacity, and a dedicated rapid-triage pathway for late-presenting patients at MNRH are urgently needed.
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ItemPrevalence of low back pain and associated factors among military personnel attending the orthopedic clinic of the General Military Hospital Bombo(Makerere University, 2026)Background: Low back pain (LBP) is a significant medical and social problem among military personnel, contributing to high health care costs, reduced productivity and disability. However, in Uganda there is generally paucity of literature on the prevalence and factors associated with LBP amongst this special group of people despite their occupational exposure. This study aimed to determine the prevalence of LBP and its associated factors amongst military personnel. Methods: This was a cross-sectional study conducted at the Orthopedic clinic of the General Military Hospital Bombo, targeting military personnel. LBP was assessed using a modified Nordic Musculoskeletal Questionnaire. Data on the sociodemographic, psychosocial and occupational exposure were collected through an interviewer-administered structured questionnaire. Factors associated with LBP were identified using Modified Poisson regression analysis, with statistical significance set at p < 0.05. Data were analysed using STATA version 15. Results: The study enrolled 327 military personnel, with a mean age of 36.0 ± 9.3 years and a predominance of males (n= 244), (74.6%). The overall prevalence of LBP was 61.5% (n=201), with an age standardized prevalence of 64.1%. The prevalence of LBP was highest in participants aged more than 50 years (85.3%), the Senior Commissioned Officers (87.5%), the Recruits/Cadets (81.0%) and those working in the artillery unit (87.0%) and the service unit (68.8%). Pain was predominantly sharp and shooting in character (49.3%), with the majority of affected personnel reporting radiation to the thigh (27.4%), buttocks (19.9%), and foot (11.9%), alongside burning sensations (28.4%) and muscle spasms (28.9%). This pattern of neuropathic-quality pain with dermatomal radiation is consistent with nerve root irritation. LBP was found to be significantly associated with few years of service [1–5 years] (aPRR 0.5 [0.268 - 0.891], p=0.02) or 6–10 years (aPRR 0.5 [0.258 - 0.844], p=0.012) and engaging in physical activity for only 0–5 hours per week (aPRR 1.4 [1.055 - 2.073], p=0.048) as compared to those who had served the military for over 20 years or engage in physical activity for more than 16 hours respectively. Conclusion: LBP is highly prevalent among military personnel (64.1%) and has substantial functional impact. Early-career personnel and those with lower levels of physical activity are at increased risk. Strengthening preventive strategies, including structured physical conditioning, ergonomic interventions, and early rehabilitation programs, is recommended to reduce the burden of LBP and maintain operational readiness within the Uganda People’s Defense Forces.
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ItemMortality rate and associated factors among polytrauma patients with orthopedic injuries managed at Mulago National Referral Hospital(Makerere University, 2026)Background: Polytrauma remains a major cause of morbidity and mortality worldwide, with a particularly high burden in low and middle income countries like Uganda. Orthopedic injuries are among the most common and resource-intensive components of polytrauma. This study aimed to determine the in-hospital mortality rate and associated factors among polytrauma patients with orthopedic injuries managed at Mulago National Referral Hospital. Objective: To determine the mortality rate and associated factors among polytrauma patients with orthopaedic injuries managed at Mulago National Referral Hospital. Methods: A prospective cohort study was conducted between January and March 2026, enrolling 160 polytrauma patients with orthopedic injuries from the Accident and Emergency unit at MNRH. Polytrauma was defined as two or more severe injuries in at least two body regions, with at least one major musculoskeletal injury. Mortality was considered for any death occurring during hospital stay. Data collection included medical record review, head-to-toe physical examination, and follow-up until discharge, death, or study conclusion Kaplan-Meier survival analysis estimated survival probability, and logistic regression identified factors independently associated with mortality. Results: Of the 156 patients analysed (four lost to follow-up; response rate 97.5%), the median age was 32 years (IQR 25–40) and 82.1% were male. The in-hospital mortality rate was 16.03% (95% CI: 11.1%–22.6%), with over half of all deaths occurring within the first 24 hours of admission. Kaplan-Meier analysis showed a 7-day survival probability of 81.8%, with 96% of deaths occurring within the first seven days. Multivariate analysis identified advanced age (≥60 years, AOR=5.6), GCS <8 on admission (AOR=19.6), presence of tachypnea at admission (AOR=16.7), and unmet blood transfusion indication (AOR=13.7) as factors independently associated with mortality. Conclusion: Polytrauma patients with orthopaedic injuries at MNRH experience high in-hospital mortality, with virtually all deaths occurring within the first seven days. Mortality was associated with advanced age, severe neurological compromise, respiratory distress, and unmet transfusion need. These findings highlight the need for early resuscitation, age-specific care protocols, timely transfusion, and enhanced patient support to improve outcomes. Keywords: Polytrauma, Orthopedic injuries, Mortality, Uganda.