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Background: In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Using a consensus-based approach, the aim of this study was to identify research priorities for clinical trials and research in MSK trauma care across sub-Saharan Africa. Methods: A modified Delphi technique was utilized; it involved an initial scoping survey, a 2-round Delphi process, and, finally, review by an expert panel with members of the Orthopaedic Research Collaboration in Africa. This study was conducted among MSK health-care practitioners treating trauma in sub-Saharan Africa. Results: Participants from 34 countries across sub-Saharan Africa contributed to the 2 rounds of the Delphi process, and priorities were scored from 1 (low priority) to 5 (high priority). Public health topics related to trauma care ranked higher than those focused on clinical effectiveness, with the top 10 public health research questions scoring higher than the top 10 questions for clinical effectiveness. Ten public health and 10 clinical effectiveness questions related to MSK trauma care were identified; the highest-ranked questions in the respective categories were related to education and training and to the management of femoral fractures. Conclusions: This consensus-driven research priority study will guide health-care professionals, academics, researchers, and funders to improve the evidence on MSK trauma care across sub-Saharan Africa and inform funders about priority areas of future research.

Background: Ankle arthrodesis is generally considered the gold standard for the treatment of a painful arthritic ankle not responding to conservative treatment. The goal is to eliminate pain and achieve a stable plantigrade foot. There are over 30 different methods of ankle fusion to date. Weutilized a technique of placing one smooth Steinman’s pin across the ankle joint after excising the articular cartilage and aligning the joint in patients with severely osteoporotic bone where screws did not have good purchase.Methods: A retrospective study was undertaken of patients done ankle fusion between 2007 and 2010 at PCEA Kikuyu Hospital. Biodata, indications for surgery, complications, and functional as well as radiological outcome were analyzed.Results: Thirty three patients were evaluated, 17 males and 16 females. The age of the patients ranged from 11 to 80 years (mean 50). Ankle arthrodesis was done for ankle arthritis in most cases. Follow up period ranged from 2 to 5 years (mean 3 years and 2 months). At 12 weekspostoperatively 31(94%) joints were fused clinically and radiologically. The two (6%) cases of nonunion required revision surgery with bone grafting and screw fixation. However one of these patients declined further surgery. There was one case of pin site infection and one case of cellulitis. According to the Mazur ankle score at final follow-up, 22 patients (67%) had excellent results, 8 (24%) good, 2 (6%) fair and 1(3%) poor results.Conclusion: Ankle arthrodesis using a vertical Steinman’s pin is a reliable technique in low resource settings and in patients with severely osteoporotic bone.Key Words: Ankle, arthrodesis, osteopenia, Steinman’s pin.