​What kinds of symptoms do patients experience before receiving treatment?

The common symptoms of an ORIF include: extreme pain; inability and/or difficulty in using legs. Mass symptoms vary depending on the type of tumor. Not all tumors - cancerous or benign - show symptoms. A common benign tumor, such as a lipoma (fatty tumor), may cause local pressure and pain, or may be disfiguring and socially stigmatizing. This is mass excision followed by an open reduction and internal fixation (ORIF) procedure. It is indicative for conditions such as ameloblastoma- a rare, benign tumor of odontogenic epithelium commonly appearing in the lower jaw. An ORIF corrects a severe, poorly aligned fracture where the ends of affected bones are far apart. Such a fracture may occur anywhere in the body (leg, hip, arm, jaw, etc.), usually as a result of trauma. Broadly, masses come in two types: benign (not cancer) and malignant (cancer). The types of tumors are many and could range from osteosarcoma of the jaw (a bone tumor) to thyroid enlargement to breast lump to fibroma (benign fat tumor), among others.

​What is the impact on patients’ lives of living with these conditions?

Without an ORIF, a non-union leads to chronic disability, pain, and inability to work. If the tumor is cancerous, it is usually aggressive and invasive. If not treated (like certain skin cancers, for example) there could be great tissue destruction, pain, deformity, and ultimately death.

What cultural or regional factors affect the treatment of these conditions?

Because there are so many different kinds of masses, it is difficult to pinpoint certain cultural and/or regional causes.

What does the treatment process look like?

The patient will generally stay in the hospital for 2-3 weeks after surgery, and return for a checkup in 6 weeks.

What is the impact of this treatment on the patient’s life?

Curative. An ORIF fixes the broken bone restoring it to complete function and thus, enables the patient to be able to work. In the case of cancer, the procedure can be life-saving. In the case of benign tumors, patients can be free of pain or social stigma.

What potential side effects or risks come with this treatment?

In an ORIF, there is medium surgical risk. Overall, the risk of surgery is less than the risks of the alternative (traction), or doing nothing. In addition to the scenarios above, fractures may occur in older people with osteoporosis or because of cancer or infections like TB. In mass excision, if the tumor is cancerous, the surgeon will only try to remove it if the procedure would be curative. If the cancer has already spread, then surgery cannot help. Most of these surgeries are not very risky.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are few quality orthopedic centres in developing countries. Any American would go to their local hospital and get an ORIF. There are few qualified facilities and surgeons to perform this procedure in Africa.

What are the alternatives to this treatment?

Traction is an alternative for some—but not all—cases. And traction requires a patient to be in the hospital, immobile, for months—leading not only to lost wages but risk of bedsores, blood clots, and hospital-acquired infections. It depends on the type of tumor. If the tumor is cancerous, chemotherapy may help, but that treatment is even less available than surgery. If the tumor is benign, it depends on the condition - but just watching the mass over time would be one option.