Orthopaedic Surgery in Palau – A Quantitative Assessment to Support Capacity-Building

Introduction
Palau, an island nation in Micronesia, is a medically underserved area with no full-time orthopaedic surgeons. Orthopaedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral.

Objectives
The purpose of this study was to assess the prevalence of orthopaedic conditions in Palau and quantify referral spending to inform interventions to build orthopaedic surgery capacity.

Methods
Data was collected from Belau National Hospital’s electronic health record (EHR) and from the Palau Medical Referral Committee (MRC) reports. All encounters with orthopaedic diagnoses in the EHR between November 2022 and July 2023 and all orthopaedic referrals between October 2018 and June 2023 were included. Results were reported descriptively.

Results
In eight months of EHR data, there were 1,235 patients with orthopaedic diagnoses, totaling 1,762 encounters. The most common body parts affected were the back/spine, knee/lower leg, and foot/ankle. The most common diagnoses were pain (due to sciatica, osteophytes, etc.), osteoarthritis, sprain/tear, and fracture.