Orthopedic Trauma Care in Libya: Self-Reported Initial Fracture-Management Practices, Perceived Gaps, and Barriers to Definitive Treatment

Abstract

The initial management of orthopedic fractures requires systematic clinical assessment, appropriate immobilization, early management of open fractures, and timely access to definitive treatment. In resource-limited healthcare settings, however, variations in clinical practice and limitations in hospital resources may affect the quality and continuity of trauma care. This study assessed selected initial fracture-management practices and perceived barriers to definitive orthopedic treatment among orthopedic doctors in Libya. A cross-sectional descriptive survey was conducted among orthopedic doctors in different cities across Libya using an online questionnaire created with Google Forms and disseminated through social media platforms. The questionnaire was distributed between June and August 2026. A total of 186 completed responses were included. Six domains were assessed: neurovascular examination, reassessment following fracture reduction or splinting, early intravenous antibiotics for open fractures, initial fracture immobilization, access to timely surgery and necessary fracture implants, and perceived resource-related barriers. Responses were categorized as Yes, No, or Not sure. Descriptive statistics were used. Among 186 respondents, 137 (73.7%) reported routinely performing and documenting neurovascular examinations. Reassessment following fracture reduction or splinting was reported by 128 (68.8%). Early intravenous antibiotics for open fractures were routinely reported by 99 (53.2%). Initial immobilization was reported by 165 (88.7%). Only 72 respondents (38.7%) reported timely access to surgery and necessary fracture implants, whereas 90 (48.4%) reported inadequate access. Limited resources and hospital facilities were identified as major barriers by 145 (78.0%) respondents. The study demonstrates variation in selected aspects of initial fracture management among orthopedic doctors in Libya. Although immobilization was widely reported, important gaps were identified in neurovascular reassessment and early antibiotic administration for open fractures. Limited access to definitive treatment and resource constraints were prominent concerns. Standardized trauma protocols, reliable availability of essential medications and implants, and strengthened referral pathways may improve orthopedic trauma care in Libya.