The self-reinforcing constellation of the chronic noncommunicable diseases and conditions – diabetes, obesity, hypertension, and respiratory and cardiac disease – that adversely affect the management of orthopedic conditions in high-resource countries present more varied and complex problems in the developing world. Besides occurring at a younger age and being poorly controlled, patients may not be aware of the extent of their medical problems, may fail to understand the need for long-term medication to control the pathology, or may not have the resources to buy necessary drugs. The expensive tests, therapies, and consulting expertise found in Western health systems to prepare patients for elective surgery are lacking in resource-poor settings. Managing trauma in the face of unaddressed and unmanaged comorbidities can transform already complicated situations into complex life-threatening ones [1, 2].
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