Open fractures: epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria

David Odoyoh Odatuwa-Omagbemi, David Odoyoh Odatuwa-Omagbemi

Abstract

Introduction: Management of open fractures poses a constant challenge to Orthopaedic surgeons in Nigeria. Our aim is to determine the epidemiological pattern of open fractures in our centre and share our experiences on the initial management and problems encountered.

Methods: This was an 18 month prospective study of patients that presented with open fractures at our emergency room. Already prepared data collection sheets were used to collect relevant data directly from patients and patients' files.

Results: There were 58 open fractures in 52 patients (31 males and 21 females). Mean age of patients was 36.4 ± 12.2 years. Most patients (82.7%) fell within the age group of 20-49 years. Traders (28.9%) and students (19.6%) were mostly affected. Most open fractures (88.5%) were due to road traffic accidents. The tibia and fibula were the most frequently affected (44.4%). Most injuries were Gustilo et al. types IIIA & IIIB (79.3%) open fractures. Patients had initial resuscitation followed by debridement in 42 cases (72%). Fractures were initially stabilized with external fixators in 23 cases (39.7%) and cast slabs in 19 cases (32.8%). The average time between presentation and debridement was 30 hours and average hospital stay was 36 days. Forty two point five per cent of wounds were infected.

Conclusion: Open fractures were mostly due to road traffic accidents and affected the tibia and fibula most frequently with Gustilo et al. types IIIA and IIIB forming the bulk of the injuries. Management was challenging with late presentations, scarcity of resources and consequent high rate of infections, prolonged morbidity and hospital stay. These problems were worsened by delay in antibiotic commencement and initial debridement, sub-optimal treatment at peripherial hospitals and mis-management by traditional bone setters.

Keywords: Open fractures; external fixators; management challenges; road traffic accidents.

Conflict of interest statement

The author declares no competing interest.

© David Odoyoh Odatuwa-Omagbemi et al.

Figures

Figure 1
Figure 1
Gustilo and Anderson type III open fracture of right tibia and fibula at presentation
Figure 2
Figure 2
X-ray of the limb after debridement and application of external fixator

References

    1. Olsen SA, Willis MD. Initial Management of Open Fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green's Fractures in Adults. Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2006. pp. 390–424.
    1. Yusuf E, Steinrücken J, Buchegger T, Trampuz A, Borens O. A Descriptive Study on the Surgery and the Microbiology of Gustilo Type 111 Fractures in an University Hospital in Switzerland. Acta Orthop Belg. 2015;81(2):327–332.
    1. Brinker MR, O'Cornor DP. The Incidence of Fractures and Dislocations referred for Orthopaedic Services in a Capitated Population. J Bone Joint Surg Am. 2004;86(2):290–297.
    1. Nogueira Giglio P, Fogaça Cristante A, Ricardo Pécora J, Partezani Helito C, Lei Munhoz Lima AL, Dos Santos Silva J. Advances in Treating Exposed Fractures. Rev Bras Ortop. 2015;50(2):125–130.
    1. Ibeanusi SEB, Ekere AU. Epidemiology of Open Tibial Fractures in a Teaching Hospital. Port Harcourt Med J. 2007;3(1):156–160.
    1. Gustilo RB, Anderson JT. Prevention of Infection in the Treatment of One Thousand and Twenty Five Open Fractures of Long Bones: Retrospective and Prospective Analysis. J Bone Joint Surg Am. 1976;58(4):453–458.
    1. Gustilo RB, Mendosa RM, Williams DN. Problems in the Management of Type 111 (Severe) Open Fractures: a new classification of Type 111 Open Fractures. J Trauma. 1984;24(8):742–746.
    1. Arti HR. Comparism of Early Versus Delayed Debridement in Open Fractures. Pak J Med Sci. 2012;28(5):856–859.
    1. Noufanangue Kanfitine Kombate, Atchi Walla, Kolima Akloa, Komi Amakoutou, Batarabadja Bakriga, Gamal Ayouba. Epidemiology of Open Limb Fractures in a Country with Low Income. Open J Orthop. 2017;7:356–361.
    1. Court-Brown CM, Bugler KE, Clement ND, Duckworth AD, McQueen MM. The Epidermiology of Open Fractures in Adults: a 15-year Review. Injury. 2012 Jun;43(6):891–7.
    1. Orthopaedic Trauma Association: Open Fracture Study Group A new classification scheme for open fractures. J Orthop Trauma. 2010;24(8):457–465.
    1. Patzakis MJ, Wilkins J, Moore TM. Considerations in Reducing the Infection Rate in Open Tibial Fractures. Cin Orthop Relat Res. 1983;178:36–41.
    1. Cross WW, Swiontkowski MF. Treatment Principles in the Management of open Fractures. Indian J Orthop. 2008;42(4):377–386.
    1. Keating JF1, Blachut PA, O'Brien PJ, Court-Brown CM. Reamed Nailing of Gustilo Grade 111B Tibial Fractures. J Bone Joint Surg. 2000;82b(8):1113–1116.
    1. Odatuwa-Omagbemi DO, Bock Oruma AA, Enemudo RET, Otene CI, Iwegbu GC, Okeke MO, et al. Epidemiology of Road Traffic Crash Injuries as Seen in the Emergency Room of a Tertiary Hospital in Delta State, Nigeria. Br J Med Med Res. 2017;20(10):1–10.
    1. Jaña Neto FC, de Paula Canal M, Alves BA, Ferreira PM, Ayres JC, Alves R. Analysis of characteristics of patients with open tibial fractures of Gustilo and Anderson Type 111. Rev Bras Ortop. 2015;51(2):143–149.
    1. Elachi IC, Yongu WT, Odoyoh OO, Mue DD, Ogwuche EI, Ahachi CN. An Epidemiological Study of Burden of Trauma in Makurdi, Nigeria. International Journal of Critical Illness and Injury Science. 2015;5(2):99–102.
    1. Natuya VM, Reich MR. The Neglected Epidemic: Road Traffic Injuries in Developing Countries. BMJ. 2002 May 11;324(7346):1139–41.
    1. Odatuwa-Omagbemi DO, Inikori AK, Otene CI, et al. Musculo-skeletal Injuries: a cross-sectional Study in a Sub-urban Teaching Hospital. Nig J Ortho Trauma. 2013;12(1):66–70.
    1. Sharr PJ, Buckley RE. Current Concepts Review: Open Tibial Fractures. Acta Chir Orthop Traumatol Cech. 2014;81(2):95–107.
    1. Hungria JOS, Mercadante MT. Open Tibial Shaft Fractures: Treatment with Intramedullary Nailing after Provisional stabilization with Non-penetrating External Fixator. Rev Bras Ortop. 2013;48(6):482–490.
    1. Pollak AN, Jones AL, Castillo RC, Bosse MJ, MacKenzie EJ, LEAP Study Group The Relationship between Time to Surgical Debridement and Incidence of Infection after Open High Energy Lower Extremity Trauma. J Bone Joint Surg. 2010;92(1):7–15.
    1. Almeida-Martos M, Castro-Fillo RN, Pinto da Silva BV. Risk Factors Associated with Infection in Tibial Open Fractures. Revista de la Facultad de Ciencias Medicas. 2013;70(1):14–18.
    1. Okike K, Bhattacharyya T. Trends in the Management of Open Fractures. J Bone Joint Surg. J Bone Joint Surg Am. 2006 Dec;88(12):2739–48.
    1. O'Brien CL, Menon M, Jomba NM. Controversies in the Management of Open Fractures. The Open Orthop J. 2014;8(Suppl 1: M7):178–184.
    1. Patzakis MJ, Wilkins J. Factors Influencing Infection Rate in Open Fracture Wounds. Clin Orthop Relat Res. 1998;283:36–40.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir