Abstract
Type III open tibial fracture is the commonest type of open tibia fracture. The aim of this study was to determine the outcome of Gustilo-Anderson type III open tibial fracture managed with external fixator. Patients that presented with Gustilo-Anderson type III open tibial fractures were recruited. Patients with bone pathology, prior debridement and concomitant spinal cord injury were excluded. Ethical approval and informed consent were obtained. A structured proforma was used to collect the participant’s socio-demographic data, time of injury, fracture location, interval and number of debridement, need for skin graft or flap, duration of hospital stay, outcome of treatment, complications and events at follow-up. Wound biopsy was taken and processed for microscopy, culture, and sensitivity. Delayed union was diagnosed when the fracture united between 4-6 months. Non-union was defined as a varus or valgus angulation of >5 degrees or anterior or posterior angulation of >10 degrees. Patients were followed up for 6 months. Chi square was used to determine association between categorical variables. SPSS 20 was used for analysis. Significance was p value <0.05. Of 35 patients, males were 22 (62.9%) while females were 13 (37.1%) and mean age was 38 years. Average interval between injury and presentation was 14.5 hours. Fourteen (40%) patients had type IIIA, 18 (51.4%) patients had type IIIB while 3 (8.6%) patients had type IIIC. Mean time to fixation was 59.2 hours. Wound infection, malunion, delayed union, pin loosening and compartment syndrome were found in 42.9%, 21.3%, 21.3%, 11.5% and 1.6% respectively. Infection rate was significantly positively correlated with grade of fracture (p=0.04) and time to debridement (p=0.018). A significant association between the mechanism of injury and associated injury (p=0.027) but not mechanism of injury and grade of type III fracture (p=0.292). Significant difference between the duration of hospital stays and categories of type III fractures (p = 0.026) but not associated injury (p=0.403). No significant difference in location of fracture and time of union (p=0.723). Type III fractures managed with external fixator is associated with some complications among which infection is the commonest and delay in treatment is associated with higher risk. Post-debridement microscopy and culture is a better predictor of wound infection.
Highlights
Traumatic injuries are major causes of death and disability globally [1]
The aim of this study was to determine the outcome of Gustilo-Anderson type III open tibial fracture managed with external fixator
Road traffic accidents are the main cause of type III open tibial fractures in our environment
Summary
Traumatic injuries are major causes of death and disability globally [1]. Trauma accounts for most fractures of the lower limbs [2]. High-speed lifestyles, with motor vehicles and motorcycles, contribute to the increasing incidence of lower limb fractures in contemporary society [3]-[5]. Open fractures are fractures that communicate with the external environment through a skin wound [6]. Despite the discovery and use of antibiotics following injuries, infection continues to be an important challenge in open fractures leading to longer hospital stays, increased cost of treatment, morbidity and mortality [7]. Deep fracture-site infections can lead to chronic osteomyelitis, nonunion, loss of function, or even limb loss
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
