The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania.

Njee Nobert,Isdori H Ngayomela,Jeremiah Seni,Ramesh M Dass,Japhet M Gilyoma,Nyambura Moremi,Stephen E Mshana

doi:10.1186/s13032-016-0036-7

Abstract

BackgroundUrgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures.MethodsA prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11.ResultsThe male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading (p-value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5–10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p-value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6–11.5) days and 6 (5–10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI.ConclusionsOpen long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes.

Highlights

Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection
The negative health impact related to open fractures due to road traffic accidents (RTA) are many ranging from increased hospital admissions in the intensive care unit, infections, longer duration of hospital stays, long term disabilities and deaths [2, 8, 9]
All patients were managed according to Bugando Medical Centre (BMC) management protocol on open long bone fractures which included Advanced Trauma Life Support, urgent baseline investigations (Hemoglobin estimation, blood grouping and cross matching); radiological tests (x-rays of the affected bone); provision of systemic antibiotic prophylaxis (Ceftriaxone and Metronidazole) and anti tetanus prophylaxis; grading of open long fracture according to Gustilo-Anderson classification system [10]; surgical debridement in the theatre followed by fracture stabilization by Plaster of Paris cast (POP), external fixation and open reduction and internal fixation (ORIF), and early soft-tissue coverage whenever required

Summary

Introduction

Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures. The growing burden of open fractures is apparently of global concern and contribute significantly to high morbidity and long-term disabilities [1,2,3,4]. The negative health impact related to open fractures due to road traffic accidents (RTA) are many ranging from increased hospital admissions in the intensive care unit, infections, longer duration of hospital stays, long term disabilities and deaths [2, 8, 9]. The long debated optimal timing of surgical debridement basing on the “6 h rule” still remain to be controversy as some studies support it whereas others refute it to be associated with plausible outcome in terms of less incidences of surgical site infections and shorter LOS [13,14,15,16,17,18,19,20]

Methods

Results

Discussion

Conclusion