Surgical Sciences Research Society, Zaria and Association of Surgeons of Nigeria
Abstract
Background:Fracture of a normal tibia shaft constitutes a major trauma
mostly sustained by young adults during high-energy injuries. Its
superficial location and the subcutaneous characteristics of its
anteromedial aspect easily causes open fracture. The objectives of this
study were to determine the pattern of presentation, and determinants
of management outcome in open fractures of the tibia. Methods: This
is a prospective hospital based study. A total of 89 patients aged 4 to
80 years with open fractures of the tibia with or without fibula
involvement were studied. All the patients received anti tetanus
prophylaxis and intravenous antibiotics as well as wound irrigation,
debridement and skeletal stabilisation. Results: Students and traders
accounted for the majority of the cases (57.3%). Most of the open tibia
fractures 69 (77.5%) had above knee Plaster of Paris cast. The majority
of the cases were Gustilo and Anderson type II 32 (36.0%) cases and
type I 22(24.7%) cases. There was Correlation between the presence of
wound infection and (i) Gustilo and Anderson grading (F -.352, P .001);
(ii) Injury to Debridement time in hours (F -.304, P .004); (iii)
Osteomyelitis (F .397, P .001); (iv) Delayed union (F .253, P .017);
and (v) Union time in weeks (F -.350, P .001). There was also
correlation between the following: (i) Injury to Debridement time in
hours and the distance from the accident scene to the hospital (F .464,
P .001); (ii) The fracture pattern and the union time in weeks (F .353,
P .001); and (iii) The presence of osteomyelities and delayed union (F
.382, P .001). The commonest complications observed were wound
infection 35(39.3%) patients and delayed union 30(33.7%) patients.
Conclusion: This study shows that the higher the Gustilo and Anderson
grading of the open fractures of the tibia, the more severe the wound
and bone infection that occurred. The interval between injury time and
wound débridement time affected the treatment outcome