Background: Although open tibial fractures are common in Malaysia, the
outcomes for these patients have not been evaluated in the literature.
This retrospective study was conducted to examine the factors
associated with infection and non-union in open tibial fractures
managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009.
Methods: From 1 January until 31 December 2009, the Department of
Orthopaedics of HTAA managed 58 patients with open tibial fracture who
had a minimum of a one year follow-up period. The median age was 24.5
years (range: 4 to 72 years). The open tibial fractures were graded
using the Gustilo open fracture classification as follows: 4 grade I,
21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were
subjected to a standard treatment protocol at HTAA, which includes the
use of prophylactic antibiotics, emergency debridement, fracture
stabilisation, wound coverage, and bone reconstruction when required.
The mean time from injury to the initial debridement was 29.7 hours
(range: 13 to 216 hours). Results: Seventeen (29%) cases were
complicated by infection, and 10 patients (17%) developed non-union.
The grade of the open fracture was significantly associated with
infection, and age and the time interval between the injury and the
initial wound debridement were significantly associated with non-union.
Conclusions: The high rates of infection and non-union, particularly in
severe open fractures, indicate that there is a need to improve the
management of open tibial fractures treated at HTAA. The time to
initial debridement is an important factor that can be readily amended
to improve the outcome. Further studies with larger sample sizes are
likely needed to replicate and confirm our findings