Abstract
The tibia is the most commonly fractured long bone and is susceptible to open injuries. Open fractures are difficult to manage despite advances in medical care and result in high rates of non union, delayed union and sepsis. Concerns with delay in surgical debridement resulted in our review of open tibial fractures at out institution.
We did a retrospective review of 27 open tibial fractures with a follow up of 6 to 18 months. There were 20 males and 7 females. Sixteen fractures were incurred as pedestrians. There were 12 associated injuries. Eleven patients were referred from peripheral hospitals. There were 9 Gustilo grade 1 injuries, 8 grade 11 and 10 grade 111. Fracture patterns were a range from simple 42 A1 to C3 (AO). Eleven patients were managed by wash-out in casualty, and admission for intravenous antibiotics. Sixteen patients were debrided in theatre. Delay to theatre ranged from 6 hours to 19 days. This was a combination of referral delay and insufficient theatre availability. Nine patients had an external fixator applied, 2 intramedullary nails and 5 plaster casts.
Five patients required repeat procedures, 3 redebridements, and 2 skin grafts. Average hospital stay for patients managed non-operatively was 3 days and operatively 22 days. Union was documented clinically and radiologically in 22 patients at between 12 weeks and 6 months. Eight patients united after 5 months. There were 5 nonunions, 6 cases of superficial sepsis, and 2 deep sepsis. Early complications included one compartment syndrome, and one peroneal nerve palsy.
This study showed a high complication rate for open tibial fractures. We concluded that an improvement in the referral system and local availability of theatre facilities would improve our complication rate.
Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.
