Outcomes and factors associated with open tibia fractures in adults managed at Mulago National Referral Hospital

Abstract

Background: Open Tibial Fractures are among the most common presenting fractures at Mulago National Referral accident and emergency unit. They arise from high energy trauma and require a robust approach in management encompassing, antibiotic prophylaxis, fracture debridement, stabilization, and early definitive wound cover. However not much is documented regarding patient outcome post-management in our set up. Hence, we seek to describe the outcome of open tibial diaphyseal fractures managed in Mulago National Referral Hospital. The main objective was to describe the clinical and radiological outcomes and their associated factors among patients who have undergone management for open tibial fractures at least 9 months post-injury. Methods: The study was a cross-sectional survey of 384 participants previously managed as open tibial diaphyseal fractures at least 9 months post-injury. Their clinical (leg length discrepancy and discharging sinus) and radiological (union, non-union, and malunion) outcomes and associated factors were studied using descriptive and inferential statistics. Results: Of the 384 participants, 16.41% have significant shortening of the leg, 38.54% have discharging sinus(es) and none has a wound. HIV (p-value 0.001), diabetes (p-value 0.008), and Gustilo Grade III (p-value 0.021) are associated with discharging sinus (es). The radiological outcome shows that 50.52% have a union, 17.71% have a nonunion and 31.77% have malunion. The nonunion is associated with HIV (p-value 0.015), right injured leg (p-value 0.035), and Gustilo II (p-value 0.009). The malunion is associated with the smoking habit (pvalue 0.015), time to debridement of 6 to 12 hours (p-value < 0.001), Gustilo I (p-value 0.002) and II (p-value 0.018). Conclusion: The high rates of abnormal outcomes both clinical and radiological indicate that there is a need to improve the management of open tibial diaphyseal fractures treated at Mulago National Referral Hospital. HIV, diabetes, and higher Gustilo grades are the significant contributing factors to the high rate of the discharging sinus (es). The nonunion is associated with HIV and right injured leg; whereas malunion is associated with smoking habits and time to debridement. The lower Gustilo grades are associated with both nonunion and malunion due to inappropriate stabilization methods.