Early Outcomes of Open Gustilo-3 Tibia Diaphyseal Fractures Treated With Uniplanar External Temporary Fixation at the KNH, Nairobi

Abstract

Introduction: Fractures of the tibia are common after trauma whether isolated or as part of multiple injuries. Due to the tibia’s subcutaneous nature, they are susceptible to breaking the skin and being open injuries. Gustilo 3 open tibia shaft fractures are commonly high velocity with poor soft tissue cover and can be treated with uniplanar external fixation (EF) initially. These require multiple surgeries and have high morbidity. The uniplanar EF may be carried to fracture union but is often complicated with frequent adverse outcomes. Most are converted to intermedullary fixation or plated after adequate soft tissue recovery and/or flap cover. There have been local publications to demonstrate the early outcomes and impact of EF for open tibial fractures. This study aims at describing the early outcomes of uniplanar EF for Gustilo 3 open tibial fractures among patients admitted and managed at the KNH, Kenya Study Objective: To determine the pattern of early outcomes of uniplanar EF of Gustilo 3 open tibial fractures at KNH in Nairobi, Kenya. Methodology: A descriptive cross-sectional study was conducted at the KNH orthopaedic department. A total of 70 patients who had undergone treatment for diaphyseal Gustilo 3 tibial fractures with EF were enrolled in the study. Data was collected using an interviewer guided questionnaire and uploaded into SPSS software for cleaning, coding and analysis. Descriptive data on number of surgeries, infection, status to soft tissue closure and conversion to definitive management at two weeks is presented using means and standard deviations around the mean for numerical variables such as age and number of days stayed in hospital. Bivariable analysis was undertaken for the outcomes of the EF and correlates of the socio demographic and clinical characteristics done. A p value of 0.05 was taken to be statistically significant. Results: The social demographics showed approximately half the participants were married. Many came from low economic status and only 21.4% had attained tertiary education. There were 45% patients who had one injured site on skeletal survey with 28.6% and 27.8% with two sites and more than two sites respectively. Gustilo classification was 31.4% IIIA and 68.5% IIIB. Wound infection was present in 35.7%. Soft tissue cover was 47.1% covered at two weeks post EF. Malalignment necessitated revision in 37.1%. Maintenance of EF beyond two weeks was 92.9%. No association was found between fracture type by AO/OTA/OTA classification and outcomes. Significance of the Study: The findings showed that there was low conversion of EF to internal fixation at 7.1% which is not recommended.