Prevalence and Pattern of Open Fractures in Level-II Hospital, Central Africa

Abstract

Introduction: Open fractures are known orthopaedic emergencies associated with healing problems and risk of infection. The open fractures are common cases because of motor vehicle and motorbike accidents, falls from height and sometimes gun-shot wounds. Significant morbidity and subsequent disability may happen, if not managed properly. Aim: To evaluate the pattern of open fractures associated with healing problems and achieving sound bone union, avoiding infection and regaining full functional recovery of the limb. Methods: This retrospective study included all the patients who were hospitalized with open fractures of lower limbs in a United Nations Level II Hospital of Bangladesh Medical Contingent at Kaga-Bandoro in Central African Republic from April 2015 to November 2018. Results: There were 57 patients with open fractures resulting 17.8% of total trauma patients. The mean age was 31.8±11.6 years. Most patients were in the 20-39 years age group. The male to female sex ratio was 4.2:1. Road traffic accident was the main cause of open fractures (59.6%). Fractures of tibia-fibula and femur contributed 49.1% and 15.7% respectively and 89.4% satisfactory results were achieved after treatment. Conclusion: The management of open fractures presents a challenge due to risk of infection, healing problems and subsequent morbidity. Adequate debridement and copious lavage remains one of the cornerstones of management of open fractures. The initial management of open fractures affects the ultimate outcome. Key-words: Open fracture, Orthopaedic emergencies, Level-II hospital, Central Africa. Introduction Open fractures are a common and major public health problem that keeps the orthopaedic surgeons preoccupied. These usually have adverse effects on the economy of the patients. Initial management constitutes a principal step which has to be early and appropriate. The aims of treatment for open fractures include achieving sound bone union, avoiding infection and regaining full functional recovery of the limb1,2. The basis of treatment includes immediate, meticulous and repeated wound debridement with copious irrigation using normal saline, stabilization of the fracture, ‘closure’ of the wound, early parenteral administration of broad-spectrum antibiotics, and early bone grafting when indicated1,3-5. Patterns of fractures vary within different communities as their occurrence depends on the type and the speed of activities in the local area. Similarly, the outcome of treatment will depend on the type of care given to the patient3,5-7. Materials and Methods The Ethical Committee of the center approved this study having satisfied all issues about patients’ confidentiality and the best practice methods concerning human research. This was a retrospective cross sectional study of patients admitted and treated in a United Nations level-II hospital of Bangladesh Medical Contingent, located at Kaga-Bandoro in Central African Republic for injuries between April 2015 and November 2018 by analyzing the relevant information contained in their medical case files as recorded. The admitted patients with limb fractures with or without other associated injuries and those with hemodynamic instability following their injuries around their limbs were included in this study. Those with pathological fractures and those who had received their initial wound debridement before arrival at this hospital were excluded from the study. Majority of these patients were local Central African treated as a part of Civil-Military Co-operation activities. The patients’ folders within the study period were retrieved from the medical records. Data were also obtained from the operation registrars. The data analyzed included the age, sex, diagnosis, etiology, the part of the limb affected, the treatments carried out, complications, and the duration of hospital stay. Here, Tucker et al criteria was used for evaluation of the outcome. Analysis was done with the Statistical Package for Social Sciences version 20. Statistical significance was considered when p value is <0.05.