Analysis of machete cut fractures in Nigerian civilian trauma setting

Abstract

Machete cut fracture is an important component of morbidity associated with machete injuries although it is under reported. This was a retrospective study to assess machete cut fractures in patients seen in Federal Teaching Hospital Abakaliki and National Orthopaedic Hospital Enugu from 2009 to 2018. There were 91 patients with 154 fractures, male- to- female ratio was 10:1 and mean age was 31.6 ± 14.6 years. The aetiological factors were assault (57, 62.6%), armed robbery (29, 31.9%) and accidental injury (5, 5.5%). The three top bones involved were ulna, metacarpal and finger-phalanx. Fracture was communited in (17, 11.0%), and Gustilo Anderson grade IIIC in (22, 14.3%). Injury to hospital arrival interval later than 6 h was common and correlated with prolonged length of hospital stay (p < 0.001). Anaemia, wound infection and hemorrhagic shock were the three top complications. Nine (5.8%) fractures ended in extremity amputation. Eleven (12.1%) patients left against medical advice, and 5 (5.5%) were transferred. Normal union in 98.3% of the fractures treated and followed up for a minimum of one year. Case fatality rate was 2.2%; none of the patient that died had pre hospital care, and hemorrhagic shock accounted for all the mortality. These call for appropriate injury preventive mechanisms, and improved rates of early presentation of patients to hospital, and pre hospital care.

Analysis of risk factors for wound infection after extremity fracture caused by machete cut in a resource-limited setting

“…The prevalence of wound infection in this study is similar to the overall wound infection rate after machete cut fractures in a recently published report from a resource-limited setting [ 16 ]. However, it is quite different from the non-evidence of wound infection found in a series of eight patients with extremity fractures caused by machete cuts reported by Raymszwseski et.al in Glasgow [ 13 ].…”

“…Thus, an injury-to- hospital arrival interval >6hrs identified as an independent risk factor for wound infection after machete cut extremity fracture is not surprising. In a resource-limited setting, injury to hospital arrival interval later than 6hours is common among victims of machete cut fractures [ 16 ]. Therefore, measures aimed at improving the rate of early presentation of patients with machete-cut fractures to a hospital with a capacity for prompt and adequate care is important and should be one of the top priorities in wound infection preventive strategies in this setting.…”

“…in Glasgow, Scotland, is consistent with a low rate of wound infection expected in this type of fracture [ 13 ]. However, a recently published report indicates that the prevalence of wound infection after machete cut fractures was 34% in a resource-limited setting [ 16 ]. Also, Serra et al in Caribbean reported a wound infection rate of 14.4% in a case series of forearm fractures caused by machete cut [ 5 ].…”