Open Tibial Shaft Fractures

Abstract

Background: Open tibial shaft fractures are an important source of disability in Latin America. High-income countries (HICs) worldwide have established standardized treatment protocols for open tibial fractures, but less is known about their treatment in middle-income countries (MICs) in Latin America. This survey of Latin American orthopaedic surgeons characterizes open tibial fracture treatment patterns. Methods: Orthopaedic surgeons from 20 national orthopaedic societies throughout Latin America completed an online survey assessing their treatment of open tibial fractures. Demographic information was collected. Treatment patterns were queried according to 2 groupings of Gustilo-Anderson (GA) fracture types: treatment of type-I and type-II fractures (GA-I/II) and treatment of type-III fractures (GA-III). Treatment patterns were evaluated across 4 domains: antibiotic prophylaxis, irrigation and debridement, fracture stabilization, and wound management. Summary statistics were reported; analysis was performed using the Fisher exact test (p < 0.05). Results: There were 616 survey participants from 20 Latin American countries (4 HICs and 16 MICs). Initial external fixation followed by staged internal fixation was preferred for GA-I/II (51.0%) and GA-III fractures (86.0%). Nearly one-third (31.5%) of GA-IIIB fractures did not receive a soft-tissue coverage procedure. Stratifying by country socioeconomic status, surgeons in MICs more commonly utilized delayed internal fixation for GA-I/II (53.3% versus 22.0%, p < 0.001) and GA-III fractures (94.0% versus 80.4%, p = 0.002). Surgeons in MICs more commonly used primary closure for GA-I/II (88.9% versus 62.8%, p < 0.001) and GA-III fractures (32.6% versus 9.8%, p < 0.001). Conclusions: This survey reports Latin American orthopaedic surgeons’ treatment patterns for open tibial shaft fractures. Surgeons in MICs reported higher delayed internal fixation use for all fracture types, while surgeons in HICs more routinely avoid primary closure. Soft-tissue coverage procedures are not performed in nearly one-third of GA-IIIB fractures because of a lack of operative personnel and training.

Epidemiology of Fractures Sustained During Electric Scooter Accidents

“…The observed lower-limb fracture patterns are typically secondary to high-energy trauma, which is stressed both by the high rates of open fractures (7.6%) and the higher Injury Severity Score. In many cases, the management of these injuries requires a staged surgery protocol in which initial temporary fracture stabilization is applied and later, as the soft-tissue edema subsides, is converted to definitive internal fixation [22][23][24] . All of the above contribute to the findings that the lower-limb *AO/OTA classifications for which there were no fractures in the cohort are not shown.…”

Open tibial shaft fractures: treatment patterns in sub-Saharan Africa

“…The survey assessed surgeons' treatment decisions for open tibial shaft fractures, based on both individual preference and perception of institutional capability. Survey questions were developed based on existing literature on open tibial fracture management and a similar survey conducted among Latin American providers 12 (see Appendix, Supplemental Digital Content 1, http://links.lww.com/ OTAI/A72). The survey was reviewed and edited based on feedback from orthopaedic surgeons in Tanzania, Malawi, South Africa, the United Kingdom, and the United States who participate in the Orthopaedic Research Collaboration for Africa (ORCA).…”

“…2,[6][7][8][9] However, the management of these fractures in other settings, particularly LICs and LMICs in Africa, varies based on numerous factors, including fracture type, surgeon training, resource limitations, treatment setting, and availability of financial mechanisms such as insurance to provide care for patients without ability to pay. 10,11 Compared with other practice settings, nationally recognized best practices and treatment patterns for open tibial shaft fractures across Africa are less well-documented, 5,11,12 and these injuries may be managed by a wider spectrum of providers, 13,14 including general surgeons, paramedical orthopaedic clinical officers, and traditional bonesetters. Identifying discrepancies in treatment patterns and the barriers to care that lead to them will inform future decisions about resource allocation that can best improve the treatment of these injuries in African countries.…”

“…Compared with other practice settings, nationally recognized best practices and treatment patterns for open tibial shaft fractures across Africa are less well-documented, 5,11,12 and these injuries may be managed by a wider spectrum of providers, 13,14 including general surgeons, paramedical orthopaedic clinical officers, and traditional bonesetters. Identifying discrepancies in treatment patterns and the barriers to care that lead to them will inform future decisions about resource allocation that can best improve the treatment of these injuries in African countries.…”

An audit on open tibia fracture management at a tertiary level ortho-plastic center in Sri Lanka: are we following current guidelines?

“…Despite widespread awareness of these guidelines and emphasis of their importance in orthopaedic and plastic surgery, the level of adherence to these protocols in developing countries is reported to be highly variable, mostly related to fracture stabilization, antibiotic prophylaxis and flap coverage [8]. The deviations from the recommended practice could be partly attributed to a lack of awareness among surgeons [8], hence regular audits to evaluate patterns of orthopaedic management in local settings are recommended. To our knowledge, there are no published audits on the management of open tibia fractures in Sri Lanka to date.…”