Aim: To determine the rate of infection in open tibial fractures treated by conversion of an external fixation into an intramedullary nail, and to identify the factors contributing to the infections. Methods: The study included a total of 52 patients. Multiple variables were assessed as risk factors that could lead to infection in open tibial fractures treated primarily with an external fixator and later converted into an intramedullary nail. The factors looked at were: age, average time taken from injury to debridement, average time taken from admission to debridement, antibiotics administration, facility that admitted the patient before intramedullary nail, average time for conversion of external fixator into intramedullary nail insertion, type of soft tissue management, initial Gustilo and Anderson classification and retrospective re-classification of fractures, existence of superficial sepsis or pin-tract infection, radiologic evidence of infection, the Injury Severity Score and the type of external fixator used. A p value < 0.05 was used as the threshold for level of significance. Results: The average follow-up was 37 weeks (median 24 weeks). We had a 40% infection rate CI [27%, 55%]. Factors that were found to be the most statistically significant (p≤0.05) were amount of soft tissue injury and fracture comminution; this is after the fractures were retrospectively reclassified. All other factors looked at were not statistically significant as risk factors for infection (p>0.05). Conclusion: The study suggests that correct classification of open tibial fractures, with recognition of soft tissue injury and bone comminution, is important in reducing infection rates and in ensuring proper initial management of these fractures. Treatment should be based on the classification done in theatre during the initial debridement, rather than on presentation in the trauma unit.

Objective: The aim of this study was to review the results of non-operative treatment of odontoid fractures in Steve Biko Academic Hospital, Pretoria. Methods: Records for all patients treated for odontoid fractures from 2008 to 2018 were reviewed. 28 patients met the study criteria. Demographic data, mechanism of injury, associated injuries, neurology, imaging studies and treatment were reviewed. Results: There were 23 males and 5 females. The average age at presentation was 39.5 years. 25 patients were injured in road traffic accidents. Associated injuries were present in 21 patients, mostly involving the spine and head. 18 fractures were classified as Type II and 15 as Type III. Fracture comminution (5), angulation (6) and translation (10) were noted. Primarily treatment modalities were cones callipers, Philadelphia collar or halo vest. Fracture union was assessed radiologically at 3, 6 and 9 months. Type II and III fractures had high union rates at 6 and 9 months. Significantly displaced fractures had a statistically lower union rate (p = 0.0285) at 6 months. Conclusion: Minimally displaced odontoid Type II and III fractures can be effectively treated non-operatively in young adults. Extent of fracture displacement is the single important factor in non-union rate.