Locally-developed External Fixators as Definitive Treatment of Open Tibia Diaphyseal Fractures: A Clinical Prospective Study Conducted in Ivory Coast

Abstract

Background: This study sought to evaluate the effectiveness of locally-developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast.Methods: Gustilo I, II and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with a locally-developed external fixator. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct’s integrity. Predictive factors of failure or poor results were assessed.Results: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases, and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome.Conclusion: In comparison with the results obtained in the same environment without a locally-developed external fixator, the provision of such a device improved significantly the OTDF management, as it provided better stability and superior fracture healing rates. PTI remains an essential problem but with, hopefully, limited negative consequences. Trial registration: This study protocol was registered in Pan African Clinical Trial Registry under N°PACTR202009854874448. Date of registration 28 September 2020 ‘retrospectively registered’. www.pactr.org.