Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review

Abstract

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.

Clinical and microbiological profiling of infections in open tibia fractures at Muhimbili Orthopaedic Institute

“…Staphylococci were the only Grampositive bacteria isolated in which 17 (23.3%) isolates comprised of 14 (19.2%) Staphylococcus aureus and 3 (4.1%) isolates were Coagulase negative Staphylococci (CoNS) (Table 3). (9), the present study found 100% of open tibial shaft fractures in the study population were managed with either external fixators or interlocking intramedullary nails. This is striking in view of known complications with cast immobilization compared to surgical fixation.…”

“…Gustilo II and III fractures were associated with higher risk of complications and the overall rate of infection was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3% and 7% of the cases, respectively (9).…”

An Easy-To-Use External Fixator for All Hostile Environments, from Space to War Medicine: Is It Meant for Everyone’s Hands?

“…The implementation of the EZExFix provides a solution to these challenges, eliminating the dependency on healthcare facilities altogether. The EZExFix is made with materials that reduce the cost and allow local production in order to increase accessibility also for developing countries that are in need of easy accessible stabilization methods [41][42][43]. The EZExFix could be also considered for inclusion in a medical kit because it is compact, portable (requires only a battery for the drill; no external power supply needed), lightweight (1 kg without the drill), and takes up minimal space (35 × 20 × 10 cm, maximum of a shoebox) in the limited resources available such as on a spacecraft.…”

Music as an Adjuvant Therapy in Postoperative Pain and Physiologic Parameters: Pre-Test, Post-Test Intervention Study

“…During intraoperative, fracture fixation and surgical debridement of dead tissues is done. [7] Successful management of fractures postsurgery entails tissue closure, rehabilitation practices, pain management, and antibiotic prophylaxis. This approach can improve outcomes, including chronic pain and postoperative complications such as nonunion and bone infections.…”