Treatment Outcome of Open Tibial Shaft Fractures in A Teaching Hospital in Ghana

Tolgou, Y.; Ofori, Alex Owusu; Holdbrook-Smith, Henry A; Wegdam, Harry H.J.

doi:10.60014/pmjg.v6i1.111

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Tolgou et al . [ 18 ] and Ibeanusi and Ekere[ 20 ] also reported a similar statistic with 87.4% and 91% of their participants, respectively, sustaining their injury from MVA and with over 50% motorbike involvement. The high incidence of motorbike-related accidents gives credence to the worrying trend of motorbikes increasingly becoming the major source of public transport hence cause of Road traffic injuries.…”

Section: Discussionmentioning

confidence: 64%

“…This is consistent with other research findings in the subregion. Tolgou et al .,[ 18 ] Abang et al .,[ 19 ] Ibeanusi and Ekere,[ 20 ] and Kumar et al . [ 21 ] also reported similar findings in Ghana and Nigeria.…”

Section: Discussionmentioning

confidence: 99%

“…Tolgou et al . [ 18 ] reported 11% Gustilo type I fractures, 36% type II fractures, 21% type IIIA fractures and 32% type IIIB fractures. Kumar et al .…”

Section: Discussionmentioning

confidence: 99%

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Prevention of equinus deformity after external fixation for open tibia fractures: A comparison between plaster of Paris backslab and passive ankle physiotherapy

Lartey,

Holdbrook-Smith,

Baddoo

et al. 2023

J West Afr Coll Surg

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Background: Ankle equinus deformity is a common complication of prolonged external fixator use in tibia fractures with an incidence of 15%–16%. It affects gait and may lead to foot, leg, and back problems. Treatment of equinus deformity increases the cost of treatment of open tibia fractures and increases the time spent off work. Several preventive modalities have been suggested in literature with variable success, but no standard protocol exists. Objectives: The aim of this study was to determine the most appropriate method of preventing equinus deformity of the ankle joint during the management of open tibia fractures with unilateral uniplanar external fixators by comparing plaster of paris (POP) backslab application with passive ankle physiotherapy using strips of car tyre inner tubing. Materials and Methods: The study was a prospective randomised study involving patients with open tibia fractures who were managed with external fixators at the Korle Bu Teaching Hospital between April 2020 and February 2021. Patients were randomised into two groups; one group had below knee POP backslab and the other group did passive ankle physiotherapy using a strip of car tyre inner tubing. The passive ankle range of motion was measured at the beginning and after 6 weeks using a goniometer. Results: Fifty-six participants were recruited with 29 in the POP backslab group and 27 in the ankle physiotherapy group. The median age was 35.0 years. Male-to-female ratio was 4.6:1. Motor vehicle crash contributed to over 90% with 42.9% being motorbike riders. Initial and final mean ankle measurements for the POP backslab group were 6.79° and 10.14° for dorsiflexion and 29.93° and 34.52° for plantarflexion, respectively. The ankle physiotherapy group had initial and final dorsiflexion of 7.19° and 12.85° and plantarflexion of 30.44° and 34.52°, respectively. The ankle physiotherapy group had a better range of motion (47.37°) than the POP group (40.66°) with a P value of 0.008. One participant (3.7%) from the ankle physiotherapy group had equinus deformity compared with seven (24%) from the POP backslab group, a difference which gives a P value of 0.029. Conclusions: Passive ankle physiotherapy with car tyre inner tube is a better and cheaper modality of preventing ankle equinus deformity and maintaining ankle range of motion.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Prevention of equinus deformity after external fixation for open tibia fractures: A comparison between plaster of Paris backslab and passive ankle physiotherapy

Lartey,

Holdbrook-Smith,

Baddoo

et al. 2023

J West Afr Coll Surg

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A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

Foote

Tornetta

Reito

et al. 2020

Journal of Bone and Joint Surgery

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Update This article was updated on February 9, 2021, because of a previous error. On page 269, in the Note at the end of the article, the surname that had read “Merner” now reads “Mener.” An erratum has been published: J Bone Joint Surg Am. 2021 Mar 17;103(6):e25. Background: Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. Methods: We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection. Results: We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). Conclusions: High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. Level of Evidence: Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.

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

Kouassi¹,

Manon²,

Fonkoué³

et al. 2021

Acta Orthop Belg

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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.

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Treatment Outcome of Open Tibial Shaft Fractures in A Teaching Hospital in Ghana

Cited by 3 publications

References 19 publications

Prevention of equinus deformity after external fixation for open tibia fractures: A comparison between plaster of Paris backslab and passive ankle physiotherapy

Prevention of equinus deformity after external fixation for open tibia fractures: A comparison between plaster of Paris backslab and passive ankle physiotherapy

A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

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

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