Early Management of Open Tibial Fractures in Benin - City - Result of a Structured Treatment Protocol

Open fractures of the tibia shaft are caused by major musculoskeletal injury, most times high energy transfer trauma. The determinants of a successful treatment outcome are effective infection control, skin coverage and adequate stabilization. We evaluated the outcome of a structured management protocol based on the afore mentioned determinants carried out on 39 patients with 39 open tibial shaft fractures. The fractures were categorized as type I - III^C based on Gustillo Anderson Classification. There were 2 (5.1%) type I, 17 (43.6%) type II, 9 (23.1%) III^A, 8 (20.5%) III^B and 3 (7.7%) of III^C. The treatment outcome in each group was evaluated on the basis of primary wound healing and fracture union in line with the method of treatment chosen in the protocol.
Overall, primary wound closure was done in 17 (43.6%) in types I, II and III^A with a 100%, 60% and 22% primary wound healing respectively. 15.4% wounds in type II and III (4 and 2 respectively) treated by delayed (primary) suturing proceeded to heal primarily. The success or healing rate with primary wound closure for types I & II was significantly high (x². 8.743, of 2 P. 0.013) P<0.05 when compared with the overall outcome of cases treated with primary closure in other groups.
Of 11 cases in type III^B and III^C (8 and 3 respectively) who had delayed split thickness skin graft or fascio-cutanous flaps as primary procedure, 50% had successful graft take.
Plaster of Paris was successfully used in 12 patients (30%) with predominantly type I & II fractures. Primary intramedullary nailing was carried out in 13 (33.3%) cases out of which 69% proceeded to union.