Morbidity of Open Tibia Fractures in Lagos, Nigeria.

Background: Open fractures of the tibia are complex injuries of bone and soft tissue. And on account of the open nature has a tendency to increase morbidity. The main objectives of this study was to determine peculiar issues in the management of open tibia fractures with regards to the pattern, aetiology and management outcome of treatment of open tibia fractures. Outcome measures included functional outcome, complications, morbidity and case fatality in our environment Lagos; Nigeria.
Methods: This prospective study was carried out at Lagos University Teaching Hospital (LUTH), Lagos Nigeria between July 2011 and June 2014. Demographic data, fracture related characteristics, aetiology, location radiologic features and microbiological cultures were collected. Diagnosis of open tibia fracture was based on clinical and radiological evaluation. Infection was diagnosed on the basis of a combination of clinical evidence\microbiological evidence (culture). All cases were followed up till discharge or death and subsequently in our out –patient clinic after discharge for 12months. Complications arising in the course of case management as well as functional outcome were documented.
Results: A total of 197 patients with open tibia fracture out of 6071 patients presenting to the accident and emergency department over 3 years period were reviewed. Open tibia fracture represented 3.24% of all presentation. 145 (73.6%) were male, while 52 (26.4%) were female with average age range from 1-90 years (mean 36.9±18.9years). The peak age of incidence was in the age bracket 21- 50years. Vehicular accident accounted for 78.2%, whereas other forms of injury accounted for 21.8%. The pattern of fracture was oblique 93 (47.2%), Transverse fracture 63(32%). while comminuted, segmental and spiral were 22(11.2%), 11 (5.6%) and 8 (4.1%) respectively the most common lesion was type II (49.2%) injury. The complication rate was 68 (34.5%) patients with wound infection accounted for 44(22.3%). Other complication observed included malunion 6.6%; nonunion 3%, four patients (2%) had amputation. Both of whom had Gustilo Anderson type III c Injuries with mangled extremities severity score greater than seven. The functional outcome was quite satisfactory.
Conclusion: This study has shown that open fracture pose some unique risks beyond those encountered with similar closed fractures that may occur with similar amount of force and that wound infection is the commonest complications. It also shows that morbidity is associated with injury severity.

Keywords
Open tibia fracture; Internal fixation; External fixator; Plaster of Paris (POP)