The burden of open fractures of the tibia in a developing economy

Background and purpose of study : Open fractures are difficult to treat particularly because of the risk of infective complications. The rudimentary emergency rescue services in a developing country like ours with attendant delays in presentation of patients amongst other factors would suggest a dismal outcome for open tibial fractures in Nigeria. Patients and methods : Ninety two patients with 98 open tibial fractures who presented to the University College Hospital (UCH), Ibadan over a 12-month period were reviewed. The aetiology and severity of these fractures were explored as well as the treatment outcomes. Result : The mean age was 33.3 years (peak 21-40 years) with men being 2.4 times at risk. Eighty three percent were from road traffic injuries; pedestrian crashes led other traffic injuries with 32% of cases. A quarter of the patients presented after 8 hours of injury. Three quarters of the fractures occurred in the shaft. Gustilo type IIIb injuries was the commonest (36.7%). The methods of treatment included plaster cast (71.5%), external fixation (15.7%), plating and primary amputation (5.7% each), and  intramedullary nailing (1.4%). Average time to union was 26.2 ± 12.7 weeks. Forty six late complications occurred in 32 fractures (there were 6 cases of chronic osteomyelitis). Conclusion : The incidence and severity of open fractures in our environment calls for urgent steps geared towards reducing the incidence of road crashes. The provision of standard, prompt and affordable emergency as well as definitive health care facilities for the victims should be a priority.