Open fractures present a significant challenge to the patient and his family and the managing surgeons. Open fracture often results from high energy injuries such as road traffic crashes, gunshot injuries, falls from heights and high-speed sports. Open fractures are associated with life-threatening and limb threatening injuries and are often associated with complications such as infection, malunion, and non-union. Controversies abound in the pattern of presentation, management, and outcome of open fractures. This study aims to evaluate the pattern of presentation, treatment, and outcome of open fractures treated in a regional trauma centre in Nigeria.
Prospectively collected data of all cases of open fractures treated at the Regional trauma centre from 1st January 2007 to 31st December 2012 was evaluated to determine the pattern of presentation, treatment given and outcome of the cases. Cases of open fractures referred to other centres or those that died shortly on arrival before treatment was commenced were excluded. Descriptive statistics of the obtained result was generated and presented in tables and scientific figures while inferences were drawn as considered appropriate.
The total number of the cases were open fractures seen at the centre during the period under evaluation was 1758 which constituted (39.10%) of all the fractures seen at the centre during the period. Persons between the ages of (21-30) years were the highest affected group with open fractures at the centre (706, 40.2%) while children and persons older than 60 years contributed 67 (3.8%) and 45 (2.6%) respectively. The male to female ratio was 4.3:1. A significant proportion of the cases resulted from road traffic crashes (1262, 71.8%) while gunshot injuries contributed 313 (17.8%) of the cases. Type I and II open fracture constituted (587, 33.4%), and (500, 28.4%) respectively while types III open fractures represented 671 (38.2%) of the cases and a significant proportion of the cases involved the tibia (869, 41.4%). Most of the fractures were treated by external fixation (731, 41.6%) but 38 (2.2%) cases had amputation. The most frequent complication was infection in 126 of the cases (7.2%). The length of hospitalization, duration to fracture union and occurrence of infection were all significantly related to the severity of the open fracture.
Open fractures are relatively common at the centre particularly amongst males in the age group of (21-30) years and often result from high energy injuries such as road traffic crashes and gunshot injuries. Adherence to established principles of management produces acceptable outcome even in the face of limited resources. Preventive approach for open fractures will require increased advocacy on road safety and stricter control of light weapons and criminality in the region.