Assessment of applicability of Ganga Hospital Score in the management of open tibia fracture.

Aims: Open fractures of the tibia encompass a wide spectrum of injuries, posing multiple challenges for treating surgeons. This study evaluates the Ganga Hospital Open Injury Severity Score (GHOISS) in predicting the outcomes of open tibia fractures in Rwanda, focusing on its ability to guide wound management choices and assist in decision-making between preservation and amputation.

Methods: This was a prospective cohort study conducted between March and September 2022 in Kigali, Rwanda, involving patients aged 18 years and older with open tibial fractures. The GHOISS was calculated, and the patients were organized into three groups: Group I: score 1 to 13; Group II: score 14 to 16; and Group III: score ≥ 17. Outcome data were collected at one and six months of follow-up. The predictive validity of the GHOISS was determined through sensitivity, specificity, and predictive values. Correlation and analysis of variance (ANOVA) tests were also conducted to compare groups. Ethical considerations were respected, and institutional review board approval was obtained.

Results: The study involved 111 participants, with a mean age of 34 years (18 to 80) and a male-to-female ratio of 3.44:1. The amputation rate was 10 (9.0%), with a mean hospital stay of 30.55 days (SD 34.09). The infection rate was 54.05%, and the need for soft-tissue reconstruction was 36.9%. The GHOISS in predicting the amputation showed high sensitivity of 100% and sensitivity of 96.03%, with a positive predictive value of 71.4% and negative predictive value of 100%. ANOVA revealed significant differences between the groups (F (2,108) = 21.12; p < 0.001), and a strong positive correlation was found between the covering tissue score and the need for soft-tissue reconstruction.

Conclusion: The GHOISS demonstrated a remarkable ability to predict amputation and salvage in open tibia fractures and the potential for predicting related outcomes. The GHOISS subscore, which assesses skin and covering injuries, has shown a significant ability to predict the need for soft-tissue reconstruction.