Outcome of a 2-stage management of open tibia fracture in a low-income country lacking plastic surgeons: A retrospective cohort study

Background

Given the multiple constraints preventing optimal management of open tibia fracture (OTF) and lack of plastic surgeons in the entire country, we developed a two-stage approach. This study aimed to assess the outcome of this approach and identify factors influencing the outcome.

Methods

Consecutive series of 158 patients with OTF managed according to our two-stage protocol, with a minimum follow-up period of 12 months, from July 2015 to June 2021 ​at a tertiary care hospital in Yaoundé (Cameroon), were retrospectively reviewed. Patients were invited to return for a prospective ultimate radio-clinical evaluation. Main outcomes included bone union, functional status, severe complications and reoperation rate. Multivariate logistic regression was used to determine the independent predictors of severe complications.

Results

The mean follow-up period was 30.02 ​± ​17.05 months. Surgical site infection (SSI) was the main early complication, found in 44 (36.4%) cases. The main delayed complications was fracture-related infection in 36 (29.8%) cases. At final follow-up, only 64 (52.9%) patients had achieved bone union without any complication. The reoperation rate was 36.02%. Severe complications at final follow-up included nonunion in 13 (10.3%) patients, chronic osteomyelitis in 17 (14%) patients and amputation in 5 (4.1%) patients. In multivariable logistic regression, the only independents predictors of severe complications were severe OTF [OR ​= ​0.08, 95%CI: 0.02–0.30, P ​< ​0.001] and SSI [OR ​= ​4.53, 95%CI: 1.36–15.02, P ​< ​0.01].

Conclusion

Despite the progress observed with our 2-stage approach, nearly half of patients still develop complications. This study highlights the need for orthoplastic approach of OTF in developing countries.