Patterns of open tibia fractures and outcomes of intramedullary fixation using surgical implant generation network nail at Moi Teaching and Referral Hospital

Abstract

Background: Open tibial fractures are common and severe injuries that are frequently complicated by infection. Surgical fixation of these fractures with locked intramedullary nails has been shown to have good outcomes in both developed and low- and middle-income countries alike. With the steady rise in the number of open tibial fractures (12 treated in 2005 and 36 in 2014) seen at Moi Teaching and Referral Hospital (MTRH) and the proven economic burden of these injuries on the patient, the search for the best method to manage open tibial fractures at MTRH is a priority. The Surgical Implant Generation Network (SIGN) nail is a solid locked intramedullary nail and has been used increasingly in the management of open tibia fractures at MTRH, since its introduction in 2005.Although used in the management of open tibia fractures, the treatment outcomes of the SIGN nail are undocumented. Objectives: To quantify the treatment outcomes by infection rate and union rate and functional outcome using the Euroquol-5Dimension-3Level instrument following SIGN nail fixation of open tibia fractures in MTRH. Methods: Adult patients presenting with open tibia fractures that received SIGN nail surgery at MTRH between July 2015 and September 2016 were recruited. The study design was prospective descriptive with each patient followed at 6-week intervals over 6 months and examined for complications. The study was approved by the Institutional Research and Ethics Committee (IREC). Data was collected using a structured interview and clinical examination and analysed using SPSS v 23 and results were presented in tables and charts. Results: There were 52 patients with 52 open tibial fractures with 3 lost to follow up and 2 with incomplete data. Median age was 29, IQR 23-38. Ninety-one percent of patients were male. Road traffic accidents were the most common cause. The infection rate was 8.5%, with infection present in Grade II and Grade IIIA fractures only. The union rate was 79% at 6 months. The mean index score for EQ5D 3L was 0.905(maximum score is 1.000), with 72% of patients reporting no problems with mobility. Conclusions: The infection rate following SIGN nail fixation was low and the union rate was high. Majority of patients reported good outcomes. Recommendations: The SIGN nail is safe and effective for use in grade I to grade IIIA open tibial fractures at MTRH. Further studies into treatment outcomes in Grade IIIB and Grade IIIC fractures needed.