Outcomes of openlong bone fractures in patients treated with external fixators at Moi Teaching and referral Hospital, Eldoret, Kenya

Abstract

Background: Open fractures result from high energy trauma with the long bones being most commonly affected. Because they are minimally invasive, available and allow for concomitant management of soft tissue injuries, external fixators are the treatment modality of choice for these injuries. Once the scope concerning usage of temporary external fixators, clinical and radiological outcomes including complication rates is achieved, it will benefit the patients, clinicians and Moi Teaching and Referral Hospital (MTRH) as an institution. Objective: To describe the outcomes of open long bone fractures treated using external fixators at MTRH, Eldoret, Kenya. Methods: This was a prospective descriptive census study conducted among adult and paediatric patients with open long bone fractures treated using external fixators at MTRH between November 2015 and October 2016. An interviewer-administered questionnaire was used for data collection. Data on characteristics and aetiology of open fractures, temporary use of external fixators, pain scores, union, non-union and pin-site infection rates were recorded. Categorical variables were summarised using frequencies and percentages. Continuous variables were summarized using mean and standard deviations. Data was analysed using R statistical package (R Core team 2017). Mann Whitney U, Fisher‘s exact, post-hoc and Chi-square tests were used to assess the associations. Results: A total of 95 patients were recruited in the study. Mean age of the patients was 37.3 years (SD: 15.2). Male patients were 78 (82.1%). Gustilo-Anderson type III fractures were seen in 58 patients (61.1%). Only modular type of external fixators was used. Forty (42.1%) patients had temporary external fixators converted to mostly intramedullary nailing 24 (60%) and plating 12 (30.0%). There was a statistical difference in mean pain score between all review periods (p < 0.001). Those who had delayed union were significantly older (p= 0.033). There was a statistically significant association between non-union and severity of open fractures (p= 0.003). Major early complications included superficial infections affecting 22 (23.1%) patients and 7 (7.3%) had peripheral nerve injuries. Major Late complications included non-union seen in 23 (44.2%) of patients and 15 (28.9%) delayed union. Pin-site infection rate was 67 (70.5 %). Five (9.6%) patients had complete union. There was a statistical difference between severity of fractures and outcomes (p= 0.0028). Conclusions: All patients were treated with modular external fixators. Major clinical and radiological outcomes included pin-site infections, non-union and delayed union. Low union rate was seen at 6 months. Recommendations: Modular external fixator is optimal for temporary use, thus are not suitable for definitive management. More research to be carried out in areas such as pin-site infection and non-union post external fixation in order to improve patient care.