Tibial diaphyseal fractures: Aetiology, morphology and treatment approach in adult patients at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Tibial diaphyseal fractures (TDF) arise from various forms of trauma and assume various morphology or patterns. They are responsible for high morbidity and mortality despite the various treatment approaches. There is paucity of published research information regarding the tibial diaphyseal fractures in terms of the etiology, morphology and treatment approaches at MTRH, Eldoret. Objective: To analyze and establish the mechanism of injury, the resulting morphology and treatment methods of tibial diaphyseal fractures in adult patients seeking treatment at MTRH. Methods: This was a hospital based descriptive prospective study involving adult patients with tibial shaft fractures carried out at MTRH orthopedics wards and outpatient fracture clinic. Informed consent was obtained before enrollment. Consecutive sampling was used. Data collection was via interviews of patients, summary of file notes and patients x-ray interpretation entered into a standardized questionnaire and analysed using standard software for statistical analysis and computation (R Core Team, 2015). Association between categorical variables was assessed using Pearson’s Chi Square test. Results: A total of 89 patients with 93 TDF were recruited into the study. Median age was 28.0 (IQR: 24.0, 40.0) years with a minimum and maximum of 18 and 75 years respectively. Male participants were more than three quarters of the population with male to female ratio of 3.2:1. Most of the TDF (67.4%) were due to Road Traffic Accidents (RTAs); fall 16 (18.0%) and the least, gunshot 3 (3.4%). Up to 40.9% of the fractures were open type while (59.1%) were closed. Middle 1/3 tibia shaft was the commonest site of fracture at 52.7%. Fibula fracture was the most associated injury at 62.9%. Most fractures (61.6%) were managed operatively. Conclusion: Most participants were male. RTAs were the major cause of TDF with motorcycles injuries leading. Most TDF were closed type; mainly type A and at mid third level. Fibular fractures were the most associated injuries. Treatment to TDF was mainly surgical with locked intramedullary nail (SIGN). Recommendations: Education to the young males in the population on road safety. Maintain and strengthen the SIGN programme at MTRH as an implant of choice in the treatment of these fractures.