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.