Open tibial shaft fractures: treatment patterns in sub-Saharan Africa
Abstract. Objective:. Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented. Meth...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2023-06-01
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| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000228 |
| _version_ | 1827805149400137728 |
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| author | ORCA Study Group |
| author_facet | ORCA Study Group |
| author_sort | ORCA Study Group |
| collection | DOAJ |
| description | Abstract. Objective:. Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented.
Methods:. A survey was distributed to orthopaedic service providers across sub-Saharan Africa. Information gathered included surgeon and practice setting demographics and treatment preferences for open tibial shaft fractures across 3 domains: initial debridement, antibiotic administration, and fracture stabilization. Responses were grouped according to country income level and were compared between LMICs and upper middle-income countries (UMICs).
Results:. Responses from 261 survey participants from 31 countries were analyzed, with 80% of respondents practicing in LMICs. Most respondents were male practicing orthopaedic surgeons at a tertiary referral hospital. For all respondents, initial debridement occurred most frequently in the operating room (OR) within the first 24 hours, but LMIC surgeons more frequently reported delays due to equipment availability, treatment cost, and OR availability. Compared with their UMIC counterparts, LMIC surgeons less frequently confirmed tetanus vaccination status and more frequently used extended courses of postoperative antibiotics. LMIC surgeons reported lower rates of using internal fixation, particularly for high-grade and late-presenting fractures.
Conclusions:. This study describes management characteristics of open tibial shaft fractures in sub-Saharan Africa. Notably, there were reported differences in wound management, antibiotic administration, and fracture stabilization between LMICs and UMICs. These findings suggest opportunities for standardization where evidence is available and further research where it is lacking.
Level of Evidence:. VI—Cross-Sectional Study. |
| first_indexed | 2024-03-11T21:20:27Z |
| format | Article |
| id | doaj.art-f776b5967a57400c9ad162d77a2a6f88 |
| institution | Directory Open Access Journal |
| issn | 2574-2167 |
| language | English |
| last_indexed | 2024-03-11T21:20:27Z |
| publishDate | 2023-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj.art-f776b5967a57400c9ad162d77a2a6f882023-09-28T07:17:33ZengWolters KluwerOTA International2574-21672023-06-0162e22810.1097/OI9.0000000000000228OI90000000000000228Open tibial shaft fractures: treatment patterns in sub-Saharan AfricaORCA Study GroupAbstract. Objective:. Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented. Methods:. A survey was distributed to orthopaedic service providers across sub-Saharan Africa. Information gathered included surgeon and practice setting demographics and treatment preferences for open tibial shaft fractures across 3 domains: initial debridement, antibiotic administration, and fracture stabilization. Responses were grouped according to country income level and were compared between LMICs and upper middle-income countries (UMICs). Results:. Responses from 261 survey participants from 31 countries were analyzed, with 80% of respondents practicing in LMICs. Most respondents were male practicing orthopaedic surgeons at a tertiary referral hospital. For all respondents, initial debridement occurred most frequently in the operating room (OR) within the first 24 hours, but LMIC surgeons more frequently reported delays due to equipment availability, treatment cost, and OR availability. Compared with their UMIC counterparts, LMIC surgeons less frequently confirmed tetanus vaccination status and more frequently used extended courses of postoperative antibiotics. LMIC surgeons reported lower rates of using internal fixation, particularly for high-grade and late-presenting fractures. Conclusions:. This study describes management characteristics of open tibial shaft fractures in sub-Saharan Africa. Notably, there were reported differences in wound management, antibiotic administration, and fracture stabilization between LMICs and UMICs. These findings suggest opportunities for standardization where evidence is available and further research where it is lacking. Level of Evidence:. VI—Cross-Sectional Study.http://journals.lww.com/10.1097/OI9.0000000000000228 |
| spellingShingle | ORCA Study Group Open tibial shaft fractures: treatment patterns in sub-Saharan Africa OTA International |
| title | Open tibial shaft fractures: treatment patterns in sub-Saharan Africa |
| title_full | Open tibial shaft fractures: treatment patterns in sub-Saharan Africa |
| title_fullStr | Open tibial shaft fractures: treatment patterns in sub-Saharan Africa |
| title_full_unstemmed | Open tibial shaft fractures: treatment patterns in sub-Saharan Africa |
| title_short | Open tibial shaft fractures: treatment patterns in sub-Saharan Africa |
| title_sort | open tibial shaft fractures treatment patterns in sub saharan africa |
| url | http://journals.lww.com/10.1097/OI9.0000000000000228 |
| work_keys_str_mv | AT orcastudygroup opentibialshaftfracturestreatmentpatternsinsubsaharanafrica |