An audit on open tibia fracture management at a tertiary level ortho-plastic center in Sri Lanka: are we following current guidelines?

Abstract

Introduction Despite the availability of guidelines for the surgical management of open tibia fractures set out by developed countries, the adherence of the surgical teams to current recommendations is explored sparsely in resource-poor surgical settings. Here, we report current practice and ortho-plastic care gaps at managing open tibia fractures at the National Hospital of Sri Lanka [NHSL].

Methods An audit was conducted on patients with open tibia fractures presenting to the NHSL. We explored if the ortho-plastic management practices adhere to the recommendations of the standard international guidelines.

Results Thirty patients with compound fractures of the tibia were analyzed. The majority [n=12, 40%] had Gustilo-Anderson type 2 injuries. The median time of presentation from the injury was 2h [IQR=2.5h]. Only 50% of the patients received the first dose of antibiotics within three hours of injury. Initial wound debridement was conducted after a median time of 4.5h [IQR=2.2h] after admission. Only 16.6% of procedures liaised with the plastic surgical team. The median flap cover time was 10 [IQR=4] days. None of the patients underwent simultaneous internal fixation and soft tissue cover by orthopaedic interventions.

Conclusions Timely antibiotic prophylaxis for open tibia fractures was achieved only in 50% of the patients due to late presentation. There were divergences from the current recommendations in the timing of soft tissue debridement and simultaneous ortho-plastic interventions, probably due to limited facilities, theatre time and relatively high patient load. We recommend strengthening ortho-plastic approaches and developing national guidelines for open tibia fracture management which could help improve surgical outcomes.