MANAGEMENT OF OPEN LEG FRACTURES IN A RESOURCE-LIMITED SETTING: A STUDY OF 32 CASES IN TOAMASINA
DOI:
https://doi.org/10.61841/2d8dhp93Keywords:
open fracture, leg, tibia, Gustilo-Anderson, Madagascar, traditional treatment, discharge against medical advice, traumaAbstract
Introduction: Open leg fractures are severe injuries, particularly in hospitals where implants, external fixators, operating-room access and soft-tissue coverage are limited. This study describes the patients, the treatments administered, and the early outcomes observed at two university hospitals.
Methods: A retrospective, two-center study of 32 eligible cases among 235 trauma admissions from January 1 to December 31, 2014. Sociodemographic, injury-related, therapeutic and early outcome variables were analyzed descriptively.
Results: The hospitalization rate was 13.6%. The mean age was 33.7 ± 14.2 years; 26 patients (81.3%) were male, and 23 (71.9%) were aged 15–44 years. Road traffic accidents accounted for 25 cases (78.1%), of which 22 were motorcyclerelated (88.0% of road traffic accidents). Lesions were mainly located in the middle third (56.3%), were segmental in 53.1%, and classified as Gustilo II in 62.5%. Infection was severe in 53.1%. Delays were prolonged: admission > 24 hours in 53.1%, debridement > 24 hours in 78.1%. Immobilization with a splint or cast was used in 56.3%, reflecting frequent use of conservative measures. Ten patients (31.3%) had received traditional treatment prior to admission, and six (18.8%) were discharged against medical advice, primarily due to financial constraints (3/6) or reliance on traditional treatment (2/6). Infection was present in 31.3% of cases, and bone union was delayed in 53.1%. Traditional prehospital treatment was associated, in a non-significant exploratory analysis, with a higher probability of discharge against medical advice (OR 6.67; 95% CI 0.97–45.80; p = 0.060) and infection (OR 3.40; 95% CI 0.69–16.69; p = 0.217). Conclusion: Open leg fractures primarily affected young men involved in motorcycle accidents. Delays, contamination, lack of stabilization resources, and the cost of care negatively impacted outcomes. Improvements require immediate antibiotic therapy, organized emergency debridement, subsidized access to fixators/implants, and dialogue with families regarding traditional treatment.
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Copyright (c) 2015 Randrianirina A, Ahmed AA, Rabesalama SEN, Rakotoarijaona AH, Solofomalala GD, Razafimahandry H.J.C (Author)
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