The Management of open Tibial Fractures

No study has been done in Zambia on external fixation of fractures. The objectives of this study therefore are to show the outcome of external fixation of open tibial fractures and whether or not tap water is as effective as normal saline in wound irrigation (lavage).
This study was done at the University Teaching Hospital, Lusaka, and Saint Francis' Hospital, Katete. Twenty-nine patients, 30 legs, were randomly recruited to the
study using pre-labelled proformas as "tap water" (study
group) and "normal saline" (control group).The study group (17 legs) and control group (13 legs) were subjected to a similar line of management except for the type of fluid in wound irrigation. Ten litres of tap water and six litres of saline were used for wound irrigation respectively. Most patients were managed and followed up by the investigator. Seven of the 29 patients received primary external fixation up to the time of discharge. Nine had plaster casts primarily until they finally healed. The others, however, had a combination of plaster casting and external fixation.
The average age of patients was 27 years with a sex ratio of M:F; 5:1. RTA was the commonest cause of injury. The middle third of the tibia was affected most. Pedestrians suffered open tibial fractures most. Ipsilateral fibular fracture was common.
Complications were equinus deformity of the foot in two legs; maximum limb shortening was 2.5 cm in four legs (types II and III) . Five legs of 11 (control) and 9 of 17 (study) suffered superficial wound infection respectively while 1 leg of 11 (control) and 6 of 17 (study) had chronic osteomyelitis. This study shows that external fixation is a good method of managing open tibial fractures and that large volumes of tap
water should be used for wound debridement (in these fractures).