Disability can be avoided after open fractures in Africa—results from Malawi

• Published in: Injury Vol. 35; no. 9; pp. 846 - 851
• Main Authors: Bach, O., Hope, M.J., Chaheka, C.V., Dzimbiri, K.M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-09-2004; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Developing Countries; Disability after trauma; Diseases of the osteoarticular system; Dynamisation; External fixation; Femoral Fractures - surgery; Follow-Up Studies; Foot Injuries - surgery; Forearm Injuries - surgery; Fracture Fixation - instrumentation; Fracture Fixation - methods; Fracture Healing; Fractures, Open - surgery; Functional fracture treatment according to Sarmiento/Latta; Hand Injuries - surgery; Humans; Injuries of the limb. Injuries of the spine; Malawi; Medical sciences; Mycobacterium; Open tibial fractures; Posttraumatic osteitis; Soft tissue management; Tibial Fractures - surgery; Traumas. Diseases due to physical agents; Malawi; Africa; Open tibial fractures; Posttraumatic osteitis; Soft tissue management; External fixation; Dynamisation; Developing countries; Disability after trauma; Functional fracture treatment according to Sarmiento/Latta; Disability; Skin disease; Open fracture; Orthopedics; Diseases of the osteoarticular system; Anesthesia; Bone; Trauma; Resuscitation; Result
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2003.11.014

In a free-at source hospital in Malawi, East Africa, 55 open fractures were treated within a 3-year period. The majority (33/55) involved fractures of the lower leg. The treatment regimen contained the following: primary external fixation; scheduled sequential debridement; immediate coverage of any bone devoid of periosteum using local muscle or fasciocutaneous flaps, alternatively limb shortening; no skin closure; controlled secondary healing under moist dressings; dynamisation and/or removal of the external fixator followed by functional treatment (Sarmiento and Latta) as soon as the soft tissues permitted.
The first 34 consecutive cases were monitored from the time of treatment; 24 of them attended for clinical review at 36 (±16) weeks after injury. Only 72% (13/22) patients had reached the hospital within 24
h after sustaining the fracture; 80% (18/22) had developed a septic wound infection, which healed in all cases after 20 weeks. At the time of follow-up, recovery of function was found in 20 (80%) of the injured extremities. Only three patients (12%) remained disabled due to the open fracture, one other patient died during treatment from tuberculosis secondary to AIDS and one patient required knee disarticulation.
Conclusion: If the biological principles guiding the contemporary treatment of open fractures in the first world are respected, results under third world conditions do not differ as much as the differences in setting might suggest. The application of recent advances of global knowledge in trauma surgery into methods of treatment appropriate to the health care systems of highly resource constraint countries remains a rewarding task for modern trauma surgeons and their scientific community.