ArticlePlastic and reconstructive surgery. Global open2020
The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania.
Article in Plastic and reconstructive surgery. Global open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Predictors of quality of life, economic impact, and loss to follow-up after open tibial shaft fractures in Ghana.OTA international : the open access journal of orthopaedic trauma · 2024Article
- Open tibial shaft fractures: treatment patterns in sub-Saharan Africa.OTA international : the open access journal of orthopaedic trauma · 2023Article
- Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings.OTA international : the open access journal of orthopaedic trauma · 2022Article
- Minimizing treatment complexity of combat-related soft tissue injuries using a dedicated tension relief system and negative pressure therapy augmented by high-doseBurns & trauma · 2021Article
- A Cost-Effectiveness Analysis of Intramedullary Nailing Versus External Fixation for Open Tibial Fractures in Tanzania.JB & JS open accessArticle
- An Assessment of Open Fracture Management in Hospitals in Malawi Before and Immediately After Implementing Open Fracture Guidelines.JB & JS open accessArticle
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Authors and funding
6 authors.
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Abstract
Managing lower extremity fractures complicated by large soft-tissue defects is challenging for surgeons in low- and middle-income countries, and long-term quality of life (QOL) for these patients is unclear.
methodsWe examined QOL, surgical complications, and longitudinal outcomes in 10 patients with Gustilo-Anderson Classification Type IIIB open tibia fractures seen at an orthopedic institute in Tanzania, from December 2015 to March 2017. Patients completed follow-up at 2-, 6-, 12-, 26-, and 52-week time points, and returned for qualitative interviews at 2.5 years. The primary outcome was QOL, as measured using EuroQoL-5D scores and qualitative semi-structured interview responses. The secondary outcome was rate of complication, as defined by reoperation for deep infection or nonunion.
resultsTen patients enrolled in the study and 7 completed 1-year follow-up. All fractures were caused by road traffic accidents and treated by external fixation. No patients received initial soft-tissue (flap) coverage of the wound. All patients developed an infected nonunion. No patients returned to work at 6 weeks, 3 months, or 6 months. EQ-5D index scores at 1 year were poor (0.71 ± 0.09). Interview themes included ongoing medical complications, loss of employment, reduced income, and difficulty with activities of daily living.
conclusionsPatients in low- and middle-income countries with IIIB open tibia fractures not treated with appropriate soft-tissue coverage experience poor QOL, high complication rates, and severe socioeconomic effects as a result of their injuries. These findings illustrate the need for resources and training to build capacity for extremity soft-tissue reconstruction in LMICs.
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