Primary and Delayed Primary Wound Closure in Low Energy Open Tibia Shaft Fracture: Randomized Controlled Study

Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, primary wound closure is still not frequently used even for the treatment of low-energy open tibia shaft fractures especially in developing countries.

Sixty-four patients with GustiloAnderson type I and II tibia fractures were recruited for this randomized prospective intervention study to compare the infection rate, duration of wound healing, duration of hospital stay, and cost of treatment between primary and delayed primary wound closure. We randomized 68 patients into two blocks of 34 participants each using a randomization plan generated on the website, randomization.com. Each random number in a sealed serially numbered brown envelope. Clinical information and clinical findings were entered into a proforma, and data obtained were analyzed.

The majority of cases, 54 (84.4%), were Gustilo-Anderson type II. The infection rate was higher for primary wound closure (9.6%) than for delayed primary wound closure (3.0%). The mean duration of wound healing was 14.8 (±3.8) days for primary wound closure, which was significantly shorter than the 16.1 (±2.0) days recorded for delayed wound closure (p= 0.08). Also, the mean duration of hospital stay was shorter for patients treated with primary wound closure (4.1 ±3.6) days than for delayed wound closure patients 4.7 (±1.3); with a p value of 0.37. The mean cost of treatment for primary wound closure (N34,487 ±4911.4) was significantly less than that for delayed primary wound closure (N 40,536 ±1709.0), with a p-value of 0.01.

Primary wound closure for low-energy open tibia shaft fractures is both more cost-effective and associated with a shorter time to wound healing compared to delayed primary closure. Therefore, primary wound closure should be used for low energy tibia shaft fracture even in low and middle-income countries. KEY WORDS: Open fracture, Tibia shaft, Wound closure, Management.