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Early Outcomes of Open Tibial Shaft Fracture Management at a Tertiary Orthopaedic Hospital in Nigeria: A Prospective,
Kenneth Nzekwe1, Kenechi Anthony Madu2, Chisom Oscar Uzuegbunam2
1Department of Orthopaedics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
Background:
Management of open tibial shaft fractures in resource-poor settings presents significant challenges, yet prospective data on treatment outcomes in Sub-Saharan Africa remain limited. These injuries, often resulting from high-energy trauma, carry substantial risks of non-union, deep infection, and long-term disability. In Nigeria, care pathways are frequently adapted due to constraints including cost, implant availability, and limited access to subspecialist care.
Aims:
This study prospectively evaluates early (6-month) healing outcomes, infection rates, and associated modifiable factors in patients with open tibial shaft fractures managed at a tertiary orthopaedic hospital in Enugu, Nigeria, to identify targets for quality improvement in trauma care delivery.
Methodology:
A prospective, observational study was conducted on 71 consecutively enrolled adult patients with 78 open tibial fractures, managed via a standardised protocol. Primary outcomes were early fracture healing status, surgical site infection (SSI), and length of hospital stay (LOHS). Statistical analyses used fracture as the primary unit of analysis, except for demographic comparisons (per patient). Bivariate tests and multivariate regression identified predictors of outcomes.
Results:
Of 50 fractures completing follow-up, early union was observed in 68%, with delayed healing in 22% and early non-union in 10% at 6 months. Mean time to union was 16.5 weeks. Overall SSI rate was 44% (22/50), of which 5 were superficial and 17 deep infections ( P =0.023). Gustilo-Anderson Grade IIIB injury ( P =0.001) and presentation >24 hours post-injury ( P =0.025) were key factors associated with impaired early healing. SSI was strongly associated with delayed wound cover >7 days ( P =0.003) and severe injury grade. LOHS (mean 38.5 days) was significantly prolonged by infection, severe injury, and treatment delays. Attrition analysis showed no significant demographic differences between patients who completed follow-up and those lost.
Conclusion:
This study highlights high early complication rates of open tibial fractures in resource-constrained settings. Findings underscore the critical importance of timely patient presentation, expeditious soft-tissue cover, and robust infection prevention protocols. These modifiable factors represent clear targets for systemic improvement in trauma care delivery.
