Abstract:

Background: Urgent debridement of open fractures has been considered to be of paramount importance for the prevention of infection. There is no scientific study done in Mwanza on the timing of surgical debridement basing on the “6 hour rule”. Therefore, the purpose of this study was to evaluate the relationship between the timing of surgical debridement of open fractures and the outcome among these patients.

Methods: A prospective study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at Bugando Medical Centre (BMC) and operated early (within 6 hours) or late (more than 6 hours). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11.

Results: A total of 143 patients were enrolled in the study with more than half being males, 89 (62.2%) giving a male to female ratio of 1.6: 1. Road traffic accident (RTA) was the most common of fractures (67.8%). Majority of the patients, 91 (63.6%) had Gustillo-Andersom grade II and the timing of debridement was significantly associated with this grading (p-value=0.005). Nine (6.3%) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5-10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group (7.5%) versus 4.8% respectively, p-value = 0.503) and LOS was also longer in the late group compared to the early group [7 (6-11.5) days and 6 (5-10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI.

Conclusion: Open long bone fracture attributable to RTA are common. The findings of more SSI and longer LOS in the late group implies increased risk of complications in this group necessitating the need for early surgical debridement in this group so as to reduce infections as shown in this study. However infection rate was low and comparable to other countries.