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Tibia

Session: ITCF Podium Session IV: Lower Extremity

Predictors of Clinical Outcomes for Open Tibia Fracture Management Across Latin America: A Prospective Multinational Study

Wednesday, October 18, 2023
4:15 PM - 4:21 PM PST
Location: 608-609
Purpose: Open tibia fractures represent a growing cause of orthopaedic morbidity in Latin America, a region with the highest worldwide rates of reported road traffic accidents. Despite the rise in the incidence of such injuries, limited literature exists on the management of open tibia fractures in this region. This study prospectively assessed open tibia fracture treatment practices throughout Latin America and identified factors associated with improved clinical outcomes.

Methods: A 12-month prospective observational study was conducted across 19 trauma centers in 8 Latin American countries. Adult patients with AO/OTA type 42 open tibial shaft factures were eligible for inclusion. Patients were enrolled and treated according to local surgeons’ preference. Demographics, medical history, injury characteristics, and treatment patterns were collected. Follow-up data were reported at 2, 6, 12, 26, and 52 weeks post-injury.

Results: In total, 423 patients were consented and enrolled with 295 (69.7%) completing follow-up at 1 year. Of those patients who completed follow-up, the average age was 34.1 years, and the majority were male (84.7%). Most fractures were Gustilo-Anderson Type II (59.7%), followed by Type IIIA (23.1%), and Type I (11.8%). Road traffic accidents were the most common cause of injury (81.0%) and most patients traveled less than 25 km for definitive care (72.5%). Only 44.7% of patients received definitive fixation at the time of their initial treatment. Patients’ initial treatment was nonoperative management with splinting/cast (33.9%), followed by intramedullary fixation (33.9%) and external fixation (29.8%). Intramedullary nailing was the most common definitive fixation method (81.3%). Univariate analysis showed there was no association between deep infection and socioeconomic predictors of education level and insurance status. However, there was a relationship observed between nonunion and education level (P = 0.03) and insurance status (P = 0.02).

Conclusion: This study represents the largest prospective multicenter, multinational study evaluating open tibia fracture management in Latin America, demonstrating feasibility of such studies in the region. This work described the demographics of patients sustaining these injuries, their initial and definitive management, and outcomes including complications. Surgeons demonstrated a preference for staged treatment of open tibia fractures with definitive fixation using intramedullary nails. There was an association between several socioeconomic predictors and tibial nonunion, which will guide future investigation.