TITLE:
Epidemiological and Clinical Pattern of Open Fractures of Long Bones of the Lower Limbs in the South-West Region of Cameroon: A 5-Year Review
AUTHORS:
Chunteng T. Nana, Fokam Pius, Mokake N. Martin, Morane Mbongnu, Sam D. Movuh, Freddy Mertens Bombah, Ndasi Henry, Palle J. Ngunde, A. Chichom-Mefire
KEYWORDS:
Open Fractures, Long Bones, Lower Limb
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.11 No.9,
September
23,
2021
ABSTRACT: Background: An open fracture is an injury in which the fracture site and/or hematoma
communicates with the external environment. It is associated with significant morbidity
and disability and is a challenge to the surgical team. The lower extremities are
the most often exposed to traumatic injuries compared to other anatomical parts
of the body. Patterns of open fractures differ with different mechanisms of injury
and the segment of the long bone affected. The correct and timely management of
open fractures is beneficial to the patients and leads to a more favorable outcome. This study aimed at describing
the pattern of open fractures of long bones of the lower limb treated in 3 major
hospitals of the south west region, Cameroon. Methodology: This was a hospital-based
retrospective review of files of patients with open fractures of long bones of the
lower limb managed at the surgical units of three secondary health facilities in
the South-West region of Cameroon from the 1st of January 2015 to the
31st of December 2019. The socio-demographic characteristics, clinical
presentation, treatment modalities, and outcomes were recorded. The data was stored
and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. Results: A total of 195 files of patients aged 8 to 80 years were studied. The main age
group affected was between 20 - 40 years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases
(50.3%), the left
side was more involved. The tibia was the most common long bone affected in 75 (38.5%)
cases. Comminuted fracture was the most common fracture pattern encountered in 126
cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA.
External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases
(42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases
of limb shortening as the most common complications. Other complications include: 20 cases (17.1%) of mal-union,
27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%)
chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were
associated to chronic osteomyelitis (P = 0.02). Conclusion: Open fractures of long bones of the lower limb affect the active age group of
the population and road traffic crashes are the most common causes. It tends to affect the left
side and the tibia being the most fractured long bone. A reasonable proportion of
these fractures subsequently get infected. Comminuted fracture is the common fracture
pattern.