OJEM  Vol.2 No.3 , September 2014
Time Management of Open Lower-Leg Fractures in Morocco
ABSTRACT
Background: It is recommended that the management of open lower-leg fractures should occur within six hours to avoid complications affecting both prognosis and functionality. This study aimed to evaluate the time taken for each step of management, identify causes of delay, and propose solutions to reduce the rate of complications. Patients and methods: This was a prospective study involving 153 patients treated from January 2011 to December 2012. Standardized data collection forms documented the times taken for each management step from the accident until surgical intervention. Results: For patients admitted directly to our institution, median time to surgical debridement from arrival was 5 hours. Median time for bone fixation was 24 hours. External fixation was used in 119 patients. There were several causes of delay; lack of financial resources was the most common. Certain causes of delay were significantly correlated with time to debridement. However, although 86.7% of patients who developed an infection had a time from injury to debridement greater than six hours, there was no statistically significant association between infection and delay beyond six hours (p = 0.403). Conclusion: By identifying causes of treatment delay, we hope to be able to avoid complications, and therefore reduce the socio- economic impact of these important surgical emergencies.

Cite this paper
Magoumou, A. , Andaloussi, Y. , Fahsi, S. , Hiba, O. , Fadili, M. , Nechad, M. , Ouarab, M. , Widad, F. , Nani, S. , Hassoune, S. and Maaroufi, A. (2014) Time Management of Open Lower-Leg Fractures in Morocco. Open Journal of Emergency Medicine, 2, 53-61. doi: 10.4236/ojem.2014.23010.
References
[1]   Pollak, A.N. (2006) Timing of Debridement of Open Fractures. Journal of the American Academy of Orthopaedic Surgeons, 14, S48-S51.

[2]   Moyikoua, A., Oko, N., Buang, B. and Mondzoto, J. (1992) Résultats du traitement initial des fractures ouvertes récentes des membres. Médecine d’Afrique Noire, 39, 755-761.

[3]   Court-brown, C.M., Bugler, K.E., Clement, N.D., Duckworth, A.D. and McQueen, M.M. (2012) The Epidemiology of Open Fractures in Adults. A 15-Year Review. Injury, 43, 891-897. http://dx.doi.org/10.1016/j.injury.2011.12.007

[4]   Zryouil, B., Dkhissi, M., Ouarab, M. and Trafeh, M. (1990) La fixation externe dans les fractures ouvertes de jambe. Rev. Maroc. Chir. Orthop. Traumato, 1, 74-79.

[5]   Hohmann, E., Tetsworth, K. and Radziejowski, M.J. (2007) Comparison of Delayed and Primary Wound Closure in the Treatment of Open Tibial Fractures. Archives of Orthopaedic and Trauma Surgery, 127, 131-136. http://dx.doi.org/10.1007/s00402-006-0222-6

[6]   Beltsios, M., Savvidou, O. and Kovanis, J. (2009) External Fixation as a Primary and Definitive Treatment for Tibial Diaphyseal Fractures. Strategies in Trauma and Limb Reconstruction, 4, 81-87. http://dx.doi.org/10.1007/s11751-009-0062-3

[7]   Ashford, R.U., Mehta, M. and Cripps, R. (2004) Delayed Presentation Is No Barrier to Satisfactory Outcome in the Management of Open Tibial Fractures. Injury, 35, 411-416. http://dx.doi.org/10.1016/S0020-1383(03)00236-5

[8]   Be, J., Agoh, S., Goulibaly, A., Kone, S. and Bana, A. (2001) L’enclouage centromédullaire des fractures ouvertes de jambe stade II, au delà de la 6ème heure. Rev.Maroc.Chir.Orthop.Traumato., 11, 33-37.

[9]   Leong, C.M., Leong, A.P.K. and Low, B.Y. (1988) Management of Open Tibia Fractures. Singapore Medical Journal, 29, 42-44.

[10]   Janniere, D. and Carli, P. (1995) Organisation des SAMU et SMUR, et la Réanimation pré hospitalière. In: Samii k-Anesthésie réanimation chirurgicale, 2th Edition, Flammarion Médecine et science, Paris, 1607-1700.

[11]   Souna, B.S., Ganda, S., Amadou, S. and Abdoulaye, A. (2008) Le fixateur externe de Hoffmann dans la prise en charge des fractures ouvertes de jambe à Niamey. Mali Medical, 23, 11-15.

[12]   Namdari, S., Baldwin, K.D. and Matuszewski, P. (2011) Delay in Surgical Debridement of Open Tibia Fractures: An Analysis of National Practice Trends. Journal of Orthopaedic Trauma, 25, 140-144.

[13]   Kamat, A.S. (2011) Infection Rates in Open Fractures of the Tibia: Is the 6-Hour Rule Factor Fiction? Advances in Orthopaedics, 2011, Article ID: 943495.

[14]   Potier, L. (2011) Couverture et reconstruction des segments osseux du membre inférieur à l'h?pital principal de Dakar. Ma?trise orthopédique.

[15]   Hanhart, W.A., Malinverni, R. and Kehtari, R. (2006) Enquête sur les délais d’attente au Centre médico-chirurgical d’urgences, H?pital des Cadolles, Neuchatel. Revue Médicale Suisse, 10, 2429-2433.

[16]   Muhr, G. (1991) Therapeutic Strategies in Fractures with Soft Tissue Damage. Chirurg, 62, 361-366.

[17]   Jarrar, M., Khlifi, S., Amor, W.B., El Afrit, S. and Ghannouchi, S. (2005) L’accueil et la durée de la prise en charge des patients au service des urgences du CHU Farhat Hached. Journal Maghrébin D’anesthésie-Réanimation et de Mé- decine D’urgence, 15, 251-257.

[18]   Buteera, A. and Byimana, J. (2009) Principles of Management of Open Fractures. East and Central African Journal of Surgery, 14, 2-8.

[19]   Lenen, D. (2011) Fractures ouvertes de jambe: Vingt ans d’expérience d’ostéosynthèse et de chirurgie des lambeaux. E-Mémoires de L’Académie Nationale de Chirurgie, 10, 25-32

[20]   Okike, K. and Bhattacharyya, T. (2006) Trends in the Management of Open Fractures. Journal of Bone and Joint Surgery, 88, 2739-2748. http://dx.doi.org/10.2106/JBJS.F.00146

[21]   Zalavras, C.G. and Patzakis, M.J. (2003) Open Fractures: Evaluation and Management. Journal of the American Aca- demy of Orthopaedic Surgeons, 11, 212-219.

[22]   Bednar, D.A. and Parikh, J. (1993) Effect of Time Delay from Injury to Primary Management on the Incidence of Deep Infection after Open Fractures of the Lower Extremities Caused by Blunt Trauma in Adults. Journal of Orthopaedic Trauma, 7, 532-535. http://dx.doi.org/10.1097/00005131-199312000-00008

[23]   Chapman, M.W. (1986) Therole of Intra Medullary Fixation in Open Fractures. Clinical Orthopaedics & Related Research, 212, 26-34.

[24]   Dubrana, F., Genestet, M. and Moineau, G. (2007) Fractures ouvertes de jambe. Injury, 38, 14-86.

[25]   Velazco, A., Whitessides, T.E. and Fleming, L.L. (1983) Open Fractures of the Tibia Treated with the Lottesnail. Jour- nal of Bone and Joint Surgery, 65, 879-885.

[26]   Vidal, J., Buscayert, C., Connes, H., Melka, J. and Orst, G. (1983) Guidelines for Treatment of Open Fractures and Infected Pseudarthroses by External Fixation. Clinical Orthopaedics & Related Research, 180, 83-95.

[27]   Brumback, R.J., Ellison, P.S. and Poka, A. (1989) Intramedullary Nailing of Open Fractures of the Femoralsha. Jour- nal of Bone and Joint Surgery, 71, 1324-1331.

[28]   Ribault, L., Faye, M., Latouche, J.C. and Badiane, A. (1991) Bilan de 5années d’utilisation du FESSA à l’h?pital principal de Dakar. Médecine d’Afrique noire, 38, 433-441.

[29]   Tripuraneni, B., Ganga, S., Quinn, R. and Gehlert, R. (2008) The Effect of Time Delay to Surgical Debridement of Open Tibia Shaft Fractures on Infection Rate. Orthopedics, 31, 1195.

[30]   Zué, A.S., Josseaume, A., Nsafu, D.N, Galoisy-Guibal, L. and Carpentier, J.P. (2003) Les urgences chirurgicales au Centre Hospitalier de Libreville. Annales Fran?aises d’Anesthésie et de Réanimation, 22, 189-195. http://dx.doi.org/10.1016/S0750-7658(03)00008-X

[31]   Najeb, Y., Abkari, I., Massous, A. and Kechkar, T. (2008) Résultats du traitement des fractures de jambe par un fixateur externe low cost d’adaptation locale. Rev.Maroc.Chi.Orthop.Traumato, 36, 14-17.

[32]   Charalambous, C.P., Siddique, I., Zenios, M., Roberts, S., Samarji, R., Paul, A. and Hirst, P. (2005) Early versus Delayed Surgical Treatment of Open Tibial Fractures: Effect on the Rates of Infection and Need of Secondary Surgical Procedures to Promote Bone Union. Injury, 36, 656-661. http://dx.doi.org/10.1016/j.injury.2004.10.007

[33]   Owens, B.D. and Wenke, J.C. (2007) Early Wound Irrigation Improves the Ability to Remove Bacteria. Journal of Bone and Joint Surgery, 89, 1723-1726. http://dx.doi.org/10.2106/JBJS.F.01210

[34]   Yannascoli, S., Schenker, L., Ahn, J. and Mehta, S. (2011) The Urgency of Surgical Debridement and Irrigation in Open Fractures: A Systematic Review of the 6-Hour Rule. University of Pennsylvania Orthopaedic Journal, 21, 7-11.

[35]   Lima, A., Zumiotti, A., Uip, D. and Silva, J. (2004) Predictable Factors of Infection in Patients with Open Fractures in Lower Limbs. Acta Ortopédica Brasileira, 12, 32-39.

[36]   Spencer, J., Smith, A. and Woods, D. (2004) The Effect of Time Delay on Infection in Open Long-Bone Fractures. Annals of the Royal College of Surgeons of England, 86, 108-112. http://dx.doi.org/10.1308/003588404322827491

[37]   Kohlprath, R., Assal, M. and U?kay, I. (2011) Fractures ouvertes de la diaphyse tibiale chez l’adulte: Prise en charge chirurgicale et complications. Revue Médicale Suisse, 7, 2482-2488.

 
 
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