Outcome of open tibial shaft fractures treated by using external fixation as a primary and definitive treatment in Tibebe Ghion specialized hospital, Bahir Dar University, Ethiopia
Authors: Ayenew Asteray Assmie , Mulat Yeab , Ferede Biruk 
Published: February 2022

Abstract
Background: The treatment of open tibial shaft fracture is very challenging especially in developing counters like Ethiopia where medical equipment’s, orthopedic experts are scarce, and poor economy and health seeking behavior. In orthopedics and trauma surgery, external fixation is comparatively safe in treating tibial open injuries, meanwhile it has advantage of minimal disruption, convenient subsequent soft tissue repair and easy application. However, the procedure is accompanied by a serious of problems in bone healing and alignment. Therefore, this study aimed to assess the outcome of open tibial shaft fractures treated by using external fixation as a primary and definitive treatment in Tibebe Ghion specialized hospital, Bahir Dar University, Ethiopia.Methods: This is a cross-sectional study with a retrospective facility-based data collection technique. All patients who were managed for open tibial shaft facture from September 2018 to February 2021 were included. The patient's chart number were collected from the Orthopedics surgery morning register sheet and their case folders were retrieved from the medical record department. We used a structured and pretested checklist, and chart review for data collection. The collected data was cleaned, coded, and entered into EPI-Info version 7 and exported to SPSS version 24 for analysis. Binary logistic regression analysis was used to identify factors associated with a pelvic fracture.Result: We studied 53 cases of open tibial shaft fracture during the study period. The majority of cases were from rural area (66%), and open tibial shaft fracture were common among males (67.9%). The mean age of patients was 34 ± 14 SD years, and the commonly affected age group was between 21 to 40 years (49.1%) followed by 41-60years (32.1%). The leading cause of the open tibial fracture was road traffic accident 19(35.8%) followed by bullet injury in 15(28.3%) of patients. For more than 2/3 of the patients debridement was done within 24 hours of injury and antibiotics was provided for 98.1% of patients. More than half (58%) were categorized under GAIIIB, the average time for hospitalization was 2-14 days, and the mean follow up time was 18±6 SD months. Among the included patients 64% developed surgical site infection, 15.1% developed mal-union, and 24.5% developed non-union after the procedure. Additionally, the mean time of bone union was 20.1±4 weeks and the mean duration of external fixation use was 18 weeks.Conclusion: the majority of patients with open tibial fracture were rural residents, male and younger population. The leading cause of the open tibial fracture was road traffic accident followed by bullet injury. The majority of open tibial fracture patients in this study were diagnosed as GAIIIB fracture. Using external fixation as a definitive treatment for open tibial fracture results a high rate of infection, bone mal-union, and non-union. Thus, health facilities and health care professionals working on this area should revise the procedure to promote better stability, to decrease the risk of surgical site infection, and miss alignment and delayed union. Additionally, to reduce tibial fracture and its complication, interventional programs to reduce car accident, and effective treatment, characterization of thee fracture is crucial to guide the decision making process for better management of patients for survival, healing, improvement of patients, and for better clinical outcome in patients with open tibial fracture.