Open fractures I Rwanda: The Kigali experience

Background: Open fractures are an important cause of morbidity and mortality. Their severity depends on Gustilo grading which is based on degree of soft tissue destruction, contamination and neurovascular state. Methods: This was a retrospective descriptive study that included all patients that were hospitalized with open fractures of lower limbs in the department of surgery of CHUK from 1st Jan 2004 – 31st Dec. Results: There were 191 patients with 193 fractures. The mean age is 31 years. Most of the patients were in the 18 – 44 years age group. The male to female sex ratio of 3.3: 1. The commonest cause was road traffic trauma recorded in 71.5% of lower limb open fractures. Fractures of tibia and fibula and of the femur contributed 69.4 % and 17.6% respectively. Using Gustilo’s Classification, Grade III were 48.7% of which 17.6% were Grade IIIa, 23.8% Grade IIIb and 7.3% Grade IIIc. Comminuted fractures with musculo-cuteneous lesions of Grade III had a high rate of complication and were difficult to treat. A total of 71.5% of our patient had treatment initiated within 24 hours. The average duration of treatment was 5.36 days with a STD of 10.8. Delay in starting treatment had a significant negative effect on the outcome of management; the longer the delay the more the complication especially infections. For the immobilization of the fractures, the plaster of Paris (POP) was applied in 32% of cases followed by external fixators in 31.6%.Conclusion: Road traffic accidents are the main cause of open limb fractures and involved males more than females. The tibia and fibula were more affected tha the femurs. External fixation was associated with a higher risk of complications especially infection. Delay in treatment was also associated with higher risk of sepsis