Nigerian Journal of Orthopaedics and Trauma

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Challenges of Managing Severe Open Lower Limb Fractures in Northern Nigeria

YZ Lawal, A Ajibade, MI Maitama, IL Dahiru, MO Ogirima, FS Ejagwulu


Background: Open lower limb injuries are the commonest type of injuries reported in thethe accident and emergency rooms of hospitals in Nigeria. They range from the simple laceration to a mangled lower extremity with neurovascular complications requiring amputation. The occurrence of these injuries comes at a high economic and social cost to the victims and the country in general. With no agreed protocol of managing these patients in our environment, we present our experience and our method of dealing with these conditions.
Methods: Over a period of seven years in three different hospitals in the north west of Nigeria, two hundred and eight patients with open lower limb fractures were prospectively seen. One hundred and five of the patients belong to Gustillo I and II open tibial fractures. Gustillo I and II injuries were treated by debridement; primary wound closure, manipulation and casting. Gustillo III A and B patients were treated by early wound debridement, antibiotic cover, and fracture stabilization by external fixation or casting, split thickness skin graft and segmental bone loss is treated by nonvascularised fibula strut and cancellous grafting. Only one Gustillo IIIC fracture was seen which was treated by external fixation and reverse saphenous vein graft for the lacerated femoral artery. Data on all patients were collected and analyzed with SPSS Version 17.
Results: Two hundred and eight patients with open lower limb fractures were seen. One hundred and five of the patients belong to Gustillo I and II open tibial fractures, accounting for 50.50% of all patients seen. One hundred and two were Gustillo IIIB fractures accounting for 49.04% all patients seen. Of the one hundred and three patients with Gustillo III, oOne patient had Gustillo IIIC accounting for 0.97% of severe injuries of the lower limbs. 5% of 8888 and six patients with Gustillo I and II open fractures, making 33% compared to 40% seen in patients with Gustillo IIIB and C injuries. Amputation rate was 28.4 % in the severe open lower limb fracture. Their average mangled extremity severity score was 7.5.
Conclusions: The management of severe open lower limb fractures is long and onerous. It is also expensive and requires cooperation and commitment from both the patient and the attending team. A reasonable outcome can be expected from our protocol of managing these patients in our economically challenged environment.

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