Treatment of Gustilo and Anderson type IIIB open fractures of both leg bones: what are the results in a regional hospital in Burkina Faso?

Résumé fourni par la source

Objective : To present the results of the management of Gustilo and Anderson type IIIB open fractures of both bones of the leg in the Surgery department of the Ouahigouya Regional University Hospital Center (CHUR-OHG). Methodology : A retrospective descriptive study was conducted on patients admitted for type IIIB open fractures of both leg bones and treated between January 1, 2022 , and June 30, 2024, at the CHUR-OHG. Sociodemographic, clinical, therapeutic, and outcome variables were collected and analyzed. Results: Thirty-two cases were collected. The mean age of the patients was 34.5 ± 3 years. There were 22 men and 10 women, with a male-to-female ratio of 2.2. Road traffic accidents were the main cause (96.88%). According to the AO classification, type A fractures of the distal tibia represented 53.13% of cases, and 60% of fibular fractures were located in the diaphysis. The mean time to treatment was 12.56 hours. Empirical antibiotic therapy was systematically administered, and amoxicillin plus clavulanic acid was the main antibiotic used in 53.12% of cases . Debridement and excision were performed . Tibial fixation was performed in 62.50% of cases, and fibular pinning combined with external fixation in 18.75% of cases. Skin coverage was achieved in 43.75% with a fasciocutaneous flap, in 46.87% with directed healing followed by a skin graft, and in 9.38% with muscle flaps. Complications included infection in 37.50% and nonunion in 25%. The mean time to union was 9.81 months in 26 patients. The anatomical and functional results obtained were generally good (37.50%) and excellent in 15.62% of cases. Conclusion: Gustilo and Anderson type IIIB open fractures of both lower leg bones are frequently encountered in road traffic accidents. Young people were most commonly affected, with a male predominance. Medical and surgical treatment involving debridement and bone stabilization generally yields good anatomical and functional results. The postoperative course was often complicated, with bone infection and nonunion being the main complications. Keywords: Open fracture; Leg; Gustilo IIIB; External fixator; Complications.

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