The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania.

BACKGROUND: Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures.

METHODS: A prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11.

RESULTS: The male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading ( p -value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5-10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p -value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6-11.5) days and 6 (5-10) days respectively, p -value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI.

CONCLUSIONS: Open long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes.