The Incidence and Treatment Outcome of Open Fractures of the Extremities at Muhimbili Orthopaedic Institute

A retrospective study of patients with open fractures admitted to Muhimbili Orthopaedic Institute between January 1999 to December 2001 (3 years) was done to determine the incidence; mechanism of injury; demographic pattern; and treatment outcome. A total of 507 patients with open fractures were admitted during this period; giving an incidence rate of 5.72. Among these 85.8were male. Road traffic accidents accounted for 55of the cases as a cause; followed by interpersonal violence (11.2) and falls from heights (11). Tibia and fibula were the commonest injured bones (54) followed by radius and ulna 15and the femur 11. Grade III open fractures accounted for 55.1of all fractures while out of these 7.5were crush injuries and 3.2had traumatic amputation of one of the extremities. Surgical debridement and external fixation was the most frequently used mode of treatment (42.6) while surgical debridement and POP mobilization was used in 28.4of the patients. Almost 29of the patients sustained various complications. Amputations including traumatic amputations accounted for 11; chronic osteomyelitis accounting for 7. Six patients (1.2) died due to tetanus. This study shows early proper surgical debridement and frequent use of external fixators reduces the rate of complications from open fractures

Genu valgum after proximal metaphyseal fractures in children - a report of 2 cases

"Two cases of valgus deformity of the tibia following proximal metaphyseal fractures in childhood are described. They involved a 4-year old girl and a 16-year old male. The fractures were sustained at the ages 8 months and 8 years respectively. Management in each case involved the use of corrective osteotomy but with recurrence of the deformity in the 4-year old child. A revision of the Pes Anserinus tendon plate and suturing of same was considered the mainstay of eventual successful treatment. The patho-mechanism of the deformity is discussed in terms of the ""rein check"" theory with review of literature. It is suggested that all cases of proximal methaphyseal fractures in children should be managed primarily by revision of the Pes Anserinus Tendon plate and suturing in order to avoid later corrections by osteotomies."