1. Introduction
An open leg fracture is a diaphyseal or metaphyseal, extra-articular fracture of one or both leg bones, with communication between the fracture site and the external environment present [1]. To provide a broader context, studies conducted globally have highlighted the significance of understanding open leg fractures due to their complex management and potential complications. Previous research in Africa and Europe provides comparative data that emphasizes regional differences in fracture types, causes, and treatment outcomes. This study aims to contribute to improving the management of theses fractures in Niger.
The fracture line is limited at the top by a line that passes four centimetres below the femorotibial joint and four centimetres above the tibiotarsal joint [2] [3]. They are common (8% - 10% of all trauma to the human body), accounting for 20% - 30% of leg fractures in Europe, and 39% in Africa [2] [4]. These fractures occur mainly in road accidents, and constitute a medical and surgical emergency, with serious complications that can be life-threatening [5]. The aim of this work is to share our experience in the management of open leg fractures and their complications at Zinder National Hospital.
2. Materials and Methods
This was a prospective, descriptive study carried out in the Traumatology-Orthopedics Department of the National Hospital of Zinder, Niger, over the eighteen (18) month period from December 8, 2020 to June 8, 2022. All patients of both sexes, aged over 15 years, diagnosed with an open leg fracture and managed during the study period were included in the study. The parameters studied were epidemiological, clinical, paraclinical, therapeutic and evolutionary.
Data were collected prospectively from patient records, clinical examinations, and imaging studies. The sample size was determined based on an estimated prevalence of open fractures within the region, using a 95% confidence interval and an allowable margin of error of 5%. Inclusion criteria focused on patients aged over 15 years with confirmed diagnoses of open leg fractures.
3. Results
In the course of this study, we recorded 829 cases of fracture, including 135 cases of open leg fractures, i.e. a frequency of 16.28%. There were 116 men (85.93%) and 19 women (14.07%), i.e. a sex ratio of 6.10. The mean age was 31.79 years, with extremes of 15 and 70 years. The 15 to 30 age group was the most represented with 93.33% (n = 83). Clinically, public road accidents were the primary circumstance in 93.33% of cases (n = 126). Table 1 shows the circumstances in which open leg fractures occurred.
Table 1. Distribution of patients according to circumstances of occurrence.
Circumstances |
Effectifs |
Percentages (%) |
Domestic accident |
01 |
0.74 |
Public road accident |
126 |
93.33 |
Self-inflicted wound |
08 |
05.93 |
Total |
135 |
100.00 |
Admission time was less than 6 hours in 61.48% (n = 83) of patients. Radiologically, the fracture line was simple in 54.81% (n = 74) and complex in 45.19% (n = 61) of cases, and in 39.26% (n = 53) the fracture was located in the middle third of the leg. In terms of fractured bones, fractures of both leg bones accounted for 68.89% (n = 93), followed by tibia fractures 30.37% (n = 41) and fibula fractures 0.74% (n = 1).
Therapeutic treatment was medical-surgical. Medical treatment consisted in the administration of a stage 2 analgesic (tramadol), antibiotic prophylaxis (combination of ceftriaxone and metronidazole), anticoagulant (low-molecular-weight heparin) and tetanus prevention depending on the patient's vaccination status. Surgical management consisted of careful wound trimming in all patients, fracture reduction and osteosynthesis by external fixator in 57.80% (n = 78), by screw plate in 37.80% (n = 51) and amputation in 4.44% (n = 6). Average hospital stay was 30.31 days, ranging from 8 days to 90 days. Postoperative follow-up was straightforward in 123 cases (91.11%) and complicated in 12 cases (8.89%), with delayed consolidation predominating in 2.96% (n = 4) and surgical site infection in 2.96% (n = 4).
4. Discussion
The findings of this study align with regional and international trends in the epidemiology and treatment of open leg fractures. However, certain discrepancies were observed, such as the slightly higher frequency of fractures compared to neighboring regions, potentially attributable to differences in road safety measures. Limitations of the study include its single-center design and the relatively small sample size, which may affect the generalizability of the findings. Future research should explore multi-center collaborations to validate these results.
Open leg fractures in adults are frequent, accounting for 16.28% of all fractures treated in this department. This frequency is higher than that found by Idé [6] in Niamey (Niger) and lower than that found by Touré [7] in Mali. In this series, the mean age was 31.79 years, with extremes of 15 and 70 years. The 15 to 30 age group was the most represented, with 93.33% (n = 83). The same observation was made by several African authors [7]-[9]. Male predominance was found. The same result was found by Mertens [10] and Batchom [11]. This result could be explained by the fact that in countries such as Niger, men are responsible for providing all the family's needs, and motorcycles are the main means of transport for these men, making them more exposed to road accidents. Road accidents were the primary circumstance for the occurrence of open leg fractures in this population, as demonstrated by other authors [12] [13]. Simultaneous involvement of both leg bones was the most common, accounting for 68.89% of cases. This result is comparable to the 80.2% reported by Diallo [14]. This could be explained by the violence of the trauma in public road accidents.
In this study, fracture lines in the middle 1/3 of the leg predominated, accounting for 39.26% of cases. This result is similar to those of Banza [12] and Keita [15] in 2022. This could be explained by the fact that not only is this area the most exposed during trauma, but also by its anatomical peculiarity of being covered only by the skin. In contrast, Myriem [16] found a predominance of open fractures in the lower third of the leg. In this study, external fixator osteosynthesis was the most commonly used method of bone fixation. For Bombah [12], the external fixator is the method of choice for stabilizing open leg fractures, due to the subcutaneous location of the tibia. In contrast, Touré's team [7] used the Ender nail exclusively, as the external fixator would increase the risk of infectious complications. In this study, bone consolidation was achieved in 91.11% of cases (n = 123), while the 7-month follow-up revealed 4 cases of delayed consolidation and 4 cases of surgical site infection.
5. Conclusion
Open leg fractures in adults are frequent at Zinder National Hospital, with a large predominance of young male subjects. Public road accidents were the main cause of these injuries. External fixation was the most frequently used surgical modality. In the majority of cases, the outcome was favorable. These findings have important implications for healthcare policy, particularly in improving trauma care infrastructure and road safety initiatives in Niger. Future studies should prioritize the development of standardized treatment protocols and investigate the long-term outcomes of different surgical approaches.