Type III Gustilo-Anderson open fracture does not justify routine prophylactic Gram-negative antibiotic coverage.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no competing interests. 19. Cureus. 2024 Sep 8;16(9):e68925. doi: 10.7759/cureus.68925. eCollection 2024 Sep. A Scoping Review on the Management of Open Fractures in African Trauma and Orthopaedics Centres. Zubair AA(1), Abdullateef R(2), Davis S(3), Olaniyi A(4), Joshua I(2), Emma-Nwachukwu M(2), Jessie OO(2), Kolawole AO(2), Umeh AB(2), Sunmola AA(2), Oladeji EO(1). Author information: (1)Trauma and Orthopaedics, Surgery Interest Group of Africa, Lagos, NGA. (2)Orthopaedics, Surgery Interest Group of Africa, Lagos, NGA. (3)Urology, Surgery Interest Group of Africa, Lagos, NGA. (4)Surgery, University of Ilorin, Ilorin , NGA. An open fracture is when the fractured part of a bone is exposed to the external environment by breaching the overlying soft tissue and skin. Open fractures often arise from high-energy injuries, and the risk of microbial contamination is high. There is a need to understand the management of open fractures in Africa by assessing the overall prevalence of open fractures, the mechanisms of injury, management approaches and outcomes. A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding open fracture management in Africa from inception till date. Thirty-nine (39) studies were included in this review. Road traffic accidents represented the majority of all mechanisms of open fractures, with the Tibia being the most affected bone. 320 cases were classified as Gustilo Anderson Type 1, with 487 classified as Type 2. Type 3 was divided into 3A (330), 3B (248), and 3C (34). Most studies recorded the immediate administration of intravenous antibiotics, but tetanus prophylaxis was only given in 13 studies, while initial debridement and washout were done in 35 studies. External fixators and Kirschner wires were most used for initial fixation. Follow-up for patients was between six weeks to 50 months. There were 645 cases of malunion, 83 cases of non-union, and 88 patients who had delayed union. There were 147 cases of wound infection and 119 cases of pin tract infections. Our findings emphasize the need for standardized protocols and robust emergency services to manage open fractures within Africa. Copyright © 2024, Zubair et al. DOI: 10.7759/cureus.68925 PMCID: PMC11459879