External fixation in the management of open leg fractures in Cotonou

Background: Open leg fractures are common, their management is a real challenge. External fixation is the implant of choice for severe cases. The aim of this study was to evaluate the results of external fixation in adult open leg fractures in Cotonou.Material and Methods: Patients and Methods: This descriptive retrospective study, conducted from January 2013 to December 2017, included 83 patients with 84 fractures treated with external fixation for open leg fractures. There were 67 men and 16 women, with a mean age of 37.5 years. The most common cause of injury was traffic accidents, with motorcyclists predominantly involved (78.3%). The average admission time was 90 minutes. The majority of fractures were type C (38 cases) according to the AO classification, complex fractures (58 cases) with immediate tibial bone loss (14 cases), and involved both bones (76 cases). The skin opening was mostly type IIIA (39 cases) according to Gustilo-Anderson. Emergency soft tissue debridement, fibular pinning (48 cases), and immediate external fixation (69 cases) were performed. The average time to initial surgical management was 27 hours and the average time to osteosynthesis with an external fixator was 7 days.Result: Soft tissue healing was achieved on average in 4.8 months. Bone healing was achieved (78 cases) after a mean time of 7.1 months. Secondary complications were dominated by secondary skin necrosis (60 cases), requiring directed healing followed by skin grafting, and late complications by delayed healing (30 cases). Overall results were excellent and good (55 cases). Amputation was required in 5 cases. Return to work was effective in 79 patients after a mean time of 3.8 months.Conclusion: The results of treatment of open leg fractures with external fixator are encouraging despite the long delay in treatment. The widespread use of universal health insurance and early systematic coverage for type 3B fractures would improve outcomes.