| dc.description.abstract | Background: The management of tibia shaft fractures (TSFs) is controversial worldwide however the choice of management depends on fracture pattern and location. Non-operative management has recently fallen out of favor due to the high complication rates and poor functional outcomes associated with it in literature. In Mulago National Referral Hospital (MNRH), despite the high burden of TSFs, majority are managed non-operatively despite the fracture pattern, the outcomes of which are unknown.
Objectives: To describe the short term clinical and radiological outcomes of TSFs managed non-operatively among adults at MNRH, as well as the factors associated with those outcomes.
Methodology: This was an analytical cross-sectional study carried out at the Mulago Orthopedics OPD, and trauma ward plaster room over a 4-month period (December 2022 to March 2023). One hundred and three adults with TSFs managed non-operatively were reviewed between 12 to 24 weeks post fracture and consecutively recruited. Patient demographics and injury details were recorded. Clinical outcome assessment involved assessing for clinical union, measuring knee (A)ROM, and deformity assessment. Time to full weight bearing was also recorded. Radiological outcome assessment was done by assessing radiological healing using the RUST score, and measurement of radiological alignment. The collected data was coded and entered into Epidata, and then exported to STATA for analysis. Numerical variables were summarized as means or standard deviation and medians or interquartile ranges, whereas categorical variables were summarized as proportions or percentages. Factors associated with the different outcomes were also assessed using bivariate and multivariate analysis. Significant factors were considered at a p-value < 0.05.
Results: 103 participants were recruited into the study. 76.7% were male, with a median age of 33 years. 95.2% of the TSFs were caused by high energy mechanisms, with RTAs being the commonest etiology. The commonest fracture patterns were 42-A2 (27.1%) and mid 1/3 TSFs (56.3%). Majority were also closed (65%) and isolated TSFs (71.8%). Median time of review was 16 weeks post fracture. At the time of review, 41.7% did not have clinical union. Majority had fair and poor knee ROM (43.7% and 42.7% respectively), whereas none had excellent knee ROM. Majority also had some degree of deformity (73.7% shortening, 85.4% malrotation), although majority of these were within acceptable ranges. The median time to full weight bearing was 12 weeks. Out of all the participants, 45.6% had normal healing as deduced from the RUST scores, while 31.1% and 23.3% had features of delayed union and no union respectively. Majority of the participants also had radiological malalignment in both coronal and sagittal planes although most were within acceptable ranges (54.5% and 84% respectively). The commonest coronal and sagittal plane deformities were valgus, and apex-posterior respectively. Closed fractures were found to be 2 times more likely to attain clinical union. Certain fracture patterns (42-A2, 42-B2 and 42-B3) were more likely to result in shortening. Mid 1/3 TSFs showed an 84% reduction in radiological healing. Conversion rate to operative management was 56.3%, with the commonest causes for conversion being unacceptable alignment and delayed union.
Conclusions: Non-operative management of TSFs in our setting results in low union rates, poor knee ROM, higher deformity and malalignment rates, with high conversion rates to operative management. | en_US |
