Complications and associated factors among patients with open long bone fractures discharged with external fixators from Mulago Hospital.
Pariyo, Bonane Godfrey
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Introduction: Open long bone fractures are common worldwide and are associated with significant complications. Due to high numbers of patients in the Mulago orthopaedic trauma ward, the orthopaedic department came up with a policy of discharging some patients with open fractures treated with external fixators. This policy was adopted in September 2011. The implication of this policy on complications is not known. We therefore conducted a study to assess complications and associated factors among patients being treated under this policy. Methods: Through a cross sectional study conducted between October 2013-February 2014, 77 patients were assessed for complications at the orthopaedic outpatient clinic in Mulago Hospital. Structured questionnaires were used to capture sociodemographic, clinical and radiological data. Logistic regression was used to explore factors associated with the complications. Results: Out of 77 patients studied 53(68.8%) had complications; wound infections were 31(40.2%), pin tract infections were 29(37.8%), loss of alignment were 14(18.2%), pin loosening 3(3.9%). At univariate analysis, frequency of dressing the wound (p=0.03), cigarette smoking (p=0.06) and marital status (p=0.21) appeared to be associated with complications. There was some evidence of association between complications and sex, wealth, education level and use of crutches. On multivariate analysis, the association with all factors disappeared except for cigarette smoking which remained significantly associated with complications (p=0.0598). Conclusion: A very high prevalence of complications was observed among patients treated with external fixators who were discharged from Mulago hospital. Wound infection and pin-tract infection were the main complications identified and were comparable to that found in other studies in Africa and India. Loss of alignment and pin-loosening were comparably lower than found elsewhere. Therefore there is need to consider re-evaluating those at high risk of complications before discharge.