Intramedullary Nailing of Type I and Type II Open Leg Fractures after 6 Hours at Yopougon Teaching Hospital

Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours after their initial trauma. We sought to evaluate outcomes of nailing and correlations between the risk of infection and the delay in surgery. Materials and methods: Medical files of 48 men and 15 women with a combined total of 63 open fractures of the leg during a 12-year period were reviewed. The mean age was 29 years. Thirty-four type I and 29 type II open fractures according to the classification of Cauchoix and Duparc were treated with Kuntscher nail after excision/debridement. Preoperative CRP was performed in 27 patients and in 22 cases it was positive. Twenty-six fractures were treated within a period of 6 to 24 hours, and a further 37 was operated on beyond 24 hours. The average waiting time before surgery was 2 days. Results: The infection was present in 11 patients (17.5%). We failed to establish any correlation between the time of treatment and the occurrence of infection for both type I and type II fractures treated during the same intervals with p = 0.244 (p > 0.05). But we established a correlation between the type of open fracture and the occurrence of infection with p = 0.01 (p < 0.05). There were 10 cases of infection among 22 cases of positive preoperative CRP. We couldn’t find a correlation between the positive value of the preoperative CRP and the occurrence of infection. Seven cases of infection were treated with appropriate antibiotherapy and early revision surgery. Four others cases complicated to bone infection (n = 2) and septic nonunion (n = 2). The average time of hospitalization was 22 days. The average time for fracture healing was 7 months. Conclusion: The rule of six hours is hardly applicable in our contexts. Our study showed no correlation between the preoperative period and the occurrence of infection.