Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Surgery

Supervisor

Simpson, Andrew M.

2nd Supervisor

Dubois, Luc

3rd Supervisor

Lawendy, Abdel-Rahman

Abstract

Open tibia fractures (OTF) are a management challenge. Admission to a trauma center (TC) and a coordinated approach to bony fixation and soft-tissue reconstruction (STR) have been shown to improve outcomes. The objective of this study was to describe patients who had OTF in Ontario and analyze their outcomes. Linked population data pertaining to patients who had OTF between the years 2009-2020 were examined. Demographic information, admission location, and management course were collected. 4240 patients were found. The mean age was 47, and majority were males. Patients admitted to TC had greater proportion of having Injury Severity Score >15, and associated neurovascular injuries. Patients in TC were more likely to undergo limb amputation, but also more likely to get STR with an average delay of 20 days. These findings provide a comprehensive examination of the clinical course for patients experiencing OTF in Ontario. Further analyses can help identify factors that may improve outcomes.

Summary for Lay Audience

Major extremity traumas, such as open tibia fractures, are devastating injuries that often require multiple surgical specialties to work together for bony fixation and soft tissue repair. Open tibia fractures are associated with numerous complications including inadequate bony union, hardware exposure, infections, and even amputations. Some of these complications can affect patients life-long, causing significant physical, emotional, and financial distress.

Previous research has demonstrated that early transfer to a tertiary trauma center that have trained specialists and resources available for expedited bony fixation and soft tissue reconstruction results in improved outcomes. At this time, there has not been a large population-based study examining these patients in Ontario. We do not have specific information on the characteristics of the people who get open tibia fracture, and their management and outcomes. The objective of this current work was to: (1) describe those who had open tibia fracture within an 11-year period using a linked population-based data, (2) explore what types of hospital they were admitted, and (3) examine their management and outcomes.

We saw that over 4000 Ontario individuals were affected by open tibia fracture in the described period. They were young individuals in their 40s, who were mostly male. More than 30% of the population experienced infections, and 4.5% underwent amputation of the affected limb within 1 year of their injuries. Those with more severe injuries were admitted to a trauma center, and more likely to be consulted by a plastic surgeon for a soft tissue reconstructive surgery. However, there was up to 20-day time period in these individuals in getting a soft tissue reconstruction since their injury.

This study demonstrates the current management patterns of open tibia fractures in Ontario and the patient outcomes. The results serve as a foundation for many other studies that can examine specific factors that may help improve the outcome of patients with severe lower extremity traumas.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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