Risk Factors for Delayed Management of Open Tibial Fractures in Tanzania

In a recent report in JBJS, Holler et al. investigated risk factors for delayed management of open tibial fractures in Tanzania. As the authors note, musculoskeletal injuries are a leading cause of disability globally, and they disproportionately affect people in low- and middle-income countries (LMICs). Open tibial fractures are associated with high complication rates and poor long-term quality of life for individuals in LMICs. Access the report here. 

• The authors analyzed risk factors for delayed hospital admission and surgical treatment of open tibial fractures in adult patients treated at a tertiary referral center in Tanzania. A total of 249 patients met the inclusion criteria. 
• Road traffic accidents were the primary mechanism of injury (92%). Only 12% of the patients used an ambulance, and 75% of the patients were referred to the treatment hospital from another facility. 
• 41% of the patients presented to the first hospital ≥2 hours after injury, and 95% of the patients presented to the treatment hospital after 2 hours. 10% of the patients had a delay of ≥12 hours from admission to surgery.  

• After adjusting for injury severity, the researchers found that having insurance, and wounds with approximated skin edges were associated with a decreased risk of delayed presentation to the hospital. Interfacility referrals and a rural injury location were associated with greater median times to admission to the treating hospital. Older age, single-person households, and an educational level greater than pre-primary were associated with fewer delays to surgery after admission. 

Reflecting on their study, the authors say: 

“Our study’s findings demonstrate that prehospital network and socioeconomic characteristics are associated with delays to open tibial fracture care in Tanzania. Reducing interfacility referrals and implementing surgical cost-reduction strategies may help to reduce delays to open fracture care in LMICs. We believe that this work substantially contributes to a growing body of research aimed at improving global musculoskeletal care.” 

Click here for the full JBJS report.