Open tibial fractures Part 2 : a narrative review of definitive treatment and potential applicability to the southern African context

Abstract

The purpose of this study was to conduct a review of contemporary definitive treatment options, potential complications and clinical outcomes for open tibial shaft fractures and while assessing their relevance and applicability within South African context. Treatment options available in high-income countries may not be accessible in low-resource settings, requiring adaptations to the treatment approach based on local conditions. Only one African country has attempted to establish principal guidelines for the treatment of open tibial fractures through a consensus-based approach. These guidelines cover primary assessment, antibiotics, initial stabilization, referral criteria, debridement and irrigation, documentation, wound closure, soft-tissue management, amputation, and definitive internal fixation. Unfortunately, definitive fracture management recommendations for African low-resource countries are not yet available. There is a lack of data regarding the treatment of open tibial fractures in low-resource countries, particularly in regional and rural areas. Existing guidelines address antibiotic prophylaxis and treatment, debridement and lavage, initial surgical fixation, wound closure (both primary and definitive), soft-tissue management (including flap coverage), and bone fragment retention, all adapted to local resource availability. However, guidelines for definitive treatment remain unavailable. Treatment options recommended by high-income countries are largely unsuitable, and Southern African nations should focus on developing guidelines tailored to their available resources.