Background: 

Open tibial shaft fractures are an important source of disability in Latin America. High-income countries (HICs) worldwide have established standardized treatment protocols for open tibial fractures, but less is known about their treatment in middle-income countries (MICs) in Latin America. This survey of Latin American orthopaedic surgeons characterizes open tibial fracture treatment patterns.

Methods: 

Orthopaedic surgeons from 20 national orthopaedic societies throughout Latin America completed an online survey assessing their treatment of open tibial fractures. Demographic information was collected. Treatment patterns were queried according to 2 groupings of Gustilo-Anderson (GA) fracture types: treatment of type-I and type-II fractures (GA-I/II) and treatment of type-III fractures (GA-III). Treatment patterns were evaluated across 4 domains: antibiotic prophylaxis, irrigation and debridement, fracture stabilization, and wound management. Summary statistics were reported; analysis was performed using the Fisher exact test (p < 0.05).

Results: 

There were 616 survey participants from 20 Latin American countries (4 HICs and 16 MICs). Initial external fixation followed by staged internal fixation was preferred for GA-I/II (51.0%) and GA-III fractures (86.0%). Nearly one-third (31.5%) of GA-IIIB fractures did not receive a soft-tissue coverage procedure. Stratifying by country socioeconomic status, surgeons in MICs more commonly utilized delayed internal fixation for GA-I/II (53.3% versus 22.0%, p < 0.001) and GA-III fractures (94.0% versus 80.4%, p = 0.002). Surgeons in MICs more commonly used primary closure for GA-I/II (88.9% versus 62.8%, p < 0.001) and GA-III fractures (32.6% versus 9.8%, p < 0.001).

Conclusions: 

This survey reports Latin American orthopaedic surgeons’ treatment patterns for open tibial shaft fractures. Surgeons in MICs reported higher delayed internal fixation use for all fracture types, while surgeons in HICs more routinely avoid primary closure. Soft-tissue coverage procedures are not performed in nearly one-third of GA-IIIB fractures because of a lack of operative personnel and training.

中文翻译：

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开放性胫骨干骨折：拉丁美洲的治疗方式

背景： 

胫骨干骨折是拉丁美洲的重要残疾来源。世界范围内的高收入国家（HIC）已建立了胫骨开放性骨折的标准化治疗方案，但在拉丁美洲的中等收入国家（MIC）中对其治疗的了解较少。这项对拉丁美洲骨科医生的调查显示了开放性胫骨骨折的治疗模式。

方法： 

来自整个拉丁美洲的20个国家骨科学会的骨科医生完成了一项在线调查，评估了他们对胫骨开放性骨折的治疗。收集了人口统计信息。根据Gustilo-Anderson（GA）骨折类型的两个类别查询治疗方式：I型和II型骨折（GA-I / II）的治疗和III型骨折（GA-III）的治疗。在以下四个领域对治疗模式进行了评估：抗生素预防，冲洗和清创，骨折稳定和伤口处理。报告了摘要统计数据；使用Fisher精确检验进行分析（p <0.05）。

结果： 

来自20个拉丁美洲国家（4个HIC和16个MIC）的616名调查参与者。对于GA-I / II（51.0％）和GA-III骨折（86.0％），首选初始外固定，然后进行分阶段内固定。GA-IIIB骨折中近三分之一（31.5％）没有接受软组织覆盖手术。根据国家的社会经济状况进行分层，中等收入国家的外科医生更普遍地采用GA-I / II型（53.3％比22.0％，p <0.001）和GA-III骨折（94.0％比80.4％，p = 0.002）进行延迟内固定。MIC中的外科医生更常将GA-I / II（88.9％对62.8％，p <0.001）和GA-III骨折（32.6％对9.8％，p <0.001）进行初次闭合。

结论： 

该调查报告了拉丁美洲整形外科医师对胫骨干开放性骨折的治疗方式。中等收入国家的外科医生报告说，所有骨折类型的延迟内固定使用率更高，而高收入国家的外科医生更常规地避免初次闭合。由于缺乏操作人员和培训，在近三分之一的GA-IIIB骨折中未进行软组织覆盖手术。