Long-term Outcomes of Low-Energy Open Tibial Shaft Fractures: A 10-Year Follow-up Study of Infection Rates.

BACKGROUND

Low-energy open tibial shaft fractures present a clinical challenge, particularly in resource-limited settings. While high-energy injuries have been widely studied, the long-term outcomes of low-energy mechanisms remain underreported. This study assessed the clinical outcomes and long-term complications of cast immobilization following surgical debridement in patients with low-energy open tibial shaft fractures.

METHODS

A prospective study was conducted over ten years at UNIOSUN Teaching Hospital, Osogbo, Nigeria. Sixty-six patients with Gustilo-Anderson type I or II open tibial shaft fractures caused by low-energy mechanisms were enrolled. Data were collected on demographics, injury characteristics, treatment timelines, and outcomes. Follow-up assessments were performed at 1, 5, and 10 years post-treatment to evaluate bone union, joint stiffness, and chronic osteomyelitis.

RESULTS

The majority of patients were male (77.3%) and young adults (57.6%). Most injuries were due to road traffic accidents (78.8%). All patients were managed by surgical debridement followed by plaster cast immobilization. Primary wound closure was delayed in 59.1% of cases. Bone union complications were observed in 16.7% of patients at 1 year, decreasing to 10.6% at 5 years, and 6.1% at 10 years. Joint stiffness was reported in 3.0% at 1 year but resolved by year 5. Chronic osteomyelitis occurred in 7.6% at 1 year and declined to 4.5% at 10 years. Overall, the majority of patients achieved satisfactory wound healing and functional outcomes.

CONCLUSION

Cast immobilization following timely debridement remains a viable treatment for low-energy open tibial shaft fractures in low-resource settings, with a low rate of long-term complications. Early intervention and adequate follow-up are critical to optimizing outcomes.