Impact on outcomes of a personalized educational intervention for surgeons in the management of open tibial fractures in Latin America: a before-and-after study in three low- and middle-income countries.

PURPOSE: Open tibial fractures are a major cause of disability in low- and middle-income countries (LMICs), with high rates of complications such as non-union, infection, and delayed healing. This study aimed to assess the impact of a targeted educational intervention for surgeons on improving clinical outcomes in the management of open tibial fractures in LMICs.

METHODS: A prospective, non-controlled before-and-after study was conducted across four hospitals in El Salvador, Honduras, and the Dominican Republic. Surgeons participated in a tailored AO Foundation course that included both online and hands-on cadaveric training in open fracture management, with techniques such as debridement, external fixation, and intramedullary nailing. Data were collected pre- and post-intervention, with consecutive sampling of patients based on eligibility criteria. The primary outcomes were return to work, return to recreational activities, and SF-12 physical and mental health scores at 180 days post-treatment. Secondary outcomes included bone healing (RUST score), infection and malunion rates.

RESULTS: A total of 159 patients with open tibial fractures were enrolled, with 99 completing the 180-day follow-up (50 pre-intervention and 49 post-intervention). Post-intervention, the use of reamed intramedullary nails for definitive fracture treatment increased significantly (44.0% vs. 67.3%, p = 0.019), and antibiotic regimens were better aligned with recommended practices (p < 0.001). The return-to-work rate improved significantly after the intervention (44.0% vs. 65.3%, p = 0.033), as did participation in recreational activities (28.0% vs. 55.1%, p = 0.006). Fracture healing rates also improved (28.0% vs. 53.1%, p = 0.011). There was a trend towards improvement in the SF-12 Physical Component Score (PCS) (median 36.9 vs. 46.8, p = 0.06), while the SF-12 Mental Component Score (MCS) showed no significant difference between the groups.

CONCLUSION: The tailored educational intervention significantly improved clinical outcomes for patients with open tibial fractures, particularly in return-to-work rates, recreational activity participation, and fracture healing. These findings highlight the potential of tailored educational programs for surgeons in LMICs to enhance patient outcomes, even in resource-limited settings. Further research is needed to evaluate the long-term impact and sustainability of such interventions.