Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings

Madeline C MacKechnie; Patrick D Albright; Germán Garabano; Fernando Bidolegui; Sebastian Pereira; Cesar Angel Pesciallo; Theodore Miclau

doi:10.1097/OI9.0000000000000209

Open tibial shaft fracture management in Argentina: an evaluation of treatment standards in diverse resource settings

OTA Int. 2022 Aug 4;5(3):e209. doi: 10.1097/OI9.0000000000000209. eCollection 2022 Sep.

Authors

Madeline C MacKechnie¹, Patrick D Albright², Germán Garabano³, Fernando Bidolegui⁴, Sebastian Pereira⁴, Cesar Angel Pesciallo³, Theodore Miclau¹

Affiliations

¹ Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA.
² Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, United States of America.
³ Hospital Británico, Buenos Aires, Argentina.
⁴ Hospital Sirio Libanes, Buenos Aires, Argentina.

Abstract

Background: Argentina is a country with varying access to orthopedic surgical care. The Argentine Association of Trauma and Orthopedics (AATO) "Interior Committee" was developed to address potential regional differences and promote standardization of orthopedic trauma care. The paper assesses the level of national standardization of the management of open tibia fractures across 9 provinces in Argentina.

Methods: Utilizing a matched-comparison group design, management of these injuries were assessed and compared between 3 groups: an "AATO Exterior Committee" consisting of surgeons that practice in Buenos Aires, and 2 "Interior Committees," comprising surgeons that practice in outlying provinces, 1 of which is affiliated with the AATO, and 1 that is not affiliated with the AATO. The study was conducted in 2 phases: phase 1 assessed open tibia fracture management characteristics, and phase 2 evaluated the management of soft-tissue wound coverage following open fractures.

Results: Soft-tissue coverage procedures for Gustilo Anderson Type IIIB fractures were more commonly performed by orthopedic surgeons in Interior Committees than the AATO Exterior Committee. Greater rates of definitive wound coverage within 7 days post-injury were reported in both Interior Committees compared to the Exterior Committee. Plastic surgeons were reported as more available to those in the AATO Exterior Committee group than in the AATO Interior Committees.

Conclusion: While treatment patterns were evident among groups, differences were identified in the management and timing of soft-tissue coverage in Gustilo Anderson Type IIIB fractures between the Exterior Committee and both Interior Committees. Future targeted educational and surgical hands-on training opportunities that emphasize challenges faced in resource-limited settings may improve the management of open tibia fractures in Argentina.

Keywords: Argentina; Latin America; open tibial shaft fractures; soft-tissue coverage; treatment patterns.