A linked population-based analysis of severe lower extremity traumas in Ontario

Background  — Successful management of open tibial fractures often requires a multidisciplinary approach. Previous literature has shown that admission to a trauma centre and coordinated management of early bony fixation and soft-tissue reconstruction improve patient outcomes. The objective of this study was to describe patients who had open tibial fractures in Ontario and analyse their outcomes.

Method  — Linked population-based administrative data pertaining to patients who had open tibia fractures between the years 2009 and 2020 were examined. Demographic information, admission location, timing of soft-tissue reconstruction, and complication rates were collected.

Results  — 4240 patients were identified. The mean age was 47, and the majority were males. One-third of the patients were admitted to a trauma centre. This group were more likely to have an Injury Severity Score >15, and associated neurovascular injuries of the leg. When outcomes were compared over 1 year, the trauma centre group was more likely to undergo limb amputation, but also more likely to have a soft-tissue reconstruction. The average time to soft-tissue reconstruction was 20 days. Patients receiving care in a trauma centre were more likely to have an external fixation, plastic surgery consults, and longer hospital stay. There were no differences in the odds of infection, malunion or nonunion, and 30-day mortality.

Conclusions  — These findings provide a comprehensive examination of the clinical course for patients experiencing open tibia fractures in Ontario. Future studies can help facilitate coordinated efforts between different specialties to expedite care and improve overall outcomes.