Belangero William Dias, Mariolani José Ricardo Lenzi, Olarte Salazar Carlos Mario, Xicará Rodriguez Jose Arturo, Portillo Miranda Mario Rigoberto, Vides Lemus Miguel Ángel, Landrón de la Rosa Julio Cesar, Hernández Vivas Gustavo Nahum, Escobar Soriano Gerardo Alfonso, Flores McLeod Ricardo Arturo, López Hector José, Caraccioli Walter Ramón, Nolasco Portillo Nelson Ismael, Gil de la Cruz Ángel Ramón, Cruz Cardona Jose Francisco, Santos Francisco Alberto, Marroquín Martínez Hugo Omar, Ardón Dubón José Javier, Garcia Camilo, Izaguirre Osorio Abimael Osias, Suazo Victor Rosario, Cruz Coto Jorge Luis, Rojas-Lievano Jorge, Fantin Emilio
State University of Campinas, Campinas, Brazil.
Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Eur J Orthop Surg Traumatol. 2025 Mar 5;35(1):92. doi: 10.1007/s00590-024-04172-6.
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.
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.
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.
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.
在低收入和中等收入国家（LMICs），开放性胫骨骨折是导致残疾的主要原因，其并发症发生率高，如骨不连、感染和延迟愈合。本研究旨在评估针对外科医生的定向教育干预对改善LMICs中开放性胫骨骨折治疗临床结局的影响。
在萨尔瓦多、洪都拉斯和多米尼加共和国的四家医院进行了一项前瞻性、非对照的前后研究。外科医生参加了定制的AO基金会课程，该课程包括开放性骨折管理的在线和尸体实操培训，以及清创、外固定和髓内钉固定等技术。在干预前后收集数据，根据纳入标准对患者进行连续抽样。主要结局指标为治疗后180天的重返工作岗位情况、恢复娱乐活动情况以及SF-12身体和心理健康评分。次要结局指标包括骨愈合情况（RUST评分）、感染率和畸形愈合率。
共纳入159例开放性胫骨骨折患者，99例完成了180天随访（干预前50例，干预后49例）。干预后，用于确定性骨折治疗的扩髓髓内钉的使用显著增加（44.0%对67.3%，p = 0.019），抗生素治疗方案与推荐做法的一致性更好（p < 0.001）。干预后重返工作岗位率显著提高（44.0%对65.3%，p = 0.033），参与娱乐活动的情况也是如此（28.0%对55.1%，p = 0.006）。骨折愈合率也有所提高（28.0%对53.1%，p = 0.011）。SF-12身体成分评分（PCS）有改善趋势（中位数36.9对46.8，p = 0.06），而两组间SF-12精神成分评分（MCS）无显著差异。
定制的教育干预显著改善了开放性胫骨骨折患者的临床结局，尤其是在重返工作岗位率、娱乐活动参与度和骨折愈合方面。这些发现凸显了为LMICs的外科医生定制教育项目在改善患者结局方面的潜力，即使是在资源有限的环境中。需要进一步研究来评估此类干预的长期影响和可持续性。
