The Incidence of Infection Following Open Tibia Fractures in Low-Income Countries: A Systematic Review

Infection in Open Tibia Fractures in Low-Income Countries.

Abstract

Introduction: Open tibial fractures (OTFs) are common in low-income countries (LICs), primarily caused by road traffic collisions. High rates of infection in OTFs contribute to prolonged recovery, disability, and economic loss. Identifying infection rates and causative organisms is essential for improving outcomes and guiding antibiotic treatment in LICs. This systematic review aimed to determine the incidence of surgical site infections (SSIs) following OTF treatment in LICs and identify the most prevalent microorganisms involved.

Methods: Following PRISMA and Cochrane guidelines, a systematic review was conducted using five databases. Eligible studies included randomised controlled trials, cohort studies, and case series investigating OTFs in LICs. Studies with fewer than ten participants, military medical resources, or those from high-income countries were excluded. Data were extracted for infection rates, causative organisms, and treatment modalities, with a meta-analysis performed using a random effects model to calculate incidence in person-years.

Results: Five studies, including two retrospective cohorts, two prospective cohorts, and one RCT, were analysed. The overall infection incidence was 23.21 per 100 person-years (95% CI: 9.19; 58.62). Subgroup analysis showed a slightly lower incidence of 21.88 per 100 person-years for surgical interventions. A high degree of heterogeneity (I² = 91%) was noted. Common causative organisms were not consistently reported.

Conclusion: The incidence of SSIs following OTFs in LICs is high, particularly in severe fractures. Establishing a baseline infection rate is critical for future studies to evaluate treatment efficacy and improve outcomes in resource-limited settings. Further research should focus on standardising definitions and reporting of infections to reduce heterogeneity.