Table 1: Distribution of patients according to AOFAS functional results.

Complications

There was a complication rate of 18.5% affecting five (05) patients.

The complications were wound suppuration in two (02) cases, skin necrosis in three (03) cases with guided tissue repair and secondary amputation in one (01) case.

We did not find any cases of osteitis or vascular and nerve damage in our series.

Sequelae

Most of our patients (78%) had no sequelae after recovery. However, the sequelae observed were malunion in 7% of cases, residual pain in 11% of cases and joint stiffness in 4% of patients. 

Discussion

Our study encountered a number of difficulties:

• Number of patients in our stydy because it is a new service
• The non-use of some files due to poor archiving
• Non-cooperation of some patients in data collection and evaluation due to their unavailability

1. Epidemiological Aspects

• According to gender

In our study, we found a male predominance (81%) with a sex ratio of 4.4.

This result is close to those of KOUAME I and NDAO M, who found a male predominance of 78.3% and 60% respectively [4,5].

This could be explained by the fact that men are more active and engage in more activities than women and are sometimes the most exposed in their daily activities.

• According to age

We note that the age group most affected is between 21-30 years old, with a rate of 44.4%. The age groups between 31-40 year represented 22.2% of our series, with an average age of 27.03 years.

This fact could be explained by the fact that young adults who occupy a very significant segment of our population in terms of deliveries by two-wheeled vehicles, as well as in service . They can also be very active in small bisinesses.

This result is close to that of KOUAME I [4], who found an average age of 31.

• By profession

Delivery drivers on two-wheeled motorcycles were the most affected in 48% of cases. This could be explained by the fact that this group is the most exposed to road accidents and traffic incidents. Delivery drivers are also the most dynamic and sometimes the most exposed in their daily activities due to their recklessness.

There is also a high cumulative frequency among manual workers. They are exposed to open foot injuries through their work and their journeys between home and work.

This result corresponds to that of KOUAME I [4], who found traders and laborers in his series.

• According to the Circumstances of Occurrence

We observed a high frequency of road traffic accidents, accounting for 56% of cases, which could be explained by several reasons, including:

• The significant increase in two-wheeled vehicles
• The growth in the number of vehicles on the road
• Inadequate traffic lights and road signs
• Unregulated occupation of streets
• Failure to comply with traffic regulations
• Lack of civic-mindedness encouraged by impunity

This result corresponds to that of NDAO M, who found 47.7% in his series and differs from that of KOUAME I, who found 81.9% for ACRs [4,5].

2. Anatomical and Clinical Findings

• According to the injury

In our study, we found that simple wounds were the most common injuries with a rate of 44.4%, followed by Gustilo and Anderson type 2 open fractures with 22.2%.

This result differs from that of KOUAME I [4], who found a predominance of Gustilo and Anderson type 2 open fractures with a rate of 42.1%.

• According to the affected foot

In our study, the right foot was predominantly affected, with a rate of 63%.

This can be explained by the fact that most of our population is right-footed and during accidents, victims try to save themselves or approach the road by putting their right foot forward first.

This result is comparable to that of NDAO M [5], who found a rate of 52% in his series.

• According to the location of the trauma

Our study showed a predominance of the forefoot with a rate of 59%.

This could be explained by the fact that the forefoot is less protected and therefore more vulnerable than the rest of the foot and is exposed to enormous shocks from multiple directions. This result is similar to that of KOUAME I [4] and NDAO M [5], who found 61.4% and 62% respectively.

• According to the nature of the bones affected by fractures

The metatarsals were the most affected, accounting for 54.5% of injuries. This could be explained by the fact that the metatarsals are the longest bones and are less protected by skin and muscle tissue.

Fractures of the phalanges were also significant, accounting for 34% of the fractures recorded in our series. This could be explained by the fact that the phalanges are the most prominent bones in the foot and therefore the most exposed to trauma.

This result is similar to that of TRAORE D [6] and NDAO M [5], who found 50.85% and 55% respectively.

3. Therapeutic Approach

• Depending on the time taken to provide care

Most cases (74%) were treated within 6 hours.

This result differs from that of KOUAME I [7], who found that 25.3% of patients received treatment within 24 hours.

This allowed us to establish a correlation between the time to treatment and a favorable outcome. The shorter the time to treatment, the more favorable the outcome.

• According to treatment

During our study, all our patients received medical treatment in 100% of cases, followed by surgical treatment in 100% of cases with associated procedures in 44%.

Physiotherapy was provided for 29.6% of patients.

These results led us to conclude that the management of open foot trauma is based on a treatment plan for each type of traumatic foot injury.

4. In terms of Progression

• According to the progression of fractures

In our study, we found that 61% of fractures had healed at the bone level.

This could be explained by the fact that most of our patients with open fractures were treated early with appropriate treatment and regular follow-up.

This result is comparable to that found by KOUAME I [4], who found 66.28%.

• According to the AOFAS score results

After treatment and follow-up, most results were very good at 37% of cases. Good results accounted for 33.3% and poor results for 11.1%. This study enabled us to better specify the relationship between the time taken to provide treatment and the results obtained after treatment.

On this point, our work showed that our results were similar to those of KOUAME I [4], who found 29.5% for very good results, 29.3% for good results, 10.3% for fairly good results and 10.3% for poor results and different from those of NDAO M [5], whose good results were in the majority with 93% of cases, fairly good results in 5% of cases and poor results in 2% of cases.

• According to sequelae

In our study, the absence of after-affects, therefore recovery, was the most frequent in 78% of cases.

Residual pain and malunions represent the most frequent after-effects wiyh a respective rate of 11% and 7%.

This could be explained by the fact that the majority of our traffic accident victims are treated very early in the emergency room (good result factor). This result is similar to that of NDAO M, which found 91% of cases of absence of after-effects and 5% of patients having presented malunions and that of KOUAME I which found 90% of cases of absence of after-effects and 2.4% of patients having presented malunions [4,5].

Conclusion

In view of these results, it is important to note that open foot injuries are very common in our daily practice and their management must be well codified. Of course, perfect execution and close follow-up are required, as well as patient compliance, in order to obtain a satisfactory anatomical and functional result.

Conflict of Interests

The authors declare that there is no conflict of interest related to this study.

References

1. Maestro M, Ferre B. Anatomie fonctionnelle du pied et de la cheville de l’adulte. Rev Rhum Monogr. 2014;81:61-70.
2. Toullec E. Le pied traumatique de l’adulte. Groupe d’Étude du Pied et de la Marche. 2010:44.
3. Bouffioux N. Séquelles des traumatismes de la première articulation métatarso-phalangienne. Elsevier Masson. 2011:270-86.
4. Kouamé IM, Achié JR, Aya AN, Soumahoro I, Loukou BY, Bada JL, et al. Predictive factors of functional outcome of open fractures of the foot at the Bouaké Hospital and University Center. Open J Orthop. 2024;14:510-23.
5. Ndao M. Évaluation des lésions et séquelles des traumatismes du pied [thèse de doctorat]. Dakar: Université Cheikh Anta Diop. 2018; 263.
6. Traoré D. Les traumatismes (fractures et luxations) du pied: à propos de 70 cas dans le service d’orthopédie et de traumatologie de l’hôpital Gabriel Touré [thèse de doctorat]. Bamako: Université de Bamako. 2001.
7. Brunet-Guedj E, Généty J, Moyen B. Médecine du sport. 6e éd. Paris: Masson; 2000;354. ISBN 2294002784.