Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries.

INTRODUCTION: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). METHODS: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. RESULTS: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. CONCLUSIONS: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

Isolated open tibial shaft fracture: a seven-hospital, prospective observational study in two Latin America countries / Fraturas expostas isoladas da diáfise da tíbia: estudo prospectivo observacional em sete hospitais de dois países da América Latina

ABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..

A importância da inclusão do fisioterapeuta no Programa de Saúde da Família / The importance of the physiotherapist in the Family Health Program

O fisioterapeuta é um profissional habilitado a atuar na prevenção, promoção, proteção e reabilitação da saúde, em nível individual e coletivo. Dessa forma, objetiva-se encaixar o papel do fi sioterapeuta no âmbito da saúde pública e sua inclusão no Programa de Saúde da Família (PSF), além de entender suas atividades dentro de um aspecto preventivo e como atuar junto à população, auxiliando toda a equipe de saúde. Para isso, um profi ssional capaz de estudar e investigar o movimento humano e as funções corporais é fundamental. Associado ao PSF, suas práticas se traduzem em um novo modelo de atenção que privilegia toda a comunidade. Em atuação na saúde da família, seu trabalho ganha resolutividade e efetividade, oferecendo ações de baixo custo, criando vínculo com a comunidade, valorizando a profissão e garantido o reconhecimento de sua profissão por todos que a assistem. O PSF surge, assim, como mais uma oportunidade para o fisioterapeuta desenvolver suas habilidades no âmbito social oferecendo ao indivíduo uma melhora na qualidade de vida. Por meio de uma alta motivação do paciente, também garante uma educação continuada e possibilita a recuperação da harmonia do corpo e do convívio social.

The physiotherapist is a qualified professional that can work in prevention, promotion, protection and rehabilitation of the health, in individual and collective levels. In that way, the aim of this paper is to discuss the insert of the physiotherapist in public health and in the Family Health Program (FHP), besides to understand the preventive activities and how they act together with the population, assisting all the health team. For that, it’s necessary a professional capable to study and to investigate the human movement and the corporal functions. Associated to the FHP, the therapist actions should be transformed in a new attention model that privileges the whole community. Working in the healthy of the family, they can become their acts effectiveness and essential, offering low cost procedures, creating bond with the community, valuing the profession and guaranteeing the profession recognition for everybody that attend it. The FHP appears, thus, as one more chance for the physiotherapist to develop its abilities in the social ambit offering to the patient an improvement in the quality of life. By means of a high motivation of the patient, it also guarantees a continuous education and makes possible the recovery of the harmony of the body and the social conviviality.