Epidemiological profile of patients admitted with closed fractures of shaft of tibia in a tertiary government hospital

Introduction: In the recent era of trauma, about one million people get seriously injured annually. Majority of them suffer from lower limb injuries. Due to lack of trauma registry in India, prediction models are not much effective. The aim of our study was to derive basic epidemiological parameters for lower limb injuries which can be used to develop better prediction models to reduce morbidities and mortalities. Materials and Methods: This study consists of 34 cases of fracture both bones of leg, tibia treated by internal fixation with interlocking tibia from August 2009 to July 2011, and followed up to November 2011. Results : The average age of cases in this study was 36.18 years. Fracture was more common in age groups between 20 to 39 years. There were 28 male patients and 6 female patients, showing male preponderance . Conclusion: This study helped us in identifying certain characteristics that may be useful for planning preventive strategies in an attempt to reduce the number of accidents pertaining to lower limbs and redirect public investment in health. We recommend further detailed study in this area to explore more interesting facts which can be made use to develop new preventive measures.


Introduction
Tibia is the most commonly fractured long bone and the exposed anatomical location makes it vulnerable to direct blow and high-energy trauma as a result of motor vehicle accident [1]. Tibia has precarious blood supply with inadequate muscular envelope. Tibial fractures may be associated with compartment syndrome, vascular or neural injury [2]. The presence of hinge joints at the knee and the ankle, allows no adjustment for rotatory deformity after fracture. Because of high incidence of complications, management is often difficult. Trauma accounts for about 12 percent of all causes of death worldwide. Being a significant cause for the lower limb amputations in population less than 50 years ; it affects the individual and the society. Getting back into life after amputation comes with many problems. Due to failure to comply with new conditions these people may suffer from psycho-social difficulties like depression, sense of hopelessness, low self esteem, boredom, anxiety, frustration, fear of family future, which sometimes leads them to commit suicide [3]. Trauma epidemiology is essential to describe the morbidity, disability and dependency as well as defining the most important target for prevention regarding the severity of injury. The prevention of lower limb injuries is more important for developing nations like India for its economy. It has been previously shown that lower limb injuries constitute the majority in trauma and road traffic accidents [4]

Materials and Methods
The present study was a prospective study carried out in SVRRGGH, Tirupati, to know the Epidemiological Profile of Patients Admitted with Closed Fractures of Shaft of Tibia in a Tertiary Government hospital. Approval was obtained from institutional ethical committee. 34 cases of fracture both bones of leg, tibia treated by internal fixation with interlocking tibia, were recruited for the study by convenient sampling, after obtaining free, written, voluntary informed consent.
Data Analysis: Data was analyzed by using SPSS 20.0. Frequency and percentage and Chi-square test was used. Pvalue <0.05 was considered as significant.

Results
Results are presented in table no 1 to table no 5. Table 1 presents descriptive data of age of the participants. Table 2 presents age group and gender of the participants. Table 3 presents age group of participants and side affected. Table 4 presents gender of participants and mechanism of injury. Table 5 presents chi-square test results.

Discussion
The average age of cases in this study was 36.18 years. Fracture was more common in age groups between 20 to 39 years. Keating et al [5] [5] study the male and female ratio was 6:1. Singer et al [6] and Whittle et al [7] study the male and female ratio was 3:1. Court Brown et al [8] study the male and female ratio was 4:1. Bone and Johnson et al [9] study the male and female ratio was 4.5:1. We agree with earlier studies as we have also observed the conditions in 5:1 ratio of males and females As is evident from the chart in the chapter of observations that a large majority of patients sustained their fractures due to Road Traffic Accidents. This fact gets weightage from the reports of other studies given below. These RTAs are common in the younger age group and involve high energy trauma. Also due to the increasing, vehicular traffic with time RTAs are becoming more prevalent. We agrees with earlier results as in our study there is 5 polytrauma cases out 32 , indicating tibia is more vulnerable to injury.

Conclusion
This study helped us in identifying certain characteristics that may be useful for planning preventive strategies in an attempt to reduce the number of accidents pertaining to lower limbs and redirect public investment in health. We recommend further detailed study in this area to explore more interesting facts which can be made use to develop new preventive measures.
Limitations: Major limitation of our study was small sample size and short study period.