Impact on outcomes of a personalized educational intervention for surgeons in the management of open tibial fractures in Latin America: a before-and-after study in three low- and middle-income countries.
William Dias Belangero, Jos�� Ricardo Lenzi Mariolani, Carlos Mario Olarte Salazar, Jose Arturo Xicar�� Rodriguez, Mario Rigoberto Portillo Miranda, Miguel ��ngel Vides Lemus, Julio Cesar Landr��n de la Rosa, Gustavo Nahum Hern��ndez Vivas, Gerardo Alfonso Escobar Soriano, Ricardo Arturo Flores McLeod, Hector Jos�� L��pez, Walter Ram��n Caraccioli, Nelson Ismael Nolasco Portillo, ��ngel Ram��n Gil de la Cruz, Jose Francisco Cruz Cardona, Francisco Alberto Santos, Hugo Omar Marroqu��n Mart��nez, Jos�� Javier Ard��n Dub��n, Camilo Garcia, Abimael Osias Izaguirre Osorio, Victor Rosario Suazo, Jorge Luis Cruz Coto, Jorge Rojas-Lievano, Emilio Fantin
Author Information
William Dias Belangero: State University of Campinas, Campinas, Brazil. belangerowd@gmail.com.
Jos�� Ricardo Lenzi Mariolani: State University of Campinas, Campinas, Brazil.
Carlos Mario Olarte Salazar: Fundaci��n Santa Fe de Bogot��, Bogot��, Colombia.
Jose Arturo Xicar�� Rodriguez: Centro Universitario de Occidente, Quetzaltenango, Guatemala.
Mario Rigoberto Portillo Miranda: Hospital General del Instituto Salvadore��o del Seguro Social, San Salvador, El Salvador.
Miguel ��ngel Vides Lemus: Hospital Nacional San Rafael, Santa Tecla, El Salvador.
Julio Cesar Landr��n de la Rosa: Hospital Traumatologico Ney Arias Lora, Santo Domingo, Dominican Republic.
Gustavo Nahum Hern��ndez Vivas: Instituto Hondure��o de Seguridad Social, San Pedro Sula, Honduras.
Gerardo Alfonso Escobar Soriano: Hospital General del Instituto Salvadore��o del Seguro Social, San Salvador, El Salvador.
Ricardo Arturo Flores McLeod: Hospital Nacional San Rafael, Santa Tecla, El Salvador.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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