The use of a mobile software application to improve the management of open tibia fractures in a resource-constrained environment

Abstract

Background: The aim of the study was to compare the initial management and the outcomes of patients with open tibia fractures referred to a tertiary orthopaedic unit using a mobile software application (app), Vula Medical Referral (VULA), with those referred by handwritten referral letters (HWRL).

Methods: A retrospective analysis was performed on data collected from the clinical records of patients diagnosed with open tibia fractures and referred to a tertiary level orthopaedic trauma unit over two years. The referrals originated from a community health centre and a district-level hospital via electronic means (VULA) or physical referral letters (HWRL). The primary outcomes of interest included the initial patient management, the referral delay and definitive fracture management. Comparative complication rates within one year were an additional outcome of interest.

Results: One hundred and sixty-two cases were analysed, 103 (64%) in the VULA group and 59 (36%) in the HWRL group. The two groups displayed no significant differences in demographics or injury characteristics. There was a difference in the time from referral to the time of assessment at the tertiary centre (p = 0.028), with the VULA group having a shorter time (mean of 5 hours vs 6 hours). Differences were noted between the referral groups regarding referral documentation content, initial management strategies and complication rates. There were three (2%) patients with nonunion and 17 (11%) with infection. The VULA group had comparatively fewer complications, 6% (6 of 103) compared to 24% (14 of 59) in the HWRL group.

Conclusion: This study found that using the VULA app resulted in better transfer of information and documentation of initial management of open fractures by the referring institution. Time from referral to being assessed by orthopaedics was also marginally better. While our findings suggest that there may be a lower complication rate with the use of the mobile application, further research is required to confirm this.

Level of evidence: Level 4