GHOISS as A Predictor for Amputation in Gustilo Type III A and B Tibia fractures in Uganda: A prospective Cohort Study

Abstract

Abstract Background Despite advances in antibiotic therapy and microsurgery, the management of Gustilo and Andersen type IIIA and B open tibia fractures continues to pose a considerable challenge in developing countries. This has evolved from historical immediate amputation to modern approaches that prioritize both aesthetics and functional outcomes. Nonetheless, a consensus on limb salvage versus amputation remains elusive, prompting the development of prognostic limb scoring systems. Our study assessed the predictive accuracy of the Ganga Hospital Open Injury Severity Score (GHOISS) for determining the need for amputation in patients with Gustilo type IIIA and B tibia injuries. Methods In this prospective cohort study, patients with Gustilo type III A and B tibia fractures were consecutively recruited from two Ugandan tertiary hospitals after initial resuscitation. The severity of injury for each Gustilo type III A and b tibia fracture was determined using the GHOISS, and limb salvage decisions were made irrespective of the GHOISS. Follow-up was extended for up to fourteen days to assess the necessity of secondary amputation in salvaged limbs. Results Among 53 Gustilo type IIIA and B tibia fractures, 47 were successfully salvaged, while 6 necessitated amputation (4 primary, 2 secondary). A GHOISS of 13 demonstrated maximum specificity (91.5%) and sensitivity (83.3%) in predicting amputation, with an AUC of 0.927, indicating strong discriminatory accuracy. Conclusion The GHOISS reliably predicted outcomes in patients with Gustilo type IIIA and B tibia fractures, with a score of 13 demonstrating optimal sensitivity and specificity for anticipating amputation requirements.