Abstract:

Open tibia fractures, particularly from high-energy trauma, are often infected, making treatment difficult. Honey, with its antibacterial characteristics, has been recommended as an alternative to standard wound dressings. This study compares the efficacy of honey dressings versus standard dressings in reducing microorganism presence in open tibia fractures. This a randomized, open-label, parallel-group experiment study done at the University Teaching Hospital of Kigali, Rwanda. Honey or regular saline dressings were randomly assigned to 98 Gustilo IIIA open tibia fracture patients. Days one and five wound assessments, bacterial cultures, and antibiotic sensitivities. Microorganism decrease was the main outcome, while wound size, infection rates, pain, and other wound characteristics were supplementary metrics. Statistical analysis was conducted with STATA 23 and a significance level of p<0.05. On Day one, there were no significant differences between the two groups in terms of microorganism presence or wound characteristics. However, by Day five, Honey dressing group showed a significant reduction in bacterial presence compared to the control group, with 82% of the honey-treated wounds showing no bacterial growth versus 62.5% in the control group. Honey dressings were particularly effective in reducing Staphylococcus aureus and Pseudomonas spp. infections. Antibiotic sensitivity patterns were similar between groups, although Honey-treated wounds exhibited slightly increased sensitivity to chloramphenicol combinations. In conclusion, Honey dressings reduced antibiotic-resistant microorganisms in open tibia fractures better than standard dressings on day five. These data suggest that Honey may be a feasible alternative to traditional wound care for open fractures, especially in resource-limited settings. These findings should be confirmed by larger sample sizes and longer follow-ups.

References:

[1]. Kakar, S., Tornetta, P., 2007, Open fractures of the tibia treated by immediate intramedullary tibial nail insertion without reaming: a prospective study, J Orthop Trauma, 21(3), 153–7.

[2]. Enninghorst, N., McDougall, D., Hunt, J. J., Balogh, Z. J., 2011, Open tibia fractures: timely debridement leaves injury severity as the only determinant of poor outcome, J Trauma, 70(2):352–6; discussion 356-357.

[3]. Ma, M., Basson, T., G DP, J DT, Ferreira, N., Current concepts in the management of open tibia fractures, 2019, 18(September).

[4]. Bhatty, DrS, Paul, DrR, Kaur, DrH, Study of microbilogical flora and role of primary bacterial cultures in management of open fractures of long bones, International Journal of Orthopaedics Sciences, 2018;4(2b):91–4.

[5]. Beaton-comulada, D., Davila-parrilla, A., Perez-lopez, J. C., Ortiz, K., Foy-parrilla, C., Lopez-gonzalez, F., Management of Open Tibial Shaft Fractures : Does the Timing of Surgery Affect Outcomes ? Journal of the American Academy of Orthopaedic Surgeons, 2017;25:230–8.

[6]. Chang, Y., Bhandari, M., Zhu, K. L., Mirza, R. D., 2019, Antibiotic Prophylaxis in the Management of Open Fractures, JBJS Rev., 7(2):1–15.

[7]. Panahi, Y., Izadi, M., Sayyadi, N., Rezaee, R., Jonaidi-Jafari, N., Beiraghdar, F., et al., 2015, Comparative trial of Aloe vera/ olive oil combination cream versus phenytoin cream in the treatment of chronic wounds, J Wound Care, 24(10):459–65.

[8]. Hixon, K. R., Klein, R. C., Eberlin, C. T., Linder, H. R., Ona, W. J., Gonzalez, H., et al. 2018, A Critical Review and Perspective of Honey in Tissue Engineering and Clinical Wound Healing, Adv Wound Care (New Rochelle), 8.

[9]. Laallam, H., Boughediri, L., Bissati, S., Menasria, T., Mouzaoui, M. S., Hadjadj, S., et al., 2015, Modeling the synergistic antibacterial effects of honey characteristics of different botanical origins from the Sahara Desert of Algeria, Front Microbiol, 6(NOV):1–12.

[10]. Deviandri, R., Yd, I., Singh, A., 2018, Dilution of open fracture Grade IIIA of the lower leg using normal saline 0.9 % mixed with honey compared with normal saline 0.9 % to the bacterial growth. Orthopedic Research Online Journal, 2(5):175–8.

[11]. Molan, P. C., 2006, The antibacterial activity of Honey, Bee World, 73(1):2–28.

[12]. Imran, M., Hussain, M. B., Baig, M., 2015, A Randomized, Controlled Clinical Trial of Honey-Impregnated Dressing for Treating Diabetic Foot Ulcer, 25(10):721–5.

[13]. An Insight into Aging, Senescence, and Their Impacts on Wound Healing, Adv Geriatr Med Res, 2021.

[14]. Mannocci ASVLT, 2019, Male gender, age and low income are risk factors for road traffic injuries among adolescents : An umbrella review of systematic reviews and meta-analyses, J Public Health (Bangkok), 263–72.

[15]. Mordi, R. M., Momoh, M. I., 2009, Incidence of Proteus species in wound infections and their sensitivity pattern in the University of Benin Teaching Hospital. Afr J Biotechnol [Internet], 8(5):725–30. Available from: http://www.academicjournals.org/AJB

[16]. Oryan, A., Alemzadeh, E., Moshiri, A., 2016, Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis, J Tissue Viability, May 1, 25(2), 98–118.

[17]. Ashagrie Tafere, D., 2021, Chemical composition and uses of Honey: A Review, J Food Sci Nutr Res, 04(03):194–201.

[18]. Brudzynski, K., Abubaker, K., St-martin, L., Castle, A., Debabov, D., 2011, Re-examining the Role of hydrogen peroxide in bacteriostatic and bactericidal activities of honey, Front Microbiol., 2(October):1–9.

[19]. Bodganov, S., 2016, Honey composition. Honey Book, (January):1–5.

[20]. Schade, A. T., Hind, J., Khatri, C., Metcalfe, A. J., Harrison, W. J., Systematic review of patient reported outcomes from open tibia fractures in low and middle income countries. Vol. 51, Injury. Elsevier Ltd; 2020. p. 142–6.