{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T08:11:18Z","timestamp":1770279078794,"version":"3.49.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Despite advances in antibiotic therapy and microsurgery, the management of Gustilo and Anderson 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 early failure of limb salvage in Gustilo type IIIA and B tibia injuries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This was a prospective study that examined open tibia fractures at two tertiary hospitals in the emergency and orthopaedic units between June and October 2023. Fifty-three (26 IIIB and 27 IIIA) satisfied the study inclusion and exclusion criteria. Four injuries (type IIIA) in paediatric patients that had met the inclusion criteria were excluded from analysis to ensure homogeneity and generalizability of the results due to their small numbers. 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 49 Gustilo type IIIA and B tibia fractures, 43 were successfully salvaged, while 6 necessitated amputation (4 primary, 2 secondary). A GHOISS of 13 demonstrated maximum specificity (90.7%) and sensitivity (83.3%) in predicting amputation, with an AUC of 0.923 (95% CI 0.804\u20130.977), indicating strong discriminatory accuracy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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 above which early failure of limb salvage is anticipated.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12893-025-02811-1","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:50:45Z","timestamp":1740120645000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ganga hospital open injury severity score as a predictor of early failure of limb salvage among gustilo type III A and B tibia fractures in Uganda: a prospective cohort study"],"prefix":"10.1186","volume":"25","author":[{"given":"Maxwel Dancan","family":"Okuku","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umaru","family":"Kabuye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen Angira","family":"Khadolwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abubakar Mohamed","family":"Aweis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Okedi Francis","family":"Xaviour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Demoz","family":"Abraha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Quealee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony Ayotunde","family":"Olasinde","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibe Michael","family":"Usman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,21]]},"reference":[{"key":"2811_CR1","doi-asserted-by":"publisher","unstructured":"Weber CD, Hildebrand F, Kobbe P, Lefering R, Sellei RM, Pape HC. Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications. Eur J Trauma Emerg Surg. 2019;45(3):445\u201353. Available from: https:\/\/doi.org\/10.1007\/s00068-018-0916-9","DOI":"10.1007\/s00068-018-0916-9"},{"issue":"1","key":"2811_CR2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s00068-014-0465-9","volume":"41","author":"S Rajasekaran","year":"2015","unstructured":"Rajasekaran S, Sabapathy SR, Dheenadhayalan J, Sundararajan SR, Venkatramani H, Devendra A, et al. Ganga hospital open injury score in management of open injuries. Eur J Trauma Emerg Surg. 2015;41(1):3\u201315.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"03","key":"2811_CR3","first-page":"29","volume":"11","author":"A Basu","year":"2022","unstructured":"Basu A, Nandy SN, Sarkar PS, EVALUATION OF MANAGEMENT OF GUSTILO, TYPE IIIB OPEN WOUND ACCORDING TO GANGA HOSPITAL OPEN INJURY SEVERITY SCORE (GHOISS). Int J Sci Res. 2022;11(03):29\u201333.","journal-title":"Int J Sci Res"},{"issue":"7","key":"2811_CR4","doi-asserted-by":"publisher","first-page":"e43","DOI":"10.2106\/JBJS.17.00439","volume":"100","author":"NN O\u2019Hara","year":"2018","unstructured":"O\u2019Hara NN, Mugarura R, Potter J, Stephens T, Rehavi MM, Francois P, et al. The socioeconomic implications of isolated tibial and femoral fractures from Road Traffic Injuries in Uganda. J Bone Joint Surg Am. 2018;100(7):e43.","journal-title":"J Bone Joint Surg Am"},{"key":"2811_CR5","unstructured":"Ssebuufu R, Lule H, Ssebuufu R, Okedi XF. Prehospital Factors Associated with Injury Severity of Motorcycle Related Femoral Fractures at Mbarara and Kampa. 2017."},{"issue":"10","key":"2811_CR6","first-page":"133","volume":"22","author":"H Pape","year":"2008","unstructured":"Pape H, Webb LX. History Open Wound Fract Treat. 2008;22(10):133\u20134.","journal-title":"History Open Wound Fract Treat"},{"key":"2811_CR7","doi-asserted-by":"crossref","unstructured":"Sabapathy SR, Venkatramani H, Mohan M, Initial Assessment. Debridement, and Decision Making in the Salvage of Severely Injured Lower Extremity. 2019.","DOI":"10.1055\/s-0039-1689741"},{"issue":"11","key":"2811_CR8","doi-asserted-by":"publisher","first-page":"2509","DOI":"10.1016\/j.injury.2017.09.010","volume":"48","author":"K Venkatadass","year":"2017","unstructured":"Venkatadass K, Grandhi TSP, Rajasekaran S. Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children\u2014An analysis of 52 type IIIB open fractures. Injury. 2017;48(11):2509\u201314.","journal-title":"Injury"},{"issue":"1","key":"2811_CR9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.2106\/00004623-200101000-00002","volume":"83","author":"MJ Bosse","year":"2001","unstructured":"Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Jt Surg. 2001;83(1):3\u201314.","journal-title":"J Bone Jt Surg"},{"key":"2811_CR10","doi-asserted-by":"publisher","unstructured":"Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al.  An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347(24):1924\u201331. Available from: https:\/\/doi.org\/10.1056\/NEJMoa012604","DOI":"10.1056\/NEJMoa012604"},{"key":"2811_CR11","doi-asserted-by":"publisher","unstructured":"Sivagnanam M, Ramprasath DR, Manikandan N, Ramakrishnan K. Validity of vetrivel trauma score in predicting salvage of limb in gustilo anderson grade III B and grade III C open fractures. Indian J Orthop Surg. 2021;7(4):304\u201311. Available from: https:\/\/doi.org\/10.18231\/j.ijos.2021.049","DOI":"10.18231\/j.ijos.2021.049"},{"key":"2811_CR12","doi-asserted-by":"crossref","unstructured":"Elniel AR, Giannoudis PV, Instructional Lecture. Trauma Open fractures of the lower extremity: current management and clinical outcomes. 2018;3.","DOI":"10.1302\/2058-5241.3.170072"},{"key":"2811_CR13","unstructured":"NJERI WA. Makerere university makerere university. makerere Repos. 2019;540009."},{"issue":"4","key":"2811_CR14","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1097\/TA.0000000000000154","volume":"76","author":"A Fochtmann","year":"2014","unstructured":"Fochtmann A, Mittlb\u00f6ck M, Binder H, K\u00f6ttstorfer J, Hajdu S. Potential prognostic factors predicting secondary amputation in third-degree open lower limb fractures. 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Available from: https:\/\/doi.org\/10.1186\/s12891-015-0832-7","DOI":"10.1186\/s12891-015-0832-7"},{"issue":"1","key":"2811_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1136\/bmjopen-2018-023161","volume":"9","author":"A Mehmood","year":"2019","unstructured":"Mehmood A, Hung YW, He H, Ali S, Bachani AM. Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries. BMJ Open. 2019;9(1):1\u201311.","journal-title":"BMJ Open"},{"key":"2811_CR18","doi-asserted-by":"crossref","unstructured":"Nicolaides M, Pafitanis G, Vris A. Open tibial fractures: an overview. J Clin Orthop Trauma. 2021;20.","DOI":"10.1016\/j.jcot.2021.101483"},{"key":"2811_CR19","doi-asserted-by":"publisher","unstructured":"Madhuchandra P, Rafi M, Devadoss S, Devadoss A. Predictability of salvage and outcome of Gustilo and Anderson type-IIIA and type-IIIB open tibial fractures using Ganga Hospital Scoring system. Injury. 2015;46(2):282\u20137. Available from: https:\/\/doi.org\/10.1016\/j.injury.2014.11.003","DOI":"10.1016\/j.injury.2014.11.003"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-02811-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-025-02811-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-02811-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T06:50:54Z","timestamp":1740120654000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-025-02811-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,21]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2811"],"URL":"https:\/\/doi.org\/10.1186\/s12893-025-02811-1","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,21]]},"assertion":[{"value":"24 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in accordance with the Declaration of Helsinki, and all methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was granted by the Mulago Hospital Research and Ethics Committee, and all participants and\/or their legal representatives signed an informed consent form prior to recruitment into the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"77"}}