Randomised controlled trial comparing the effect of honey versus standard dressing on fracture union and functional outcomes in open tibia fractures

Abstract

Objective: Open tibia fractures pose a high risk of infection and delayed healing, necessitating innovative wound management strategies. This randomised controlled trial evaluated the efficacy of honey dressings compared to standard saline dressings in promoting fracture union, reducing infection rates, and enhancing functional recovery in patients with Gustilo IIIA open tibia fractures. Methods: Conducted at the University Teaching Hospital of Kigali, Rwanda, this open-label, randomised trial enrolled 98 patients with Gustilo IIIA fractures from August 2022 to June 2023. Participants were randomised into two groups: an intervention group receiving honey dressings and a control group receiving saline dressings. Dressings were applied every two days, and all patients received standard antibiotic prophylaxis and fracture management. The primary outcome was fracture union six months post-surgery, evaluated via clinical and radiological assessments. Secondary outcomes included functional recovery, measured by the Lower Extremity Functional Scale, wound healing rates at 30 days, and infection rates. Results: Of the 98 participants (mean age: 36.4 ± 14.4 years; 87.8% male), honey dressings significantly improved wound healing rates by day 30 (86.0% vs. 37.5%, p<0.001) and reduced surgical site infections (14.0% vs. 31.3%, p = 0.041). At six months, fracture union was achieved in 96.0% of the honey group compared to 81.3% of the control group (p = 0.046). Functional recovery was superior in the honey group, with 14.0% achieving full function and 60.0% achieving partial function, compared to 4.2% and 35.4%, respectively, in the control group (p = 0.002). Conclusions: Honey dressings significantly enhanced wound healing, reduced infection rates, and improved long-term functional recovery and fracture union. These findings support honey dressings as a cost-effective alternative for managing complex orthopaedic trauma. Future multi-centre trials are warranted to confirm these results and explore the impact of socioeconomic factors on recovery outcomes. Trial Registration: Rwanda Food and Drug Administration (Registration No. 017/CTAC/FDA/2022).