Randomized Controlled Trial Comparing the Effect of Honey Versus Standard Dressing on Fracture Union and Functional Outcomes in Open Tibia Fractures

BACKGROUND: Open tibia fractures have high risks of infection and delayed healing, requiring innovative wound management. This randomized controlled trial assessed honey dressings versus saline dressings for their effects on fracture union, infection rates, and functional recovery in Gustilo IIIA open tibia fractures. METHODS: Conducted at the University Teaching Hospital of Kigali, Rwanda, this open-label trial included 98 patients with Gustilo IIIA fractures from August 2022 to June 2023. Patients were randomized into honey or saline dressing groups, with dressings applied every two days alongside standard antibiotic prophylaxis and fracture care. The primary outcome was fracture union at six months, evaluated through clinical and radiological assessments. Secondary outcomes included wound healing rates at 30 days, infection rates, and functional recovery as measured by the Lower Extremity Functional Scale. RESULTS: Among the 98 participants (mean age: 36.4 ± 14.4 years; 87.8% male), honey dressings significantly improved wound healing at 30 days (86.0% vs. 37.5%, p < 0.001) and reduced infection rates (14.0% vs. 31.3%, p = 0.041). At six months, fracture union was higher in the honey group (96.0% vs. 81.3%, p = 0.046). Functional recovery was superior in the honey group, with 14.0% achieving full function and 60.0% partial function in the honey group, compared to 4.2% and 35.4%, respectively, in the control group (p = 0.002). CONCLUSION: Honey dressings improved wound healing, reduced infections, and enhanced functional recovery, supporting their use as a cost-effective alternative for managing complex orthopedic trauma. Multi-center trials are needed to validate these findings.