Experience of managing open fractures of the lower limb at a major trauma centre

Ali, Adam M.; McMaster, John; Noyes, David T.; Brent, AJ; Cogswell, LK

doi:10.1308/003588415x14181254789367

Cited by 24 publications

(29 citation statements)

References 10 publications

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“…The lesions of the types III of Gustilo prevailed in our series. In the study reported by AM Ali et al, the lesions of the type IIIa, IIIb and IIIc accounted for 8%, 76% and 16% respectively [11]. With regard to the lesions of the type III, our results correspond to those of Frederico Carlos et al [10] which also noted a predominance of type IIIa Lesions.…”

Section: Discussionsupporting

confidence: 85%

Epidemiology of Open Limb Fractures in a Country with Low-Income

Kombate¹,

Walla²,

Akloa³

et al. 2017

OJO

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Section: Discussionsupporting

confidence: 85%

Epidemiology of Open Limb Fractures in a Country with Low-Income

Kombate¹,

Walla²,

Akloa³

et al. 2017

OJO

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“…In common with other studies, we have shown support for an orthoplastics service following the introduction of the trauma network. [12][13][14][15][16][17][18][19] Plastic surgical involvement is an integral factor in major trauma service planning and provision from postgraduate training to the provision of joint orthoplastics operating lists. The reduction we identified in the number of patients undergoing skeletal stabilisation and who later underwent soft-tissue coverage suggests a coordinated orthoplastic service.…”

Section: Discussionmentioning

confidence: 99%

Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007–2014

Hay-David

Stacey

Pallister

et al. 2018

annals

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Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN). A longitudinal analysis was performed between two timeframes in England (pre-and post-BOAST 4 revision): 2007-2009 and 2010-2014. Results A total of 1564 motorcyclists and 64 pillion passengers were identified. Of these, 93% (1521/1628) were male. The median age for males was 30.5 years and 36.7 years for females. There was a statistically significant difference in the number of patients who underwent skeletal stabilisation (49% vs 65%, P < 0.0001), the time from injury to skeletal stabilisation (7.33 hours vs 14.3 hours, P < 0.0001) and the proportion receiving soft-tissue coverage (26% vs 43%, P < 0.0001). There was no difference in the time from injury to soft-tissue coverage (62.3 hours vs 63.7 hours, P = 0.726). The number of patients taken directly to a major trauma centre (or its equivalent) increased between the two timeframes (12.5% vs, 41%, P < 0.001). Conclusions Since the 2009 BOAST 4 revision, there has been no difference in the time taken from injury to soft-tissue coverage but the time from injury to skeletal stabilisation is longer. There has also been an increase in patient movement to centres offering joint orthopaedic and plastic care.

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“…In 2009, the BOAST 4 Standards were published which emphasized the importance of early transfer of patients with complex open lower limb fractures to a specialist centre [15]. In 2012, major trauma centres (MTC) and associated major trauma networks were created to improve patient transfer in the UK [9–11]. The major goal was reducing complications such as osteomyelitis by means of soft-tissue coverage within 72 h of injury.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported successful results of major trauma centres (MTC) in the United Kingdom following these standards. A decrease in treatment time, fewer required surgeries per patient, and a higher successful limb reconstruction rate have led to a decrease in deep infection rate [9–11].…”

Section: Introductionmentioning

confidence: 99%

Treating open lower limb fractures successfully; thoughts and current practice on therapy and centralization in The Netherlands

Oflazoglu

Hoogendoorn

Zwaal

et al. 2017

Eur J Trauma Emerg Surg

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Introduction The British Orthopedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) updated the evidence-based guidelines for the treatment and care of open lower limb fractures (BOAST 4). Following this, a Dutch version has been developed. The main points are multidisciplinary care, planning, and treatment of these injuries. Early osteosynthesis (within 7-14 days) combined with soft-tissue coverage results in more efficient care and less complications. Aim To study the variation in treatment and thoughts among trauma, orthopedic, and plastic surgeons. Materials and methods In this cross-sectional study 94 surgeons (57 trauma, 23 plastic, and 14 orthopedic surgeons) working at 46 centers completed an online questionnaire, consisting of 5 demographic, 14 hospital-related, 8 BOAST 4-related, and 2 centralization-related questions. Results There was a strong agreement among surgeons about the best moment for multidisciplinary consultation, which was before initial debridement, while in practice, this often does not occur. All surgeons agreed that the initial debridement should be performed immediately by any surgeon, but not solely by trainees. Plastic surgeons responded that the definitive stabilization and wound cover should not exceed 7 days, while half of the trauma and orthopedic surgeons agreed that it should not exceed 14 days. Finally, most surgeons agreed that Gustilo 3 fractures should be centralized. However, there was disagreement on the need for centralization of Gustilo 2 fractures. Discussion Surgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures.

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Experience of managing open fractures of the lower limb at a major trauma centre

Cited by 24 publications

References 10 publications

Epidemiology of Open Limb Fractures in a Country with Low-Income

Epidemiology of Open Limb Fractures in a Country with Low-Income

Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007–2014

Treating open lower limb fractures successfully; thoughts and current practice on therapy and centralization in The Netherlands

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