From guidelines to standards of care for open tibial fractures

Trickett, Ryan W; Rahman, Sanzidur; Page, Piers; Pallister, Ian

doi:10.1308/rcsann.2015.0020

Cited by 31 publications

(31 citation statements)

References 16 publications

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“…Thus, we performed skin grafting when bones were covered with muscle and soft tissue. According to British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines [20], open fractures should be covered within 5-7 days after injury. In this study, the timing of wound closure of the infection group was longer than that recommended, as some patients required NPWT to improve their wound conditions.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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Background: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. Materials and methods: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. Results: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). Conclusion: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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“…Cognizant of its importance, the British Association of Plastic, Reconstructive and Aesthetic surgeons (BAPRAS) and the British Orthopaedic Association together introduced guidelines to improve the management of complex tibial fractures in 1997 [13]. Surprisingly, several authors have reported that awareness of and adherence to these recommended standards was poor, with no significant changes noted in the last decade [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma

Hohmann

Birkholtz

Glatt

et al. 2017

Injury

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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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From guidelines to standards of care for open tibial fractures

Cited by 31 publications

References 16 publications

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma

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

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