Open lower limb fractures in the UK trauma system: A multicentre prospective audit of current practice

Claireaux, Henry; Beaumont, Oliver; Parker, S.; Howgate, Daniel J; Fennelly, Joseph; Neal‐Smith, Gregory; Wali, Anuj; Healicon, R; Thind, Amarjeet Singh; Usman, Mehvish; Clifton, Laura J.; Williams, John T; Morrison, Rory; Fishley, William G; Slater, James D; Hendrickson, Susan A.; Stoddart, Michael; Svenning, Matilda Ingrid Elisabeth; Troisi, Luigi; Rich, Harvey; Hughes, Juliana; Van, M; Marsden, Nick

doi:10.1016/j.injury.2020.12.038

Cited by 7 publications

(6 citation statements)

References 22 publications

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“… 26 , 27 A study of open fractures in UK hospitals in 2021 reported an average age of 45.8 years, with 66.1% males. 39 Whilst this represents patients treated with internal fixation as well, it still provides a useful comparison and shows that the population requiring external fixation may have different demographics to these military studies.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review

Pawson,

Church,

Fletcher

et al. 2024

Strategies in Trauma and Limb Reconstruction

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Introduction External fixation devices are commonly used in orthopaedic surgery to manage a range of pathologies. In this patient population, there is currently no consensus on optimal rehabilitation techniques. There exists a large variation in practice, with a limited understanding of how these affect treatment outcomes. Methods Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review was conducted of Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PEDro, and COCHRANE databases, grey literature sources and forward and backward searching of included articles. Studies were selected following rigorous screening with predefined inclusion criteria. Data quality was assessed using validated appraisal tools. Articles were synthesised by rehabilitation type and descriptive analysis was subsequently performed. Results From 1,156 articles identified, 18 were eligible for inclusion. The overall quality was low, with clinical commentaries and case studies being the most common study type. Studies were synthesised by rehabilitation type, the most common themes being gait re-education, strengthening, therapy-assisted, active exercises and weight-bearing exercises. Conclusion There is a lack of high-quality evidence to support meaningful recommendations and guide rehabilitation practices for this patient cohort. Further research for patients being treated in external fixation, especially related to the potential effects of physical rehabilitation on bone healing, return of strength, mobility and independent function is likely to have transferability within wider orthopaedic populations. Clinical significance This systematic review is unable to provide clinical recommendations due to the poor quality of the available literature. However, it is hoped this paper will provide a foundation for further research to improve rehabilitation for patients being treated with external fixation. How to cite this article Pawson JR, Church D, Fletcher J, et al . Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review. Strategies Trauma Limb Reconstr 2024;19(1):45–55.

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Section: Discussionmentioning

confidence: 99%

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review

Pawson,

Church,

Fletcher

et al. 2024

Strategies in Trauma and Limb Reconstruction

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“…This group is previously under-reported, and this could influence service provision and the wider operative and rehabilitative needs of patients. 15,40 A significant proportion of open fracture patients were smokers (n = 335; 28.8%). The prevalence of smoking in patients with open fractures is twice that of the background UK population rates.…”

Section: Discussionmentioning

confidence: 99%

“…This group is previously under-reported, and this could influence service provision and the wider operative and rehabilitative needs of patients. 15 , 40 …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, TARN-sourced reports over-emphasize high-energy transfer trauma in the young, not representative of the wider fracture population. [14][15][16] Increasing numbers of older patients presenting with significant trauma and low-energy open fractures who do not qualify as major trauma will not feature in registry studies. [17][18][19] The evidence base is replete with studies of lower limb injuries in young patients, 20,21 but many are limited by: description of Gustilo-Anderson (GA) 22 grade III injuries of the tibia; single-centre data collection; limited sample size; and data predating the inception of modern trauma network systems and orthoplastic services.…”

Section: Introductionmentioning

confidence: 99%

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The Open-Fracture Patient Evaluation Nationwide (OPEN) study

et al. 2022

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Aims Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. Methods Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed. Results In total, 1,175 patients (median age 47 years (interquartile range (IQR) 29 to 65), 61.0% male (n = 717)) were admitted across 51 sites. A total of 546 patients (47.1%) were employed, 5.4% (n = 63) were diabetic, and 28.8% (n = 335) were smokers. In total, 29.0% of patients (n = 341) had more than one injury and 4.8% (n = 56) had two or more open fractures, while 51.3% of fractures (n = 637) occurred in the lower leg. Fractures sustained in vehicle incidents and collisions are common (38.8%; n = 455) and typically seen in younger patients. A simple fall (35.0%; n = 410) is common in older people. Overall, 69.8% (n = 786) of patients were admitted directly to an orthoplastic centre, 23.0% (n = 259) were transferred to an orthoplastic centre after initial management elsewhere, and 7.2% were managed outwith specialist units (n = 81). Conclusion This study describes the epidemiology of open fractures in the UK. For a decade, orthopaedic surgeons have been practicing in a guideline-driven, network system without understanding the patient features, injury characteristics, or dispersal processes of the wider population. This work will inform care pathways as the UK looks to the future of trauma networks and guidelines, and how to optimize care for patients with open fractures. Cite this article: Bone Jt Open 2022;3(10):746–752.

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“…Open fractures involving joint compromise and loss of bone stock around the knee are commonly caused by high-energy trauma [ 1 ]. The bone defect may result from the initial trauma itself or subsequent surgical debridement.…”

Section: Introductionmentioning

confidence: 99%

Condylar femoral arthroplasty with bone cement as a salvage measure in open fracture with articular bone defect in a young patient

Olivieri,

Franulic,

Ahumada

et al. 2023

Trauma Case Reports

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Open lower limb fractures in the UK trauma system: A multicentre prospective audit of current practice

Cited by 7 publications

References 22 publications

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review

Rehabilitation Techniques for Adults Undergoing External Fixation Treatment for Lower Limb Reconstruction: A Systematic Review

The Open-Fracture Patient Evaluation Nationwide (OPEN) study

Condylar femoral arthroplasty with bone cement as a salvage measure in open fracture with articular bone defect in a young patient

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