Outcome of the management of open ankle fractures in an ortho-plastic specialist centre

Chummun, Shaheel; Wright, Thomas C.; Chapman, Thomas; Khan, Umraz

doi:10.1016/j.injury.2014.12.017

Cited by 26 publications

(21 citation statements)

References 11 publications

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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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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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“…Vascular injury not only affects perfusion to the extremity, but it appears to serve as a surrogate marker for trauma severity and also hinders long-term function. 25,26 Whether in a trauma patient or in a diabetic patient with peripheral vascular disease, distal blood flow should be assessed prior to reconstructing any lower extremity wound, by way of physical exam, ankle-branchial indices, duplex ultrasonography, or computed tomography (CT) angiogram. In fact, peripheral vascular disease and major vascular compromise have been shown to be predictors of chronic osteomyelitis.…”

Section: Orthoplastic Reconstructive Principlesmentioning

confidence: 99%

“…42,43 The interdisciplinary approach reduces the number of overall procedures necessary to achieve similar outcomes. 26 Measures such as pain, time to definitive skeletal stabilization/ soft tissue coverage, function, length of hospital stay, postoperative complications, and need for revision procedures are improved with this approach. 41,43,44 In cases of pediatric lower extremity trauma with vascular compromise, the implementation of protocols that necessitate early triage by a microvascular surgeon improves response time and appropriate treatment.…”

Section: Orthoplastic Approach Leads To Improved Outcomesmentioning

confidence: 99%

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

Azoury

Stranix

Kovach

et al. 2019

J Reconstr Microsurg

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Background Regardless of the antecedent etiology, lower extremity salvage and reconstruction attempts to avoid amputation, restore limb function, and improve quality of life outcomes. This goal requires a treatment team well versed in neurovascular pathology, skeletal and soft tissue reconstruction, and physical rehabilitation. Methods A review was performed of historical milestones that lead to the development of orthoplastic extremity reconstruction, principles of current management and the evidence that supports an orthoplastic approach. Based on available evidence and expert opinion, the authors further sought to provide insight into the future of the field centered around the importance of a multidisciplinary management protocol. Results Historically, orthopaedic and plastic surgeons worked separately when faced with challenging reconstructive cases involving lower extremity skeletal and soft tissue reconstruction. With time, many embraced that their seemingly separate skill-sets and knowledge could be unified in a collaborative orthoplastic approach in order to offer patients the best possible chance for success. First coined by the senior author (LSL) in the early 1990s, the collaborative orthoplastic approach between orthopaedic and plastic surgeons in limb salvage for the past several decades has resulted in a unique field of reconstructive surgery. Benefits of the orthoplastic approach include decreased time to definitive skeletal stabilization/soft tissue coverage, length of hospital stay, post-operative complications, need for revision procedures and improved functional outcomes. Conclusion The orthoplastic approach to lower extremity reconstruction is a collaborative model of orthopaedic and plastic surgeons working together to expedite and optimize care of patients in need of lower extremity reconstruction. The implementation of protocols, systems, and centers that foster this approach leads to improve outcomes for these patients. We encourage centers to embrace the orthoplastic approach when considering limb salvage, as the decision to amputate is irreversible.

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“…We excluded 38 patients living outside the catchment area, 38 with a misclassified or other fracture type (including Pilon fractures), 6 with misclassified year of fracture, 7 that were conservatively treated, 6 with a previous fracture in the limb, and 25 patients with open fractures that may be considered an own entity of ankle fractures with challenging soft tissue treatment [14]. As the study aimed to collect functional scores for the patients using questionnaires as part of follow-up and often using the other leg as comparison, we excluded 2 patients with cognitive defects, 7 with polytrauma, 7 with high energy trauma (motor vehicle or motorcycle accidents, bicycle accidents, skiing accidents, pedestrians being hit by any of the above, and falls from a height of 3 m), and 2 with apoplexia cerebri/intoxication.…”

Section: Subjectsmentioning

confidence: 99%

Incidence and risk factors for removal of an internal fixation following surgery for ankle fracture: A retrospective cohort study of 997 patients

Naumann

Sigurdsen

Utvåg

et al. 2016

Injury

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Outcome of the management of open ankle fractures in an ortho-plastic specialist centre

Cited by 26 publications

References 11 publications

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

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

Principles of Orthoplastic Surgery for Lower Extremity Reconstruction: Why Is This Important?

Incidence and risk factors for removal of an internal fixation following surgery for ankle fracture: A retrospective cohort study of 997 patients

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