Abstract
Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.
Highlights
There have recently been changes to both the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures [1, 2] These changes have suggested that the initial surgical debridement and stabilisation of open fractures do not have to occur within 6 hours of injury, as previously advised [3]
Our results show significant opportunity for improvement in the acute care of open fractures
They do show that in the patients who present with grade 3 Gustilo classification fractures are more likely to have more key tasks completed and so better compliance with the guidelines
Summary
There have recently been changes to both the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures [1, 2] These changes have suggested that the initial surgical debridement and stabilisation of open fractures do not have to occur within 6 hours of injury, as previously advised [3]. Preoperative steps in management have been clearly outlined within these guidelines, and it is important that all cases receive a complete package of care on admission in light of the increased number of cases undergoing delayed surgical intervention. Both the 1997 and 2009 BOA/BAPRAS guidelines have recommended that patients should be assessed for compartment syndrome and vascular injury [3, 4]. Both sets of guidelines state that tetanus immunisation status should be recorded, IV antibiotics administered, and that the wound should be photographed [3, 4]. There is a large amount of evidence to support the use of IV antibiotics in particular [4–9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
