Abstract
IntroductionThe 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.AimTo study the variation in treatment and thoughts among trauma, orthopedic, and plastic surgeons.Materials and methodsIn 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.ResultsThere 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.DiscussionSurgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures.
Highlights
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)
All participants were asked to complete an online questionnaire to collect the following data: five hospital related, 14 current treatment related, 8 BOAST 4 guideline-based questions, and 2 questions about centralizing these injuries
Most participants (> 70%) worked in a hospital with all team members of a multidisciplinary team hold practice. These specialties were defined as ER doctors, rehabilitation specialists, plastic surgeons with microsurgery facilities, trauma surgeons, and trauma-focused orthopedic surgeons
Summary
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). Discussion Surgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures. Severe open lower limb fractures typically occur in young males as a result of a motorcycle accident [1] These typical injuries are complex and patients often present with multiple injuries. As a result, prolonged treatment, hospital stay, and rehabilitation are characteristic in these people in the middle of careers and developing family lives. These injuries have a low incidence, all these factors result in high impacts on the patient life and psychology [2]. Focus on decreasing treatment duration and postoperative complications to a minimum.
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