TEMPORARY EXTERNAL FIXATION PRIOR TO TERTIARY REFERRAL: AVAILABILITY AND ABILITY.

Abstract

Introduction: The hub and spoke model of trauma describes fracture stabilisation prior to referral. Many arrive at tertiary centres with inadequate temporary external fixation. This study investigates ex-fix availability, training and awareness of referral protocols in two regions.

Methods: Hospitals feeding two regional trauma centres were targeted with two telephone questionnaires, one for on-call orthopaedic SpRs and one for theatre nursing staff ascertaining ex-fix availability, training, knowledge of regional referral protocols, and clinical scenarios to establish common practice in each unit.

Results: 16 hospitals: 15 SpRs, 16 nurses responded

Equipment: 0/31 aware guidelines for ex-fix stock

• - Ex-fix trays per unit (all manufacturers) mean = 4.14 (1–9)

• - Majority equipment in unit = Orthofix (11), Hoffman II (5), AO (1)

• - 12/15 SpRs reported insufficient ex-fix equipment for pelvis, 4 long bones and bridging knees (Damage Control Orthopaedics = DCO)

• - 7/15 SpRs reported insufficient ex-fix for 4 long bones/ bridging knees

SpRs:

• - mean year of training = 2.2

• - Experience: Generic trauma course (9) Specific ExFix (6) Manufacturer (9)

• - 14/15 would value specific regional ex-fix course

• - DCO patient scenario SpR unable to fix -lack of knowledge vs. lack of equipment 7/15 vs. 12/15 p< 0.01

Referral Protocols:

• - 7/31 aware of transfer protocol

• - 31/31 want referral routes clearly identified

• - 12/15 would value regular regional audit

Discussion: A deficiency of ex-fix equipment for DCO/ polytrauma exists across many units in both regions. No accepted advice on equipment level requirement exists.

All trainees had attended ex-fix teaching. Those who had only attended generic courses were less confident in DCO scenarios.

Most favoured a specific regional ex-fix course.

Tertiary care protocols have been distributed, but many units are unaware of their existence. A regular regional audit of trauma referrals would provide protocol reinforcement and opportunity for feedback.