Abstract
Aims
The BOA/BAPRAS guidelines for the management of open tibial fractures (2009) recommend early senior combined orthoplastics input and appropriate facilities to manage a high caseload. St Georges Hospital is one of four London Trauma Centres fulfilling these criteria. Our aim is to determine whether becoming a trauma centre has affected the management of patients with open tibial fractures.
Methods
Data were obtained prospectively on consecutive open tibial fractures during two 8 month periods: before and after becoming a Major Trauma Centre (May 2009–Dec 2009 and April 2010–Oct 2010 respectively). Data on patient pathway including, admitting hospital, length of stay, timing and number of operations were recorded.
Results
29 open tibial fractures were admitted during the 8 months after designation as a major trauma centre compared to 15 before. 72% of patients came directly, or as A&E hot transfers (previously 60%). Of the eight tertiary transfers, six were from hospitals outside the South West Trauma Network.
The time to transfer patients initially admitted to local orthopaedic departments has fallen from 8.6 to 1.6 days. Despite this improvement as a trauma centre, these patients remained in hospital longer (16.3 vs 14.9) and had more operations (3.7 vs 2.6) than direct admissions.
As a trauma centre there were improvements in time to definitive skeletal stabilisation (4.7 to 2.2), skin coverage (8.3 to 3.7 days), average number of operations (4.2 to 2.3) and average length of hospital admission fell from 23 to 16 days.
Conclusions
The volume and management of open tibial fractures has been directly affected by introduction of a trauma centre within the London Trauma Network. Implementation of BOAST guidelines has resulted in improved management of open lower limb fractures independent of fracture grade. Our data strongly support the continuing development of trauma networks.
