Introduction: To assess the effectiveness of a regional basic external fixation trauma course.

Methods: Effectiveness of an annual, low-cost, Royal College of Surgeons of England approved, regional basic ex-fix course, led by consultant trauma experts from Yorkshire, UK, covering anatomy, surgical techniques, biomechanics, early management of open fractures and temporary external fixation placement was assessed. Pre- and post-course questionnaires asking grade, current hospital, previous experience, and a mini-test to design a temporary ex-fix construct for four fracture patterns (IIIb open tibia, open book pelvis, Schatzker 6, and total articular pilon) were used. Designs were assessed for stability, safe corridors and plastics assess.

Results:

- 10/22 participants had not previously attended an ex-fix course.

Discussion: Recently Pearse and Naique reported a 48% fixation revision rate in open tibial fractures transferred for tertiary care, suggesting that improved core skills are required to ensure appropriate packaging of patients prior to transfer with open, complex articular and pelvic fractures.

Participation in a simple ex-fix course improves knowledge of ex-fix design. Retention of knowledge must be reassessed after several months.

This course fills a gap in education of basic external fixation for orthopaedic trainees. We recommend every region with a tertiary referral system for complex trauma utilises this course.

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)

SpRs:

- mean year of training = 2.2

Referral Protocols:

- 7/31 aware of transfer protocol

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.

Introduction: To investigate adequacy of temporary ex-fix in grade III open fractures of the tibia, prior to definitive treatment by Flap & Frame at 2 UK trauma centres.

Methods: From 2000 – 2006 all open fractures of the tibia treated by the Ilizarov Method at our two institutions were entered onto the Flap & Frame database. The database was searched for all temporary external fixators placed prior to definitive Ilizarov fixation. Data collected - ex-fix type, whether revision necessary, reasons for revision.

Results:

- 97 grade III open fractures in 95 patients

Discussion: Naique and Pearse described a revision rate of skeletal fixation of 48% in grade IIIb open fractures referred to their tertiary centre. In our series 34% of temporary external fixators needed revision. Modular systems (Hoffman II and AO) required no revision, irrespective of application at a trauma centre or DGH.

All Hoffman hybrids needed revision, due to instability and plastics access. Significantly more non modular (Orthofix) ex-fixes required revision compared to modular, for poor plastics access.

We recommend modular external fixator application (Hoffman II or AO) to avoid problems with temporary external fixation of open tibial fractures. Hybrid temporary external fixation should be abandoned in such injuries.