Introduction. Open fractures are complex injuries associated with substantial morbidity. These injuries are associated with harm to both physical and emotional health as well as preclusion of work, social, and leisure activities. Patient reported outcome measures (PROMs) and health related quality of life are critical indicators of successful rehabilitation following open fracture treatment. This study aimed to measure the PROMs for patients with open lower limb fractures and investigate the relationship with injury severity. Materials & Methods. A retrospective cohort study was performed at a single major trauma centre in the UK. All adult patients with an open lower limb fracture were eligible for inclusion. Patients were identified through a search of a local Open Fracture Database. Epidemiological, clinical, and fracture classification data were obtained by reviewing case notes. Lower Extremity Function Scale (LEFS) and EQ5-D were used as PROMs and measured by a postal questionnaire, alongside return to employment data. Results. A total of 73 patients responded to the questionnaire. Median LEFS was 42 (IQR 26.5 – 59.5), and median EQ5-D was 0.69 (IQR 0.48 – 0.89). There was no significant association between open fracture classification and PROMs. Over 40% of patients reported a change in employment due to their injury. Those who changed jobs had a statistically significant reduction in the EQ5-D of 0.12 (p = 0.021); no significant difference existed in LEFS. Conclusions. This study demonstrates the devastating functional impact of open fractures. This cohort of open injuries reported lower functional and quality-of-life measures compared to population norms. Injury classification was not a valuable predictor of PROMs. A substantial proportion of patients were forced to change employment due to their injury, and these patients reported a significantly lower quality of life. Further work is required to understand the factors contributing to open fracture PROMs

We sought to evaluate the impact of a dedicated weekly ortho-plastics operating list on our ability to provide definitive soft tissue cover of open lower limb fractures within 72 hours. We reviewed all open lower limb fractures at our centre before and after the introduction of an ortho-plastics list to determine whether definitive soft tissue coverage was achieved within 72 hours. There were 23 open lower limb fractures at our centre in 2012 before the introduction of the ortho-plastics operating list of which only 7 (30%) had definitive soft tissue coverage within 72 hours. We hypothesised that the main reason for this was not patient or injury related factors but rather the logistical difficulties of coordinating theatre time on a routine trauma list with senior orthopaedic and plastic surgeon availability. To test this hypothesis we re-audited our time to soft tissue cover six months after the introduction of the ortho-plastics list and 70% of cases achieved coverage within 72 hours. Achieving definitive soft tissue coverage of open lower limb fractures within 72 hours of injury is a challenge. A dedicated weekly ortho-plastics operating list significantly improves our ability to deliver this service

Introduction. Lower limb open fractures are severe injuries, with a joint orthoplastic approach for management recommended by BOAST. An initial audit highlighted a discrepancy in time to definitive wound coverage between the Queen Elizabeth University Hospital (QEUH), which at the time was not an orthoplastic centre, and the Glasgow Royal Infirmary (GRI) which was. Our aim was to perform a secondary audit to identify if the introduction of an orthoplastic service at the QEUH led to a reduction in time to definitive wound coverage. Materials and Methods. Forty-six patients with open lower limb fractures treated at the QEUH in 2019 following introduction of the orthoplastic service were identified. Management including time to antibiotics and wound coverage, and rates of complication were compared with previous audit data. Results. Days to washout was similar between the second cohort of QEUH patients and the first (p=0.522), as was days to definitive management without plastics input (p=0.143). When plastics input was required, there was a reduction in days to wound coverage in the second cohort of QEUH patients compared to the first (3 days vs 8.5 days; p=0.002), and a similar time if compared to the GRI cohort (p=0.778). Conclusions. Time to definitive wound coverage was reduced in those that required plastics input in the second cohort of QEUH patients, with a similar time to that of the original GRI cohort. The QEUH now displays improved concordance with the BOAST guidelines, with definite wound coverage on average occurring within 72 hours

To audit adherence to the British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons 2009 review of the acute management of severe open lower limb fractures (BOAST4). Audit: Retrospective study of adherence to BOAST4 standards of 37 cases treated at Derriford Hospital between March 2010 and 2011. Intervention: a multidisciplinary approach towards the management of such injuries. Assigning department-specific roles across all specialities involved and establishing an early patient transfer pathway from non-specialist centres in the region. Re-audit: Prospective data collection of adherence to BOAST4 of 18 cases between October 2011 and April 2012. Eleven of 15 standards were comparable. Statistical analysis was performed using Fisher's exact test (p≤0.05). Six standards showed statistically significant improvement: antibiotic therapy; regular assessment of neurovascular status; urgent surgery for contaminated wounds; initial wound care; appropriate splinting and early patient transfers. One standard was adhered to in all cases. 3 standards showed improvement, although not statistically significant and 1 standard remained consistently low in adherence. Although doctors are familiar with BOAST4, many are not aware of the specific details. A coordinated and informed multidisciplinary team has enabled the successful application of an evidenced-based approach to the management these injuries

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