Open tibial fractures in major trauma centres: A national prospective cohort study of current practice. Issue 2 (February 2019)

• Record Type: Journal Article
• Authors: Young, K.; Aquilina, A.; Chesser, T.J.S.; Costa, M.L.; Hettiaratchy, S.; Kelly, M.B.; Moran, C.G.; Pallister, I.; Woodford, M.
• Is Part Of: Injury. Volume 50:Issue 2(2019)
• Page Start: 497
• Page End: 502
• Publication Date: 2019-02
• Subjects: Open fractures -- Lower limb trauma -- BOAST 4; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.10.028
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Open tibial fractures managed in major trauma centres in England have good early outcomes. Overall compliance with BOAST4 guidance in major trauma centres throughout England is poor, particularly in patients aged 65 years and above. In-hospital/thirty-day mortality rate of elderly patients with open tibial fractures was similar to that of neck of femur fracture patients. Abstract: Aims: To assess current national practice in the management of severe open tibial fractures against national standards, using data collected by the Trauma and Audit Research Network. Materials and methods: Demographic, injury-specific, and outcome data were obtained for all grade IIIB/C fractures admitted to Major Trauma Centres in England from October 2014 to January 2016. Results: Data was available for 646 patients with recorded grade IIIB/C fractures. The male to female ratio was 2.3:1, mean age 47 years. 77% received antibiotics within 3 h of admission, 82% were debrided within 24 h. Soft tissue coverage was achieved within 72 h of admission in 71%. The amputation rate was 8.7%. 4.3% of patients required further theatre visits for infection during the index admission. The timing of antibiotics and surgery could not be correlated with returns to theatre for early infection. There were significant differences in the management and outcomes of patients aged 65 and over, with an increase in mortality and amputation rates. Conclusions: Good outcomes are reported from the management of IIIB/C fractures in Major Trauma Centres in England. Overall compliance with national standards is particularly poor in the elderly. Compliance did not appear to affect rates of returning to theatre or early infection. Appropriately applied patient reported outcome measures are needed to enhance the evidence-base for management of these injuries.