NICE Recommendations Relevant to Open Fractures

2020 ◽  
pp. 205-210
Keyword(s):  
Open Fracture ◽  
Quality Standard ◽  
Open Fractures ◽  
Significant Component ◽  
Nice Guideline ◽  
Complex Fractures

In 2016 the National Institute for Clinical and Care Excellence (NICE) published a suite of five trauma-related guidelines, including the Guideline on Complex Fractures NG37. A significant component of this guideline related specifically to open fractures, and each of the relevant recommendations is discussed. Following the publication of the complete trauma Suite of guidelines there was further work by NICE resulting in the formulation of just five Quality Standard Statements; one of these was specific to open fractures. The relevant recommendations from the NICE guideline NG37 and statement from the Quality Standard are presented is this chapter for easy reference. This also allows the concordance that exists between the text in the rest of this book, the Open Fracture BOAST and NICE to be better appreciated.

scholarly journals Assessment of the Consistency of Tetabulin Injection to the Patients with an Open Fracture Referred to the Khatamolanbia Hospital, Zahedan in 2017 with the National Guidelines

2020 ◽  
Vol 10 (1) ◽  
pp. 148
Author(s):  
Mohammad Sedaghat ◽  
Alireza Dashipour ◽  
Mahtab Masood
Keyword(s):  
Open Fracture ◽  
Pearson Correlation ◽  
Open Fractures ◽  
Risk Of Infection ◽  
National Guidelines ◽  
Clostridium Tetani ◽  
Chi Square ◽  
Cross Sectional ◽  
Age Range ◽  
Positive Effect

Background and Goal: Open fractures are at risk of infection with Clostridium tetani and severe traumatic infections. Tetabulin injection is strongly recommended for the patients with an open fracture and severe wounds. The goal of this study is to assess the consistency of tetabulin injection to the patients with an open fracture referred to the Khatamolanbia hospital in Zahedan in 2017 with the national guidelines. Materials and Methods: This study is a cross-sectional descriptive study. 300 patients with an open fracture referred to the ER of the Khatamolanbia Hospital in Zahedan in 2017 were selected as the sample. Their fracture type and severity were assessed. The data were classified in the tables and statistically analyzed using Chi-square, pared t-test, Pearson correlation, and regression in SPSS 26. Findings: Among 300 patients, 275 patients (91.7%) were male and 25 patients (8.3%) were female. The most frequent age range was 20 to 30 years old (31.7%), and the least frequent ones were 5 to 10 years old (10%) and more than 50 years old (11.6%). The results showed that gender has no significant effect on the predictability of the need of tetabulin injection for the patients with open fractures (P=0.780). However, age has a significant positive effect on the predictability of the need of tetabulin injection for the patients with open fractures; as the age increases, the need for tetabulin injection also increases, and it must be injected in the 50 years and older patients (P=0.05). Conclusion: The results showed that age was effective on the decrease of the serum level of anti-tetanus antibody, however, gender had no significant effect on it. Therefore, it is concluded that tetabulin injection for open fractures is consistent with the national guideline.

A novel Caldicott-compliant hospital imaging protocol for open fracture photography

2020 ◽  
Vol 81 (6) ◽  
pp. 1-8
Author(s):  
James Houston ◽  
Luke Ashby ◽  
Jonathan Ogidi ◽  
Daren F Lui ◽  
Alex J Trompeter
Keyword(s):  
Data Security ◽  
Medical Records ◽  
Open Fracture ◽  
Major Trauma ◽  
Open Fractures ◽  
Clinical Images ◽  
Imaging Protocol ◽  
Permanent Record ◽  
Trauma Networks ◽  
British Orthopaedic Association

Open fractures incur significant morbidity and mortality, and as such have standardised guidelines for their management. Photography of open fractures is an essential component of documentation in the treatment of open fractures as per the British Orthopaedic Association Standards of Trauma and National Institute for Health and Care Excellence guidelines. Smartphones have made photography easily accessible to the clinician, but serious concerns exist regarding data security and the consent process around the use of sensitive clinical images. This project sought to overcome this issue by developing a Caldicott-compliant hospital imaging protocol that allows clinicians to use their smartphone to upload open fracture images into the patient's permanent record. Implementation of the protocol was audited and resulted in the increase of safe and secure open fracture photographic storage to inpatient medical records. This protocol would be transferrable to other hospital trusts and could be adopted across major trauma networks.

scholarly journals Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

2020 ◽  
Author(s):  
Zhao Yang ◽  
Chao Xu ◽  
Yong-Gang Zhu ◽  
Jun Li ◽  
Zi-Xiang Wu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Aesthetic Surgery ◽  
Open Fractures ◽  
Soft Tissue Reconstruction ◽  
Central Unit ◽  
Chinese Characteristics ◽  
Tissue Reconstruction ◽  
The Mean

Abstract Orthoplastic treatment based on the collaboration of orthopedic and plastic surgeons in an “orthoplastic” central unit has been recommended by the British Association of Plastic Reconstructive and Aesthetic Surgery. However, this approach is not used worldwide especially in most developing countries. Based on the aggressive orthoplastic management, orthoplastic experience with Chinese characteristics has been carried out in last 10 years. The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and April 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. The mean (±SD) age of the patients was 38±16 years. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. The overall rate of infection exhibited a lower tendency in this study. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

scholarly journals Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines

2021 ◽  
Vol 6 ◽  
pp. 228
Author(s):  
Alexander Thomas Schade ◽  
Nohakhelha Nyamulani ◽  
Leonard Ngoe Banza ◽  
Andrew John Metcalfe ◽  
Andrew Leather ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Open Fracture ◽  
Open Fractures ◽  
Fracture Management ◽  
Tibia Fractures ◽  
One Year

Background: Road traffic injury (RTI) is the largest cause of death amongst 15–39-year-old people worldwide, and the burden of injuries such as open tibia fractures are rapidly increasing in Malawi. This study aims to investigate disability and economic outcomes of people with open tibia fractures in Malawi and improve these with locally delivered implementation of open fracture guidelines. Methods: This is a prospective cohort study describing function, quality of life and economic burden of open tibia fractures in Malawi. In total, 160 participants will be recruited across six centres and will be followed-up with face-to-face interviews at six weeks, three months, six months and one year following injury. The primary outcome will be function at one year measured by the short musculoskeletal functional assessment (SMFA) score. Secondary outcomes will include quality of life measured by EuroQol EQ-5D-3L, catastrophic loss of income and implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) at one year. A nested pilot pre-post implementation study of an interventional bundle for all open fractures will be developed based on other implementation studies from low- and middle-income countries (LMICs). Regression analysis will be used to model and investigate associations between SMFA score and fracture severity, infection and the pre- and post-training course period. Outcome: This prospective cohort study will report patient reported outcomes from open tibia fractures in low-resource settings. Subsequent detailed evaluation of both the clinical and implementation components of the study will promote sustainability of improved open fractures management in the study sites and further scale-up of open fracture management guidelines. Ethics: Ethics approval has been obtained from the Liverpool School of Tropical Medicine and College of Medicine Research and Ethics committee.

scholarly journals Efficacy of Antibiotic Laden Collagen Sponge In Treating Open Fracture

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Kularaj Subramaniam ◽  
Aminuddin Che Ahmad
Keyword(s):  
Internal Fixation ◽  
Open Fracture ◽  
Female Gender ◽  
Blood Parameters ◽  
Collagen Sponge ◽  
Open Fractures ◽  
Predisposing Factor ◽  
Observational Cohort ◽  
Grade 3

Introduction: Open fractures are known as a major predisposing factor for a higher incidence of infection. The aim of this study was to assess the efficacy of antibiotic impregnated collagen sponge in reducing the risk of infection in open fractures Grade 3. Materials and Methods: This was an observational cohort study, evaluating the incidence of infection in open fractures of the femur Grade 3A/3B following insertion of gentamicin impregnated collagen sponge (Collatamp®) during definitive fracture fixation. Eryhtrocyte Sedimentation Rate (ESR) and total white count (TWC) were used as blood parameters to observe for the possibility of infection from pre-operatively up to follow up visits at the clinic. Results: A total number of 36 patients, whom had sustained open fracture of the femur Grade 3A/B, underwent internal fixation with antibiotic impregnated collagen sponge insertion. Overall, ESR and TWC in both male and female gender were downgoing trend, with p values of <0.001, and clinically there was no evidence of infection. No infection was identified in 97.2% of patients, following the internal fixation and antibiotic impregnated collagen sponge insertion. There was only one patient (2.8%) who developed infection following the definitive internal fixation and antibiotics impregnated collagen sponge insertion. Conclusion: The use of antibiotic impregnated collagen sponge in open fractures reduced the occurrence of infection. Furthermore, this allows for an uncomplicated union of the bone following definitive fixation.

The principles of managing open fractures

2014 ◽  
Vol 100 (1) ◽  
pp. 20.1-25
Author(s):  
R Walker ◽  
S Middleton ◽  
S A Stapley
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Open Fracture ◽  
Open Fractures ◽  
Improvised Explosive Device ◽  
Limb Fracture ◽  
Explosive Device ◽  
Improvised Explosive

AbstractAny fracture of a bone which communicates with the outside environment via a wound in the skin is classified as an open fracture. This may be from penetration by sharp objects from the exterior, laceration caused by the fracture fragments, or shearing forces that tear or de-glove soft tissue from a limb. These injuries vary in mechanism and severity, ranging from a broken finger caught in a bulkhead door to a catastrophic lower limb fracture suffered from an improvised explosive device (IED). We address the management principles that can be applied to all open fractures regardless of cause.

The use of Prophylactic Flucloxacillin in Treatment of Open Fractures of the Distal Phalanx within an Accident and Emergency Department: A Double-Blind Randomized Placebo-Controlled Trial

2003 ◽  
Vol 28 (5) ◽  
pp. 388-394 ◽  
Author(s):  
J. STEVENSON ◽  
G. MCNAUGHTON ◽  
J. RILEY
Keyword(s):  
Emergency Department ◽  
Open Fracture ◽  
Controlled Trial ◽  
Distal Phalanx ◽  
Open Fractures ◽  
Controlled Study ◽  
Double Blind ◽  
Accident And Emergency ◽  
Significant Difference ◽  
Accident And Emergency Department

Open fractures of the distal phalanx commonly present to the Accident and Emergency Department. Controversy surrounds the use of prophylactic antibiotics in treating this injury. A double-blind, prospective, randomized placebo-controlled study was undertaken comparing the use of prophylactic flucloxacillin to placebo in addition to meticulous wound toilet. One hundred and ninety-three adult patients with an open fracture of the distal phalanx were studied. Seven patients developed superficial infections, an overall infection rate of 4%. No patient developed osteitis or a deep wound infection. There were three cases of infection in the 98 patients (3%) in the antibiotic group and four cases of infection in the 95 patients (4%) in the placebo group. A difference of proportion test confirmed no significant difference. It is concluded that the addition of prophylactic flucloxacillin to thorough wound toilet and careful soft-tissue repair of open fracture of the distal phalanx confers no benefit.

scholarly journals OP0276-PARE CREATING POLITICAL LEVERS TO IMPROVE AXIAL SPONDYLOARTHRITIS CARE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 167.2-168
Author(s):  
J. Hamilton ◽  
D. Webb ◽  
S. Whalley
Keyword(s):  
Axial Spondyloarthritis ◽  
Delayed Diagnosis ◽  
Quality Standard ◽  
Inflammatory Back Pain ◽  
Research Support ◽  
Policy Makers ◽  
Nice Guideline ◽  
Link Type ◽  
The Uk ◽  
The Impact

Background:Research carried out in 2016 by NASS showed that the range and quality of axial spondyloarthritis (axial SpA) services generally offered around the UK were variable 1. The publication by the regulator, the National Institute for Health and Care Excellence (NICE), of a Guideline for Spondyloarthritis (NG65) in 2017 2 and the corresponding Quality Standard (QS170) in 2018 3, for the first time provided national guidance and standards of services that should be available for people with axial SpA. National oversight of the implementation of these however was missing.Objectives:NASS worked with Parliamentarians to establish the All-Party Parliamentary Group for Axial Spondyloarthritis in January 2019. We gave it a very specific objective - to oversee the implementation of NH65 and QS170. The group seeks to improve axial SpA services in England whilst raising awareness of the condition at a parliamentary level, working closely with NASS.Methods:The group is a unique forum in the UK, bringing together patients, clinicians, researchers, policy makers, national bodies and parliamentarians. The group has met five times covering a range of topics including the delay to diagnosis, the uptake of NG65 and hydrotherapy.In 2019 the group carried out a national inquiry into the standards of axial SpA services in the UK, developing a ten-question quality framework, based largely on the NICE Guideline recommendations and Quality Standard. In July 2020 a meeting was convened to discuss the impact of COVID-19 on axial SpA services. The meeting presented research carried out by NASS and M&F Health with patients and clinicians respectively.Results:The results of the national inquiry for England were published in January 2020 4. The inquiry found that large discrepancies remain in the provision of axial SpA services. Only 21% of local commissioning bodies have an inflammatory back pain pathway, and less than half of NHS providers have a specialist axial SpA clinic.The results of COVID survey shows significant impacts on the health of axial SpA patients and on the availability and modality of rheumatology services. The APPG later published a report with a set of recommendations 5, creating minimum service specifications for axial SpA services during crisis periods such as the recent pandemic, as well as service recovery. Comment on this research was also published in The Lancet Rheumatology 6.In September 2020 the work of the APPG led to a debate in Parliament on delayed diagnosis in axial SpA.Discussions on the future of hydrotherapy services has resulted in the mobilisation of stakeholders across condition areas.Conclusion:All All Party Parliamentary Group is already proving to be an effective political lever to improve axial SpA care. It has shown huge variations in the standard of care and provision of services still remain and has brought this to the attention of Parliamentarians, policy makers and clinicians.References:[1]Mohammed H Derakhshan, Himanshu Pathak, Debbie Cook, Sally Dickinson, Stefan Siebert, Karl Gaffney, NASS and BRITSpA investigators, Services for spondyloarthritis: a survey of patients and rheumatologists, Rheumatology, February 2018[2]Spondyloarthritis in over 16s: diagnosis and management (NG65), https://www.nice.org.uk/guidance/ng65, February 2017[3]Spondyloarthritis (QS170), https://www.nice.org.uk/guidance/qs170, June 2018[4]Axial Spondyloarthritis Services in England – A national inquiry, https://nass.co.uk/wp-content/uploads/2020/01/Axial-Spondyloarthritis-Services-in-England-FINAL.pdf, January 2020[5]COVID-19 & Axial SpA: Government Recommendation Paper, https://nass.co.uk/wp-content/uploads/2020/10/APPG-Recommendation-Paper-COVID-19-Axial-SpA-for-website-1.pdf, October 2020[6]Helena Marzo Ortega, Simon Whalley, Jill Hamilton, Dale Webb, COVID-19 in axial spondyloarthritis care provision: helping to straighten the long and winding road, https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30413-6/fulltext, 1 December 2020Disclosure of Interests:Jill Hamilton Grant/research support from: Funding was received from Novartis to support APPG 1, 2 and 4, Dale Webb Grant/research support from: Funding was received from Novartis for APPG 1, 2 and 4, Simon Whalley: None declared

scholarly journals Performance and Return to Sport After Open Fracture in National Football League Players

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110278
Author(s):  
Michael O. Cotton ◽  
Joseph M. Sliepka ◽  
Derek M. Klavas ◽  
Patrick C. McCulloch ◽  
Joshua D. Harris ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Open Fracture ◽  
National Football League ◽  
Return To Sport ◽  
Open Fractures ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Career Length ◽  
And Control

Background: Open fractures are debilitating injuries for athletes. No prior studies have investigated open fractures in National Football League (NFL) players. Purpose: To compare outcomes after open fracture in NFL players in terms of (1) time to return to sport (RTS), (2) postinjury career length and games played per season, (3) postinjury performance, and (4) postinjury performance compared with matched controls. Study Design: Retrospective comparative series; Level of evidence, 3. Methods: Publicly available records were used to identify NFL players who had sustained an open fracture between 1970 and 2018. Controls were matched to injured players by age, experience, position, and preinjury performance. RTS was defined as playing in at least 1 NFL game after open fracture. Comparisons between injured and control players were made using the paired-samples Student t test. Results: Injuries in 37 players were analyzed (age, 27.2 ± 3.6 years; experience, 4.4 ± 3.6 seasons).  The 3 most common locations for open fracture were the tibia/fibula (n = 16), hand/finger (n = 12), and forearm/wrist (n = 3). A total of 30 (81%) players had a mean time of RTS of 9.3 ± 8.2 months after open fracture; of these players, 4 (13.3%) who sustained hand/finger open fracture did not undergo surgical treatment. There was no difference in postinjury career length or games played per season between control and injured players. Postinjury performance was similar to preinjury performance in injured players, and postinjury performance scores were similar between injured and control players. There were significant differences between players who sustained upper extremity and lower extremity open fractures in RTS time (4.0 ± 4.8 vs 14.6 ± 7.4 months, respectively; P = .00007) and postinjury performance (6.4 ± 4.3 vs 3.3 ± 2.1, respectively; P = .03). Conclusion: RTS after open fracture among NFL players was high. Players who sustained an open fracture had similar games played per season, career length, and performance compared with matched controls. Players who sustained an upper extremity open fracture had a faster RTS time, higher RTS rate, and improved postinjury performance compared with players who sustained a lower extremity open fracture.

scholarly journals Risk Factors For Traumatic Open Fracture in Children and Adolescents Presenting With Traumatic Fractures

2021 ◽  
Author(s):  
Hongwei Wang ◽  
Jun Liu ◽  
Deluo Wu ◽  
Lan Ou ◽  
Changqing Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Lower Limb ◽  
Open Fracture ◽  
Fracture Site ◽  
Open Fractures ◽  
Multiple Fractures ◽  
Lower Limb Fractures ◽  
Limb Fractures ◽  
Upper Limb Fractures

Abstract Background: To investigate the risk factors for open fractures in children and adolescents (≤18 years old) presenting with traumatic fractures.Methods: We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures.Results: This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2±5.0 years. There were 206 patients (8.5%) who presented with open fractures. The five most common fracture sites were the tibia (31.1%, 64/206), fibula (20.9%, 43/206), phalanx (15.5%, 32/206), humerus (11.2%, 23/206) and ulna (9.7%, 20/206). Univariate logistic regression analysis showed that the aetiology (P﹤0.001) and fracture site (P﹤0.001) were risk factors for open fracture. Multivariate logistic regression analysis indicated that mechanical trauma (OR=64.229, P﹤0.001), being hurt/cut by others (OR=26.757, P﹤0.001), and being struck by an object (OR=15.345, P﹤0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR=5.970, P﹤0.001), upper limb fractures (OR=5.865, P﹤0.001) and multiple fractures (OR=5.414, P﹤0.001) were stronger risk factors than craniofacial fractures for open fractures.Conclusions: Aetiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures, upper limb fractures and multiple fractures) were independent risk factors for open fractures.

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