scholarly journals The impact of a dedicated orthoplastic operating list on time to soft tissue coverage of open lower limb fractures

2015 ◽  
Vol 97 (6) ◽  
pp. 456-459 ◽  
Author(s):  
MA Fernandez ◽  
K Wallis ◽  
M Venus ◽  
J Skillman ◽  
J Young ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Soft Tissue Coverage ◽  
National Guidelines ◽  
Management Standards ◽  
Lower Limb Fractures ◽  
Time Period ◽  
Operating List ◽  
Limb Fractures ◽  
The Impact

An observational study was conducted of 105 patients presenting with an open fracture of the tibia or ankle to determine the impact of a dedicated orthoplastic operating list on our management of these injuries over the time period January 2012 to July 2014. There were 51 patients before and 54 after the introduction of the orthoplastic list. Significant improvements were noted in our ability to deliver a service in line with national guidelines across all Gustilo–Anderson grades of injury. Among patients with the most severe grades of injury (Gustilo types IIIB and IIIC), there was a trend towards an improved time to first skeletal stabilisation (29.5 vs 14.2 hours, p=0.068), an improvement in time to soft tissue coverage (173.6 vs 88.1 hours, p=0.009) and a trend towards a reduced length of inpatient stay (32.6 vs 23.2 days, p=0.138). Where the 72-hour target had been breached, there was a significant improvement in the proportion of patients covered within 7 days of injury (48.2% vs 83.3%, p=0.017). Our compliance with national management standards increased significantly to reflect these improvements in care. These results support the implementation of dedicated orthoplastic operating sessions to meet the growing burden of patients presenting with open fractures at specialist centres.

scholarly journals Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007–2014

2018 ◽  
Vol 100 (3) ◽  
pp. 203-208 ◽  
Author(s):  
AGC Hay-David ◽  
T Stacey ◽  
I Pallister ◽  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Research Network ◽  
Soft Tissue Coverage ◽  
Patient Movement ◽  
Lower Limb Fractures ◽  
Number Of Patients ◽  
Limb Fractures ◽  
The Impact ◽  
Time From Injury

Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN). A longitudinal analysis was performed between two timeframes in England (pre-and post-BOAST 4 revision): 2007–2009 and 2010–2014. Results A total of 1564 motorcyclists and 64 pillion passengers were identified. Of these, 93% (1521/1628) were male. The median age for males was 30.5 years and 36.7 years for females. There was a statistically significant difference in the number of patients who underwent skeletal stabilisation (49% vs 65%, P < 0.0001), the time from injury to skeletal stabilisation (7.33 hours vs 14.3 hours, P < 0.0001) and the proportion receiving soft-tissue coverage (26% vs 43%, P < 0.0001). There was no difference in the time from injury to soft-tissue coverage (62.3 hours vs 63.7 hours, P = 0.726). The number of patients taken directly to a major trauma centre (or its equivalent) increased between the two timeframes (12.5% vs, 41%, P < 0.001). Conclusions Since the 2009 BOAST 4 revision, there has been no difference in the time taken from injury to soft-tissue coverage but the time from injury to skeletal stabilisation is longer. There has also been an increase in patient movement to centres offering joint orthopaedic and plastic care.

scholarly journals Update on the Management of Open Lower Limb Fractures

2012 ◽  
Vol 6 (1) ◽  
pp. 571-577 ◽  
Author(s):  
M Griffin ◽  
M Malahias ◽  
W Khan ◽  
S Hindocha
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Team Work ◽  
Current Evidence ◽  
Optimal Time ◽  
Soft Tissue Coverage ◽  
Current Recommendation ◽  
Lower Limb Fractures ◽  
Vascular Compromise ◽  
Limb Fractures

Open lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone loss and potential vascular compromise. These fracture require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties to ensure good clinical outcomes. Extensive research has improved the outcomes of open lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of open tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, providing antibiotics and soft tissue coverage will be outlined as well as the indications for amputation.

scholarly journals Update on the Management of Compound Lower Limb Fractures

2012 ◽  
Vol 6 (1) ◽  
pp. 518-524 ◽  
Author(s):  
M Griffin ◽  
M Malahias ◽  
S Hindocha ◽  
W Khan
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Team Work ◽  
Current Evidence ◽  
Optimal Time ◽  
Soft Tissue Coverage ◽  
Current Recommendation ◽  
Lower Limb Fractures ◽  
Bone Injury ◽  
Limb Fractures

Compound lower limb fractures pose a significant challenging pathology for orthopaedic and plastic surgeons to manage due to the combined soft tissue damage, bone injury and potential vascular compromise. These fractures require extensive team-work and expertise between several surgical specialties and the advice of non-surgical specialties, to ensure good clinical outcomes. Extensive research has improved the outcomes of compound lower limb fractures and current recommendation on the optimal management is always being updated to enhance patient outcomes. This review serves to provide an overview of the management of compound tibial fractures using current evidence and recently updated UK guidelines. The optimal time for surgical debridement, surgical intervention, antibiotic regime and soft tissue coverage will be outlined as well as the indications for amputation.

scholarly journals 592 Surgical Management of Open Tibia Fractures at A Major Trauma Centre: A Review of Cases Over A One-Year Period

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Khajuria
Keyword(s):  
Soft Tissue ◽  
Surgical Management ◽  
Open Fracture ◽  
Major Trauma ◽  
Trauma Centre ◽  
Soft Tissue Coverage ◽  
Internal Stabilization ◽  
Major Trauma Centre ◽  
Tibia Fractures ◽  
One Year

Abstract Introduction The BOAST/BAPRAS updated the open fracture guidelines in December 2017 to replace BOAST 4 Open fracture guidelines; the changes gave clearer recommendations for timing of surgery and recommendations for reducing infection rates. Method Our work retrospectively evaluates the surgical management of open tibia fractures at a Major Trauma Centre (MTC), over a one-year period in light of key standards (13,14 and 15 of the standards for open fractures). Results The vast majority of cases (93%) had definitive internal stabilization only when immediate soft tissue coverage was achievable. 90% of cases were not managed as ‘clean cases’ following the initial debridement. 50% of cases underwent definitive closure within 72 hours. The reasons for definitive closure beyond 72hours were: patients medically unwell (20%), multiple wound debridement’s (33%) and no medical or surgical reason was clearly stated (47%). Conclusions The implementation of a ‘clean surgery’ protocol following surgical debridement is essential in diminishing risk of recontamination and infection. Hence, this must be the gold standard and should be clearly documented in operation notes. The extent of availability of a joint Orthoplastic theatre list provides a key limiting step in definitive bony fixation and soft tissue coverage of open tibia fractures.

The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

2017 ◽  
Vol 16 (3) ◽  
pp. 212-216
Author(s):  
Nor Hazla Mohamed Haflah ◽  
Min Hwei Ng ◽  
Mohd Heikal Mohd Yunus ◽  
Amaramalar Selvee Naicker ◽  
Ohnmar Htwe ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Open Fracture ◽  
Wound Closure ◽  
Posterior Tibial Artery ◽  
Soft Tissue Coverage ◽  
Skin Defect ◽  
Vascular Repair ◽  
Posterior Compartment ◽  
Large Defect ◽  
Large Skin

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

scholarly journals Epidemiology of Orthopaedic Admissions at A Teaching Hospital of Eastern Nepal

2017 ◽  
Vol 6 (1) ◽  
pp. 56-62
Author(s):  
Bibhuti Nath Mishra ◽  
Anuja Jha ◽  
Yogendra Gupta
Keyword(s):  
Teaching Hospital ◽  
Inpatient Care ◽  
Open Fracture ◽  
Care Center ◽  
Osteoporotic Fractures ◽  
Tertiary Level ◽  
Health Care Center ◽  
Lower Limb Fractures ◽  
Closed Fractures ◽  
Limb Fractures

Background: There are many other reasons besides fracture for which a patient could potentially be admitted to orthopaedic inpatient care. The goal of this retrospective review was to analyze the spectrum of orthopaedic admissions to a tertiary level teaching hospital of Nepal.Material & Methods: This retrospective descriptive epidemiological study was based on patients admitted for orthopaedic inpatient care at a tertiary level health care center of eastern Nepal. Registry data of 1 year was used to analyze the spectrum of orthopaedic admissions.Results: Male admission outnumbered females with a ratio of 1.82:1. Trauma accounted to majority of Orthopaedic admissions (67.9%) and Infection lied second in order (12.4%). Upper and Lower limb fractures (with right sided dominance) contributed to highest numbers of trauma respectively. Incidence of closed to open fracture was 5.45:1. More than half of trauma and fractures involved the 10 – 39 years age group with predominance in 10-19 years. Fracture incidence was higher among men than women until 59 years of age after which the gender ratio reversed.Conclusions: Leading cause for orthopaedic admission was Trauma accounting more than 2/3 of the total. Biasness in gender admission reflects true picture of male dominated society. Upper limb injury, right side and closed fractures were dominating. Sexual dimorphism was apparent in fractures which may be due to higher rates of Osteoporotic fractures in elderly females.Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), Page: 56-62

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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