scholarly journals Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? a study from a major trauma centre in England

2021 ◽  
Author(s):  
Rajan Choudhary ◽  
Madhumita Gupta ◽  
Shahidul Haq ◽  
Wareth Maamoun
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Notable Increase ◽  
Definitive Surgery ◽  
Limb Fractures

<p class="abstract"><strong>Background: </strong>Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.</p><p class="abstract"><strong>Methods: </strong>This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.</p><p class="abstract"><strong>Results: </strong>There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.</p><p class="abstract"><strong>Conclusions:</strong> Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.</p>

scholarly journals Experience of managing open fractures of the lower limb at a major trauma centre

2015 ◽  
Vol 97 (4) ◽  
pp. 287-290 ◽  
Author(s):  
AM Ali ◽  
JM McMaster ◽  
D Noyes ◽  
AJ Brent ◽  
LK Cogswell
Keyword(s):  
Soft Tissue ◽  
Median Time ◽  
Lower Limb ◽  
Major Trauma ◽  
Deep Infection ◽  
Trauma Centre ◽  
Open Fractures ◽  
Trauma Network ◽  
Soft Tissue Cover ◽  
Major Trauma Centre

Introduction In April 2012 the John Radcliffe Hospital in Oxford became a major trauma centre (MTC). The British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4) require system-wide changes in referral practice that may be facilitated by the MTC and its associated major trauma network. Methods From 2008 to 2013 a multistep audit of compliance with BOAST 4 was conducted to assess referral patterns, timing of surgery and outcomes (surgical site infection rates), to determine changes following local intervention and the establishment of the MTC. Results Over the study period, 50 patients had soft tissue cover for an open lower limb fracture and there was a significant increase in the proportion of patients receiving definitive fixation in our centre (p=0.036). The median time from injury to soft tissue cover fell from 6.0 days to 3.5 days (p=0.051) and the median time from definitive fixation to soft tissue cover fell from 5.0 days to 2.0 days (p=0.003). The deep infection rate fell from 27% to 8% (p=0.247). However, in 2013 many patients still experienced a delay of >72 hours between injury and soft tissue cover, primarily owing to a lack of capacity for providing soft tissue cover. Conclusions Our experience may be relevant to other MTCs seeking to identify barriers to optimising the management of patients with these injuries.

Lower limb paediatric trauma with bone and soft tissue loss: Ortho-plastic management and outcome in a major trauma centre

Injury ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 1576-1583
Author(s):  
J Messner ◽  
P Harwood ◽  
L Johnson ◽  
V Itte ◽  
G Bourke ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Tissue Loss ◽  
Paediatric Trauma ◽  
Major Trauma Centre ◽  
Soft Tissue Loss

A comparison between the Major Trauma Centre management of complex open lower limb fractures in children and the elderly

Injury ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1376-1381 ◽  
Author(s):  
Muhammad Faheem Khadim ◽  
Ahmed Emam ◽  
Thomas C. Wright ◽  
Thomas W.L. Chapman ◽  
Umraz Khan
Keyword(s):  
Lower Limb ◽  
Major Trauma ◽  
The Elderly ◽  
Trauma Centre ◽  
Lower Limb Fractures ◽  
Fractures In Children ◽  
Major Trauma Centre ◽  
Limb Fractures

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.

UP-03.135 Urology Trauma: Urban Battlefield: Our Experience of Establishing a Urology Trauma Service at a London Major Trauma Centre

Urology ◽  
2011 ◽  
Vol 78 (3) ◽  
pp. S388
Author(s):  
J. Makanjuola ◽  
G. Kooiman ◽  
C. Brown ◽  
P. Grange ◽  
D. Sharma
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Trauma Service ◽  
Major Trauma Centre

scholarly journals 1403 Leadership and Teamwork in The Major Trauma Service – Implementation of A New Approach to Secondary Surveys

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Jefferies ◽  
A Walls ◽  
P McKeag ◽  
R Houston ◽  
D Kealey
Keyword(s):  
Quality Improvement ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Improvement Project ◽  
Orthopaedic Care ◽  
Trauma Service ◽  
Major Trauma Centre ◽  
Secondary Survey ◽  
Group 2

Abstract Aim Trauma Audit and Research Network (TARN) guidelines at a Major Trauma Centre in Northern Ireland state that all patients admitted with Major Trauma should have a secondary survey completed and documented within 24 hours of admission. Method All patients admitted with major trauma had their medical notes reviewed on discharge to look for evidence of a documented secondary survey. Two audit cycles were completed. The first from January 2018 to April 2018 (n = 38). Following a quality improvement project with specific interventions to improve compliance, including improved communication behaviours and the implementation of a revised trauma booklet, a second cycle was performed from October 2019 to January 2019 (n = 44) Results 58% of group 1 and 75% of group 2 had a documented secondary survey within 24 hours of admission. The interventions therefore resulted in an overall 17% increase in the number of secondary surveys completed within 24 hours. Patients admitted under Orthopaedic care had a significant improvement of 26% between cycles to 89% compliance. Cardiothoracics (33% to 40%), Neurosurgery (14% to 43%) and General Surgery (75% to 66%). Conclusions A quality improvement drive led by the Orthopaedic team involving the education of doctors, improving communication channels and the introduction of revised trauma documentation, resulted in a significant increase in the number of secondary surveys completed within 24 hours. Patients under the care of Orthopaedics were more likely to have a survey completed compared with other specialties. This highlights the need for more education and engagement of other specialities to increase compliance in secondary surveys.

scholarly journals Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre

2021 ◽  
pp. 101509
Author(s):  
Patrick O'Hagan ◽  
Isabella Drummond ◽  
David Lin ◽  
Keng Suan Khor ◽  
Alexandros Vris ◽  
...  
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Open Fractures ◽  
Major Trauma Centre

scholarly journals A health economic analysis of the management of open lower limb fractures in the elderly

2020 ◽  
Vol 30 (8) ◽  
pp. 1383-1391
Author(s):  
Caitlin Pley ◽  
Katie Purohit ◽  
Matija Krkovic ◽  
Ali Abdulkarim
Keyword(s):  
Lower Limb ◽  
The Elderly ◽  
Trauma Centre ◽  
Median Cost ◽  
Financial Loss ◽  
University Hospitals ◽  
Health Economic Analysis ◽  
Lower Limb Fractures ◽  
Major Trauma Centre ◽  
Limb Fractures

Abstract Aim The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature. Methods This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019. Results The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively. Conclusion This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.

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