Update on the Management of Open Lower 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.

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Update on the Management of Compound Lower Limb Fractures

The Open Orthopaedics Journal ◽

10.2174/1874325001206010518 ◽

2012 ◽

Vol 6 (1) ◽

pp. 518-524 ◽

Cited By ~ 7

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.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0222 ◽

2018 ◽

Vol 100 (3) ◽

pp. 203-208 ◽

Cited By ~ 2

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.

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Synchronus Circular Frame Stabilisation and Microsurgical Soft Tissue Reconstruction for the Acute Management of Open Lower Limb Fractures

OrthoMedia ◽

10.1302/3114-210379 ◽

2021 ◽

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Soft Tissue Reconstruction ◽

Acute Management ◽

Lower Limb Fractures ◽

Circular Frame ◽

Tissue Reconstruction ◽

Limb Fractures

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University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities

South African Journal of Physiotherapy ◽

10.4102/sajp.v73i1.362 ◽

2017 ◽

Vol 73 (1) ◽

Author(s):

Mokgobadibe V. Ntsiea ◽

Witness Mudzi ◽

Nicolette Comley-White ◽

Heleen Van Aswegen ◽

Benita Olivier ◽

...

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Soft Tissue Injuries ◽

Health Facilities ◽

Medical Conditions ◽

State Health ◽

Icu Patients ◽

Lower Limb Fractures ◽

Tissue Injuries ◽

Limb Fractures

Background: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals.Objective: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum.Methods: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition–related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum.Results: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours.Conclusion: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.0015 ◽

2015 ◽

Vol 97 (6) ◽

pp. 456-459 ◽

Cited By ~ 7

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.

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