237 Open Lower Limb Fractures: Outcomes from a Major Trauma Centre

Aim This retrospective review describes outcomes of open lower limb fractures in a major trauma centre. Method A retrospective review was undertaken of a prospective database of open lower limb fractures over a period of 20 months, in a major trauma centre following the BOAST/BAPRAS guidelines. Data was gathered using a pre-defined proforma to include demographics, injury characteristics, treatment modality and complications. Results A total of 186 patients were identified. 132 patients (71%) were directly closed, with 17 (9%) requiring a SSG, 6 a local flap (3%) and 27 a free flap (15%). We recorded major complications in 35 patients (19%), including non-union (8.6%), osteomyelitis (4.3%), amputation (2.7%), deep seated infection (9.7%), subsequent fusion (1.6%) and removal of metalware (7.5%). Our complication rates were higher for free flaps (26%); however, this likely reflects the complex nature of these injuries. 1 of the 6 local flaps (16.7%) developed a complication in comparison to 18.2% of the fractures closed directly and 17.6% of those requiring a SSG. Conclusions Open lower limb fractures are challenging to treat, and complications are common. Despite national guidelines, not all major trauma centres have a dedicated team with protected theatres for ortho-plastics trauma. Even though free flaps are required in patients with severe trauma, injuries closed primarily can still present a considerable rate of complications.