Key result
Initial open fracture management completes only ~46% of key tasks, dropping during out-of-hours assessments.
Why the study?
Few patients with open long bone fractures are managed fully according to BOA and BAPRAS preoperative management guidelines, indicating a need to evaluate current practice.
Observational (n=101)
No
Adherence to initial management guidelines for open extremity fractures is poor, particularly out of hours, highlighting a need for targeted education.
Guideline nonadherence in open fractures may compromise care; leaves open whether audits or protocols improve compliance and outcomes.
Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.
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Walton et al. (2014) conducted an observational in Open long bone fractures (n=101). Initial preoperative management was evaluated on Implementation of 7 defined key tasks for initial management. Initial preoperative management of open long bone fractures was suboptimal, with a mean of 3.23 out of 7 key tasks completed, and fewer tasks implemented during out-of-hours assessments.
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