Open Fracture Management in Wessex Major Trauma Centre

P Hei Cheng, S Barbur, Z Beech

University Hospital Southampton NHS trust

Open fractures require timely multidisciplinary approach to optimise recovery and minimise risk of infection. Suboptimal management may result in poor long term outcomes, such as delayed recovery or permanent disability. Our study aims to analyse practice in Wessex major trauma centre and compare the standards against BOAST guideline.

Retrospective cohort study of 179 patients with lower limb open fractures admitted to Southampton General Hospital between Jan 2020 – Aug 2022 and their clinical management was compared to BOAST 4 open fracture guideline. Further analysis was performed to identify impacts from COVID lockdown and these results were also compared with previous audit cycles (2018 – 19).

121 patients (67.6%) received antibiotic treatment within 1 hour when compared to previous 84.4%. Patients underwent initial debridement within appropriate time frame improved from 89.7% to 93.3% and 94 cases were performed as joint orthoplastics procedure. 45.8% of patients had definitive management within 72 hours compared to 68.5% previously.

Apart from performing initial debridement within appropriate time frame, a general decline in open fracture management had been observed since COVID lockdown started. The impact from COVID and its residue effect is still significant. This problem is further complicated by a combination of issues, such as plastic surgeons availability, pressure in A&E and staff / theatre capacity. To optimise open fracture management, it would be beneficial to have orthopaedic and plastic surgeons based at a single site, with additional theatre capacity and support from A&E department.