Open Fractures of the Lower Limb
In 1991 our Association met with the British Orthopaedic Association (BOA) to discuss how together we might manage patients with open tibial fractures to achieve better outcomes.
Members of the two professional associations will be familiar with the publication of the BOA/BAPS Guidelines that this led to in 1997, which set the benchmark for how to treat these injuries in the UK.
Since then there has been much more research and clinical evidence published in this area of practice and both associations felt the time had come to revise and update the guidelines. In 2009 a working party was established revised ‘Standards for the management of open fractures of the lower limb’ produced
The Standards include important changes for the recommended management of these injuries from the current guidelines and reflect the changes being proposed for trauma systems and trauma centres in the NHS. These changes have significant implications for both orthopaedic and plastic surgery management, with a move away from hurried initial debridement and fixation in local DGHs with subsequent transfer to a plastic surgery centre for soft tissue repair, towards the establishment of specialised teams in the major centres. These centres will have consultant plastic surgeons and orthopaedic surgeons with a sub-specialty interest in the treatment of these difficult injuries, working together in scheduled daytime operating sessions to provide the best decision-making and subsequent treatment. It is expected that the majority of patients with these injuries would be transferred either directly from scene or after local A&E assessment to the regional specialist centre for all their definitive care.
BAPRAS and the BOA would advise medical professionals to consider how these evidence-based standards of care can be delivered in their locality. And to work with the commissioners and planners of trauma care locally to ensure that they are aware of the proposals within them.
The regional nature of most plastic surgery services means that we should be at the centre of discussions of service provision for these injuries in close collaboration with orthopaedic, microbiology and rehabilitation colleagues.
Click here to download the standards guide in full
The guidelines are also available as an iphone app
Click here to download via itunes.
The app provides a readily accessible summary version of the 2009 BAPRAS and BOA standards for the management of severe lower limb trauma. There is easy access to the key management points and diagrams on arteriography, fasciotomies and surface anatomy, including safe pinning routes for the tibia. These diagrams can be viewed for either left or right leg and zoomed to view more detail.