Manchester Royal Infirmary, UK
Title: Management of open fractures in a major Trauma centre with no plastics service on site â€“ Does this affect outcomes?
My name is Mr. Louai Abdeh and I am a Trauma & Orthopedics Core Surgical Trainee at the Manchester Royal Infirmary. As a medical student and junior doctor, I have taken an active role in many clinical governance and research projects, and I have presented at a number of conferences including the ASiT International Conference 2018, Barts and London National Undergraduate Surgical Conference and Warwick Undergraduate Regional Medical Conference. I have also completed a Master of Research in Tissue Engineering for Regenerative Medicine, and I received a distinction grade for my dissertation “The Role of Macrophages and Mast Cells in Fibroblast to Myofibroblast Differentiation- An insight into the Relationship between Inflammatory Cells and Fibrosis”.
Background: Open fractures of long bones should be managed by an orthoplastic team, BOAST (2017).
Aim: To evaluate the impact of a trauma team with no plastic surgeons on the management of open fractures.
Methods: Retrospective service evaluation exercise looking at outcomes of open fractures managed at our centre over a 6-month period. Care provided was audited against BOAST guidelines on open fractures.
Results: 17 patients identified. All cases were initially managed by orthopaedic surgeons. Following initial debridement, 5 patients required plastics input for wound closure which was sought via online referral to another centre. Definitive wound closure within 72 hours, as advised by BOAST guidelines, occurred in none of the cases that required plastics input compared to 91% of cases where plastics were not required. Definitive fracture management within 72 hours occurred in only 40% of cases that required plastics input compared to 82% in cases that did not. Infection was also recorded in 67% of cases with delayed wound closure compared to none in wounds that were closed within 72 hours.
Conclusion: Delayed wound closure is associated with increased infection and delayed fixation. We suggest that these fractures are managed in centres with on-site access to plastics.