The management of compound leg injuries in the West Midlands (UK): are we meeting current guidelines?
The joint British Association of Plastic Surgeons and British Orthopaedic Association (BAPS/BOA) guidelines for the management of patients with open tibia fractures were published in 1991 and 1997 and provided a synopsis of injury epidemiology and best care. We present a retrospective review of 66 patients treated over a 2-year period (January 2001-February 2003) at a regional plastic surgery unit. There were 33 direct admissions and 33 transfers from other hospitals in which the average delay in transfer was 7.8 days (1-28) and in whom 26 (79%) patients had already undergone surgery. Plastic surgeons were involved in 46 (62%) of the 66 patient cohort and 27 (82%) transferred patients. The delay after admission until soft tissue cover was 3.8 days (0-15). Twenty-nine (44%) complications were recorded, 20 (69%) of these were in the transferred group and additional orthopaedic intervention was needed in 11 (42%) of patients who had been operated on in other hospitals. Despite widespread dissemination and teaching of the BAPS/BOA guidelines, complex extremity trauma is often not managed well in our region. There are unacceptable delays in admission, late communication, poor note keeping and follow up. The initial surgery/fixation is often sub-optimal and soft tissue reconstruction has to be considered at the least advantageous time period for the patient, leading to an increased hospital stay and complications.
Allison
K
K
University Hospitals Birmingham NHS Trust, Raddlebarn Road, Birmingham B29 6JD, UK. Kallison@ukonline.co.uk
Wong
M
M
Bolland
B
B
Peart
F
F
Porter
K
K
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D005597:Fractures, Open / Q000601:surgery*; D019983:Guideline Adherence; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery; D013997:Time Factors