title: Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb: UK Wound management of Lower Limb Fractures (UK WOLLF).
abstract: Patients who sustain open lower limb fractures have reported infection risks as high as 27%. The type of dressing applied after initial debridement could potentially affect this risk. In this trial, standard dressings will be compared with a new emerging treatment, negative pressure wound therapy, for patients with open lower limb fractures.
  
  
  
  All adult patients presenting with an open lower limb fracture, with a Gustilo and Anderson (G&A) grade 2/3, will be considered for inclusion. 460 consented patients will provide 90% power to detect a difference of eight points in the Disability Rating Index (DRI) score at 12 months, at the 5% level. A randomisation sequence, stratified by trial centre and G&A grade, will be produced and administered by a secure web-based service. A qualitative substudy will assess patients' experience of giving consent for the trial, and acceptability of trial procedures to patients and staff. Patients will have clinical follow-up in a fracture clinic up to a minimum of 12 months as per standard National Health Service (NHS) practice. Functional and quality of life outcome data will be collected using the DRI, SF12 and EQ-5D questionnaires at 3, 6, 9 and 12 months postoperatively. In addition, information will be requested with regards to resource use and any late complications or surgical interventions related to their injury. The main analysis will investigate differences in the DRI score at 1 year after injury, between the two treatment groups on an intention-to-treat basis. Tests will be two sided and considered to provide evidence for a significant difference if p values are less than 0.05.
  
  
  
  Ethical approval was given by NRES Committee West Midlands-Coventry & Warwickshire on 6/2/2012 (ref: 12/WM/0001). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences.
  
  
  
  ISRCTN33756652.
authors.affiliation: Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Juul
authors.initials: J
authors.lastname: Achten
authors.affiliation: Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Nick R
authors.initials: NR
authors.lastname: Parsons
authors.affiliation: Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Julie
authors.identifier: 0000-0002-8462-7999
authors.initials: J
authors.lastname: Bruce
authors.affiliation: Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Stavros
authors.initials: S
authors.lastname: Petrou
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tutton
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Willett
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
authors.affiliation: Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000328:Adult; D001458:Bandages; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007869:Leg Injuries / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000191:economics; D011788:Quality of Life; D006113:United Kingdom
keywords: ACCIDENT & EMERGENCY MEDICINE; ORTHOPAEDIC & TRAUMA SURGERY; WOUND MANAGEMENT