title: Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines.
abstract: OBJECTIVE
  The management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.
  
  
  METHODS
  Data on all patients with an open tibial fracture presenting to a major trauma centre between 2011 and 2012 were collected prospectively. The treatment and outcomes of the 65 Gustilo Anderson Grade III B tibial fractures were compared with historical data from the same unit.
  
  
  RESULTS
  The volume of cases, the proportion of patients directly admitted and undergoing first debridement in a major trauma centre all increased. The rate of limb salvage was maintained at 94% and a successful limb reconstruction rate of 98.5% was achieved. The rate of deep bone infection improved to 1.6% (one patient) in the follow-up period.
  
  
  CONCLUSIONS
  The reasons for these improvements are multifactorial, but the major trauma network facilitating early presentation to the major trauma centre, senior orthopaedic and plastic surgical involvement at every stage and proactive microbiological management, may be important factors.
  
  
  CONCLUSIONS
  This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care.
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wordsworth
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: G
authors.initials: G
authors.lastname: Lawton
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nathwani
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: M
authors.initials: M
authors.lastname: Pearse
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: S
authors.initials: S
authors.lastname: Naique
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dodds
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: H
authors.initials: H
authors.lastname: Donaldson
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: R
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: J
authors.initials: J
authors.lastname: Simmons
authors.affiliation: Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hettiaratchy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D005592:Fracture Fixation / Q000379:methods / Q000592:standards; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000458:organization & administration*; D019651:Plastic Surgery Procedures / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D014193:Trauma Centers / Q000458:organization & administration* / Q000592:standards; D055815:Young Adult
keywords: BOAST 4; Lower limb trauma; open fractures