title: Orthoplastic surgical collaboration is required to optimise the treatment of severe limb injuries: A multi-centre, prospective cohort study.
abstract: Open fractures are severe, complex, limb-threatening and high-energy injuries, often involving lesions of both bone and soft tissues. Traditionally, treatment has been piecemeal by orthopaedic and plastic surgeons. This study aimed to prospectively investigate whether combining orthopaedic and plastic surgery in treating these injuries is more effective than the conventional orthopaedic care. A prospective multi-centre cohort study was conducted. Differences in the type of approach to severe limb trauma allowed a comparison between combined orthoplastic and traditional exclusively orthopaedic treatment. Time for fracture and soft tissue healing and the recovery of limb function were the main outcome measures studied. All patients suffering from a severe open tibial fracture were prospectively included between January 2012 and December 2013 and followed until December 2014. Recruiting units were as follows: (1) an established orthoplastic centre, (2) a unit without experience in the orthoplastic approach and (3) a unit where the orthoplastic approach has been recently introduced in a developing country (Pakistan). A total of 160 patients were included in the study. Of these, 70% were treated with an orthoplastic approach, whereas 30% were treated by an orthopaedic team. All outcome measures were statistically improved by the orthoplastic approach. A coordinated, combined pathway to both the bony and the soft tissue components of open tibial fractures through orthoplastic surgery can be successfully delivered with attention to important timelines to achieve better patient outcomes in different socio-economic settings.
authors.affiliation: Laboratory of Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Alma Mater Studiorum - University of Bologna, Bologna, Italy. Electronic address: borianifilippo@gmail.com.
authors.forename: Filippo
authors.initials: F
authors.lastname: Boriani
authors.affiliation: Plastic Surgery Department, Jinnah Hospital, Lahore, Pakistan.
authors.forename: Ata
authors.initials: A
authors.lastname: Ul Haq
authors.affiliation: Laboratory of Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Baldini
authors.affiliation: Orthopaedic Department, Maggiore Hospital, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Urso
authors.affiliation: Laboratory of Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Granchi
authors.affiliation: Laboratory of Orthopaedic Pathophysiology and Regenerative Medicine, Rizzoli Orthopaedic Institute, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Baldini
authors.affiliation: Orthopaedic Department, Maggiore Hospital, Bologna, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Tigani
authors.affiliation: Plastic Surgery Department, Jinnah Hospital, Lahore, Pakistan.
authors.forename: Moazzam
authors.initials: M
authors.lastname: Tarar
authors.affiliation: Lower Limb Reconstruction Unit, North Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: Umraz
authors.initials: U
authors.lastname: Khan
mesh_terms: D000328:Adult; D005260:Female; D005592:Fracture Fixation; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D020127:Recovery of Function; D012959:Socioeconomic Factors; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Lower limb reconstruction; Lower limb trauma; Open tibial fracture; Orthoplastic surgery; Orthoplastics