Standards for the management of open fractures of the lower limb

The British Orthopaedic Association (BOA) and British Association of Plastic & Aesthetic Surgeons (BAPRAS) have recently published new guidelines for the management of open fractures of the lower limb.  This document represents a comprehensive update to previous guidance, and has some key changes in the recommendation for the clinical and organisational management of open fractures of the lower limb.  Many of these can be applied to the management of open fractures in general.

The document recognises the importance of specialist centres for the management of these injuries, and has robust guidance on which injuries should be managed at these centres and what capabilities they should have. 

Further it recommends that senior members of plastic and orthopaedic surgical teams are both present at the initial wound debridement to plan further reconstruction.  This has major implications for service delivery but has to be the way forward.  Impact on resources is mitigated by a longer time window to debridement - the new recommendations allow for these procedures to be conducted within 24 hours and in normal working time - provided the wound is not grossly contaminated.

The document is comprehensive covering acute management through skeletal stabilization, management of vascular injuries and wound care.  Management of complications is also covered.  The standards also discuss outcome measures for open fractures but unfortunately stop short of mandating recording of this as part of a governance and performance improvement process.  In fact the only weakness of the recommendations is a lack of standards for the quality assurance and performance improvement for the management of open fractures within a trauma system.

The full guidelines are available for download here:
www.bapras.org.uk/guide.asp?id=355#guide_278
(Why the guide has to be downloaded in sections is a mystery!)

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