Yarrow J, Rahman S, Marsden N, Pallister I, Hemington-Gorse S
Abertawe Bro Morgannwg University Health Board, UK.
Ann R Coll Surg Engl. 2015 Jan;97(1):35-9. doi: 10.1308/003588414X14055925058472.
The joint British Association of Plastic, Reconstructive and Aesthetic Surgeons/British Orthopaedic Association standards define best practice management in open diaphyseal fractures of the lower limb. The aim of our study was to review the regional approach and experience in South West England and Wales. A further objective was to evaluate service provision with regard to the standards' key recommendations.
A prospective audit was undertaken of open diaphyseal fracture patients. Compliance with published standards within all orthoplastic services in South West England and Wales was assessed, and facilities were evaluated.
A total of 86 patients were managed between October 2012 and March 2013. This was a 56% increase from 2008. Over half (56%) presented directly to the orthoplastic services with all patients undergoing debridement within 24 hours. Two-thirds (66%) of procedures were in daylight hours excluding those requiring immediate surgical intervention. Adherence to correct antibiotic therapy was 88% at admission, 50% at primary surgery and 62% at definitive surgery. Almost two-thirds (60%) of primary procedures were performed with combined senior orthoplastic teams, with 81% achieving definitive soft tissue coverage and fixation within seven days. Compliance improved in units with larger patient caseloads and where there was an early combined approach during daylight hours.
Increased open lower limb fracture workload was demonstrated across South West England and Wales, probably owing to centralisation of trauma services. An improvement in early transfer of this patient group to orthoplastic facilities has allowed all patients to be assessed and debrided within the recommended timeframe. Standards were most likely to be met in those centres seeing higher numbers of injuries and when there was a daylight hours procedure by combined orthoplastic teams.
英国整形、重建与美容外科协会/英国骨科学会联合制定的标准明确了下肢开放性骨干骨折的最佳治疗规范。我们研究的目的是回顾英格兰西南部和威尔士的区域治疗方法及经验。另一个目标是根据该标准的关键建议评估服务提供情况。
对开放性骨干骨折患者进行前瞻性审计。评估了英格兰西南部和威尔士所有整形骨科服务机构对已发布标准的遵守情况，并对相关设施进行了评估。
2012年10月至2013年3月期间共治疗了86例患者。与2008年相比增加了56%。超过半数（56%）的患者直接前往整形骨科服务机构，所有患者均在24小时内接受了清创术。三分之二（66%）的手术在白天进行，不包括那些需要立即进行手术干预的情况。入院时正确使用抗生素的比例为88%，初次手术时为50%，最终手术时为62%。几乎三分之二（60%）的初次手术由高级整形骨科联合团队进行，81%的患者在七天内实现了确定性软组织覆盖和固定。患者病例数量较多且在白天采用早期联合治疗方法的科室，其合规情况有所改善。
英格兰西南部和威尔士的下肢开放性骨折工作量有所增加，这可能归因于创伤服务的集中化。将该患者群体早期转至整形骨科设施的情况有所改善，使得所有患者能够在推荐的时间范围内接受评估和清创。在受伤患者数量较多的中心以及整形骨科联合团队在白天进行手术时，最有可能符合标准。
