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Fractures (complex): assessment and management [NG37]

Measuring the use of this guidance

Recommendation: 1.2.22

In the emergency department, administer prophylactic intravenous antibiotics immediately to people with open fractures if not already given.

What was measured: Proportion of patients given appropriate antibiotics on admission.
Data collection end: December 2014
92.4%
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.

What was measured: Proportion of people with open fractures of the lower limb who were given appropriate antibiotics (co-amoxiclav, cefuroxime or clindamycin) on admission.
Data collection end: December 2014
92.4%
Number that met the criteria: 73 / 79
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.


Recommendation: 1.2.27

Surgery to achieve debridement, fixation and cover of open fractures of the long bone, hindfoot or midfoot should be performed concurrently by consultants in orthopaedic and plastic surgery (a combined orthoplastic approach).

What was measured: Proportion of patients where a plastic surgeon was present at initial operation.
Data collection end: December 2014
33.3%
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.


Recommendation: 1.2.28

Perform debridement: immediately for highly contaminated open fractures within 12 hours of injury for high‑energy open fractures (likely Gustilo–Anderson classification type IIIA or type IIIB) that are not highly contaminated within 24 hours of injury for all other open fractures.

What was measured: Proportion of patients who had initial debridement within 24 hours.
Data collection end: December 2014
98.8%
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.

What was measured: Proportion of people with open fractures of the lower limb who had debridement and temporary fixation within 24 h.
Data collection end: December 2014
98.8%
Number that met the criteria: 83 / 84
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.

What was measured: Proportion of adult patients (>16 years old, no upper age limit) with acute Gustilo-Anderson grade 3B open tibial fractures that underwent primary debridement within 12 hours.
Data collection end: February 2016
38%
Number that met the criteria: 44 / 116
Area covered: Local
Source: Hendrickson Susan A, Wall Rosemary A, Manley Oliver, et al. (2018). Time to Initial Debridement and wound Excision (TIDE) in severe open tibial fractures and related clinical outcome: A multi-centre study. Injury. 2018 Jul 27. pii: S0020-1383(18)30406-6. doi: 10.1016/j.injury.2018.07.023


Recommendation: 1.2.29

Perform fixation and definitive soft tissue cover: at the same time as debridement if the next orthoplastic list allows this within the time to debridement recommended in 1.2.28, or within 72 hours of injury if definitive soft tissue cover cannot be performed at the time of debridement.

What was measured: Proportion of patients who received definitive soft tissue cover.
Data collection end: December 2014
56.4%
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.

What was measured: Proportion of people with open fractures of the lower limb who received definitive bony fixation and soft tissue cover within 72 h.
Data collection end: December 2014
56.4%
Area covered: UK
Source: Rymer B, Dimovska E O. F, Chou D T. S, Choa R, Davis B, and Huq S. (2017). A representative assessment of the management of open fractures of the lower limb within UK orthoplastic centres: A two-centre audit of compliance with national standards. Injury, 48(10), pp.2266-2269.



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