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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, , pp..


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, , pp..


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, , pp..


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, , pp..



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