Recommendations for research

The guideline committee has made the following key recommendations for research.

1 Temporary dressings for up to 72 hours between wound excision and definitive soft tissue cover

What is the most clinically and cost effective temporary (up to 72 hours) dressing (including negative pressure dressings) for open fractures after wound excision for:

  • minimising the number of dressing changes or supplementary dressings

  • minimising the number of associated bedding changes

  • acceptability for patients, for example, in terms of minimising pain

  • minimising nursing time.

For a short explanation of why the committee made this recommendation for research, see the rationale section on temporary dressings for open fractures after wound excision but before definitive tissue cover.

Full details of the evidence and the committee's discussion are in evidence review A: negative pressure wound therapy for temporary closure of open fractures.

2 Cystourethrogram

How accurate is the first CT scan with contrast (trauma scan) for detecting bladder injuries in people with suspected bladder injuries after a traumatic incident?

Why this is important

Bladder injuries usually occur in people with high‑energy pelvic fractures after a traumatic incident. Currently people with suspected bladder injuries have a CT scan with intravenous contrast (a trauma scan) to diagnose non‑bladder injuries. People who do not have injuries needing urgent treatment may then either be given another CT scan or a fluoroscopic cystogram to check for bladder injury. People with injuries needing urgent treatment (for example, bleeding or a neurological injury) are taken to the resuscitation room after the initial CT scan (trauma scan). Once the person's condition is stabilised they are taken to either the CT or fluoroscopy suite for a retrograde cystogram to check for bladder injury. The guideline committee agreed that these strategies are accurate for the diagnosis of bladder injuries, but felt that there were advantages to a strategy that did not involve a second set of images. The guideline committee was interested in whether the first CT scan with intravenous contrast (trauma scan) could accurately diagnose bladder injuries.

3 Pilon fractures

In adults with closed pilon fractures, what method of fixation provides the best clinical and cost effectiveness outcomes as assessed by function and incidence of major complications at 2 years (stratified for timing of definitive surgery early [under 36 hours] versus later [over 36 hours])?

Why this is important

Pilon fractures involve a significant proportion of the weight‑bearing surface of the distal tibia. The damaged joint surface is vulnerable to degeneration. Therefore, the injury can lead to long‑term disability, most commonly arthritis with pain and stiffness. Surgery can improve outcomes, allowing reduction and fixation of the fracture and early movement of the ankle joint. However, it has a high incidence of serious complications, particularly related to the vulnerability of the soft tissues around the ankle. The potential for life‑changing adverse consequences of both the injury and its treatment is known, but the best management strategy to minimise these consequences is unclear.