Summary
Open fractures are severe, complex, limb-threatening and high-energy injuries, often
involving lesions of both bone and soft tissues. Traditionally, treatment has been
piecemeal by orthopaedic and plastic surgeons. This study aimed to prospectively investigate
whether combining orthopaedic and plastic surgery in treating these injuries is more
effective than the conventional orthopaedic care.
A prospective multi-centre cohort study was conducted. Differences in the type of
approach to severe limb trauma allowed a comparison between combined orthoplastic
and traditional exclusively orthopaedic treatment. Time for fracture and soft tissue
healing and the recovery of limb function were the main outcome measures studied.
All patients suffering from a severe open tibial fracture were prospectively included
between January 2012 and December 2013 and followed until December 2014. Recruiting
units were as follows: (1) an established orthoplastic centre, (2) a unit without
experience in the orthoplastic approach and (3) a unit where the orthoplastic approach
has been recently introduced in a developing country (Pakistan).
A total of 160 patients were included in the study. Of these, 70% were treated with
an orthoplastic approach, whereas 30% were treated by an orthopaedic team. All outcome
measures were statistically improved by the orthoplastic approach.
A coordinated, combined pathway to both the bony and the soft tissue components of
open tibial fractures through orthoplastic surgery can be successfully delivered with
attention to important timelines to achieve better patient outcomes in different socio-economic
settings.
Keywords
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Article info
Publication history
Published online: February 28, 2017
Accepted:
February 17,
2017
Received:
April 3,
2016
Footnotes
☆The STROBE statement for observational studies was adhered to throughout this study. A part of these data was presented at the Combined Meeting of the Orthopaedic Research Societies, Venice, in 13th October 2013. The presentation was awarded the ICORS prize for the best inter-continental collaboration study.
Identification
Copyright
© 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
