OPEN Study

Full title

Open-Fracture Patient Evaluation Nationwide

Background

Open fractures can present to any unit prior to triage and the BOAST guideline suggests that patients with open fractures of long bones, hind foot or mid-foot should be taken directly or transferred to a specialist centre that can provide orthoplastic care.

Despite national guidance from NICE, BOAST Guidelines and the inception of trauma networks, there is no data available for this key patient group other than Trauma Audit and Research Network (TARN) publications. These publications are limited by data completeness and only have specific open fractures represented.

What we did

The OPEN Study was a multi-centre prospective service evaluation that evaluated the epidemiology, patient characteristics and management of patients that have sustained any open fracture (excluding phalanges).

1,175 patients admitted to one of the 51 participating hospitals with an open fracture (excluding phalanges or isolated hand injuries) between 1 June 2021 and 30 September 2021 were included.

What we found

Antibiotics were given to 69.0% in the emergency department, 22.0% pre-hospital, and 9.1% as inpatients.

Wounds were photographed in 72.7% cases.

Median time to first surgery was 16 hours and 14 minutes. Complex injuries were operated on sooner (median 12 hours and 51 minutess).

Of initial procedures, 90.3% occurred between 8am and 8pm. A consultant orthopaedic surgeon was present at 89.2% first procedures. In orthoplastic centres, a consultant plastic surgeon was present at 45.1% first procedures.

Overall, 60.8% patients required a single operation.