Title : Investigating adherence to current BOA/BAPRAS management guidelines for open upper limb Long bone fractures: Are they applicable
Abstract:
Aims: This study aims to expand on a previous pilot audit; characterising adherence to BOA/BAPRAS standards when managing patients with open upper limb fractures. Evidence for BOA/BAPRAS guidelines is based on open lower limb fractures.
Methods: A single centre, retrospective audit was performed in a UK Major Trauma Centre (Cambridge University Hospitals) using data collected from electronic patient record of 165 patients, admitted between January 2019 to September 2023. Adherence to 5 chosen BOA/BAPRAS standards was assessed. Outcomes were evaluated on basis of soft tissue/bony complications and need for revisional surgery after 1 year+ follow-up period.
Results: 165 patients (100 males [60.6%] and 65 females [39.4%]) with a mean age of 47.5 (6-96.5) were included. Overall, 4.8% of injuries successfully met all 5 BOA/BAPRAS standards.19.8% of patients received intravenous antibiotics within 1 hour of injury. Wound excision in <24 hours and soft tissue coverage in <72 hours occurred in 47.9% and 65.5% of patients respectively. 150 patients had direct closure of the soft tissue wound; 15 required reconstructive, plastic surgery. There were 4 free flaps (2.4%), 2 pedicled flaps (1.2%) and 9 split skin grafts (5.5%). Early-stage complications included one partial flap failure [skin paddle loss of free fibula flap salvaged by pedicled flap and split skin graft] and 3 acute soft tissue infections. Late-stage complications included non-union fractures (6.7%) and 3 cases of osteomyelitis, resulting in 4 and 3 revision operations respectively. For overall complications, there was no statistically significant difference in outcomes between patients treated within and outside of these guidelines (χ2=1.90; p = 0.75).
Conclusions: In our cohort, we found no statistically-significant difference in outcomes between patients who were managed in line with BOA/BAPRAS standards, and in those who were not. We suggest further investigation into applicability of these standards to upper limb open fractures.
