Management and outcomes of paediatric lower limb open fractures across two tertiary centres over a 13-year period

Title : Management and outcomes of paediatric lower limb open fractures across two tertiary centres over a 13-year period

Abstract:

Aim: To review the management and outcomes of paediatric lower limb open fractures across two tertiary centres a Major Trauma Centre and a regional orthoplastic unit over a 13-year period, benchmarked against BOAST 4 guidelines.

Methods: Retrospective review of lower limb open fractures in children aged 0–16 years at University Hospital Wales, Cardiff (MTC) and Morriston Hospital, Swansea. Data were collected on wound management, fixation, plastic surgery involvement, and complications. Adherence to BOAST 4 principles including timely debridement, orthoplastic decision-making, and definitive soft tissue cover within 72 hours was assessed.

Results: Sixty-five lower limb open fractures were identified. At University Hospital Wales (n=36), 75% were managed with direct closure; soft tissue reconstruction was required in 19%, with one amputation. Plastic surgery involvement was documented in 42% of cases. At Morriston Hospital (n=29), 45% underwent direct closure, 38% required free tissue transfer, and three patients underwent amputation. Plastic surgery involvement was documented in 93% of cases.

Conclusions: This study demonstrates a significant difference in reconstructive complexity and documented plastic surgery involvement between centres, reflecting centralisation of orthoplastic services at Morriston following service development in 2020. The higher free flap rate is consistent with the severity profile managed within a dedicated orthoplastic unit. BOAST 4 compliance, particularly regarding early plastic surgery involvement in all lower limb open fractures, improved following MTC designation at Cardiff. These findings support plastic surgery integration from first presentation and reinforce the case for centralised orthoplastic care in paediatric lower limb trauma.

Biography:

Miss Rachel Wallice is a Senior Clinical Fellow in Plastic Surgery, working within the Orthoplastics Team at Morriston Hospital, Swansea. She graduated from Aston University with a degree in Applied and Human Biology, including a research year conducting clinical trial research with the Ministry of Defence. She subsequently completed an MRes at the University of Birmingham before obtaining her medical degree from Swansea University. Following Core Surgical Training in South Wales, she developed a specialist interest in major trauma and lower limb reconstruction. She is committed to advancing reconstructive surgery through clinical practice, research, and quality improvement to improve patient outcomes.