Stressing the need for rapid referral of complex open fractures to a specialist centre

Guidelines from the British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons recommend the immediate referral of complex open fractures of the lower limb to a specialist centre for combined orthopaedic and plastic surgical management.¹ However, Townley et al reported that across a large area of South-West England the mean delay in referral of open tibial fractures was 5.4 ±1.7 days.²

Our institution is a regional referral centre providing free tissue transfer for a population of 3 million people. A 2-year retrospective audit of open fractures requiring soft tissue coverage (n=22) revealed a median referral delay of 3.5 days and there was no increase in the proportion of patients admitted directly to our centre (as opposed to having initial debridement ± fixation in a district hospital) following guideline introduction. Furthermore, the infection rate for indirect admissions was 33% compared with a reported rate of 3% when fixation and flap coverage are performed at the same sitting.³

With the establishment of regional trauma networks across the UK over the coming months,⁴ it is imperative that all surgeons dealing with open fractures are aware of the need for rapid referral and local mechanisms are in place to allow this to happen.