Background

For years, the Lower Extremity Assessment Project (LEAP) has been the best source of evidence for the management of open lower limb fractures. Their 2002 report helped better understand the prognosis of lower limb trauma and to compare reconstruction versus amputation in these patients. However, more than a decade later some controversies still prevail, including: timing for the reconstruction, flap type selection, strategies for bony fixation, antibiotic protocols, selection of recipient vessels and postoperative monitoring and flap training protocols. Furthermore, even for features that consensus has been reached, compliance with these standards has been variable among different units.

Trauma is a global concern, and its burden is greater in developing countries. The aim of this study is to attempt to resolve outstanding queries left by LEAP and later studies, along with identifying aspects in which consensus has been already reached, and aspects that future studies should address.

Methods

We are planning to conduct an international, multi-centre, retrospective audit of patients with open lower limb fractures, gathering a set of core outcomes for open lower limb fractures. We will aim to capture a 24-month snapshot of current trends in practice in a series of international centres covering patients treated between the 1st January 2017 until 31st December 2018, allowing follow-up for at least a year.

This audit will include all patients presenting to participant centres with open lower limb fractures. We aim to retrieve information regarding:

• Type and severity of injuries
• Co-morbidities
• Smoking status
• Timing for debridement and definitive soft tissue reconstruction
• Flap selection (free versus local and muscle versus fasciocutaneous flaps)
• Type of bony fixation
• Antibiotic prophylaxis
• Flap loss rate
• Re-exploration rates
• Thromboembolism rates
• Post-operative infection rates
• Length of inpatient stay
• Time to full weight-bearing
• Non-union rates
• Osteomyelitis rates
• Time to return to work

Get involved

Responsibilities of a collaborator to be PubMed cited

• Gain support from your department (e.g. consultant body)
• Register the INTELLECT audit (service evaluation) with your NHS Trust / Local Hospital
• Collect data on 10 cases along with their follow up to date.
• Upload anonymised information to the REDCap database

Benefits

• Certificate of involvement will be provided on completion of the project.
• Pubmed citation on any subsequent publication directly related to the collected data.
• Cited as a collaborator on any presentation relating to the collected data and RSTN website.
• Option to present local data separately (i.e. local or regional meeting).

FAQS

• What do you mean by open lower limb fractures? A – Open fractures affecting the femur, tibia, fibula or foot bones
• Which type of fractures will be included? A – We aim to review all open fractures treated at each recruiting centre, even if plastic surgery was not required.