The role of primary plastic surgery in the management of open fractures

• Published in: Injury 2015-12, Vol.46 (12), p.2443-2447
• Main Authors: Court-Brown, Charles M, Honeyman, Calum S, Clement, Nick D, Hamilton, Stuart A, McQueen, Margaret M
• Format: Article
• Language: English
• Subjects: Adult; Female; Flap cover; Fracture Fixation, Internal - methods; Fractures, Open - complications; Fractures, Open - epidemiology; Fractures, Open - surgery; Humans; Male; Middle Aged; Open fractures; Orthopedics; Plastic surgery; Reconstructive Surgical Procedures; Scotland - epidemiology; Split skin grafting; Surgery, Plastic; Surgical Flaps; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Surgical Wound Infection - surgery; Trauma Centers; Trauma Severity Indices; Treatment Outcome
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2015.09.037

Summary A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/106 /year. The incidence in open upper and lower limb fractures was 5.3/106 /year and 22.7/106 /year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom.