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@article{Wordsworth:2016:10.1302/0301-620X.98B3.35818,
author = {Wordsworth, M and Lawton, G and Nathwani, D and Pearse, M and Naique, S and Dodds, A and Donaldson, H and Bhattacharya, R and Jain, A and Simmons, J and Hettiaratchy, S},
doi = {10.1302/0301-620X.98B3.35818},
journal = {Bone and Joint Journal},
pages = {420--424},
title = {Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines},
url = {http://dx.doi.org/10.1302/0301-620X.98B3.35818},
volume = {98B},
year = {2016}
}

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TY  - JOUR
AB  - AimsThe management of open lower limb fractures in the United Kingdom has evolved over the last ten years with the introduction of major trauma networks (MTNs), the publication of standards of care and the wide acceptance of a combined orthopaedic and plastic surgical approach to management. The aims of this study were to report recent changes in outcome of open tibial fractures following the implementation of these changes.Patients and MethodsData on all patients with an open tibial fracture presenting to a major trauma centre between 2011 and 2012 were collected prospectively. The treatment and outcomes of the 65 Gustilo Anderson Grade III B tibial fractures were compared with historical data from the same unit.ResultsThe volume of cases, the proportion of patients directly admitted and undergoing first debridement in a major trauma centre all increased. The rate of limb salvage was maintained at 94% and a successful limb reconstruction rate of 98.5% was achieved. The rate of deep bone infection improved to 1.6% (one patient) in the follow-up period.ConclusionThe reasons for these improvements are multifactorial, but the major trauma network facilitating early presentation to the major trauma centre, senior orthopaedic and plastic surgical involvement at every stage and proactive microbiological management, may be important factors.Take home message: This study demonstrates that a systemised trauma network combined with evidence based practice can lead to improvements in patient care.
AU  - Wordsworth,M
AU  - Lawton,G
AU  - Nathwani,D
AU  - Pearse,M
AU  - Naique,S
AU  - Dodds,A
AU  - Donaldson,H
AU  - Bhattacharya,R
AU  - Jain,A
AU  - Simmons,J
AU  - Hettiaratchy,S
DO  - 10.1302/0301-620X.98B3.35818
EP  - 424
PY  - 2016///
SN  - 2049-4394
SP  - 420
TI  - Improving the care of patients with severe open fractures of the tibia: the effect of the introduction of Major Trauma Networks and national guidelines
T2  - Bone and Joint Journal
UR  - http://dx.doi.org/10.1302/0301-620X.98B3.35818
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000372045500021&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.98B3.35818
VL  - 98B
ER  -

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