Open Fractures – What Is the Evidence, and How Can We Improve?

Document Type : PERSPECTIVE


Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW, United Kingdom


Open fractures can have devastating consequences, including chronic infections and amputations, leaving patients
with life-changing disabilities. Prompt and appropriate treatment can spare patients the sequelae of open fractures
and the long-term economic burden these injuries often inflict. The British Orthopaedic Association Standards for
Trauma and Orthopaedics (BOAST-4) guideline outlines the acute management of patients with open fractures
and is often considered the gold standard for open fracture management in the UK. In an era of evidence-based
medicine, clinicians are continually mindful of the science behind current guidelines and practices. This article aims
to critique the evidence underpinning the BOAST-4 guidelines and suggest improvements based on contemporary
literature. Antibiotic delivery in the prehospital setting, the type and duration of antimicrobial therapy, timing for the
conversion from external to internal fixation, and the differentiation between adult and paediatric open fractures
were among the many pertinent topics critiqued, and evidence-based improvements suggested.
Level of evidence: V


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Volume 9, Issue 5
September and October 2021
Pages 559-566
  • Receive Date: 12 November 2020
  • Revise Date: 19 December 2020
  • Accept Date: 20 December 2020