Standardising the management of open extremity fractures: a scoping review of national guidelines

doi:10.1007/s00590-022-03324-w

. 2023 Jul;33(5):1463-1471.

doi: 10.1007/s00590-022-03324-w. Epub 2022 Jul 10.

Standardising the management of open extremity fractures: a scoping review of national guidelines

Juan Enrique Berner^{1

2}, Stephen R Ali^{3

4}, Patrick A Will^{5

6}, Rodrigo Tejos⁷, Jagdeep Nanchahal⁸, Abhilash Jain^{9

10}

Affiliations

¹ Kellogg College, University of Oxford, Oxford, UK. juan.berner@kellogg.ox.ac.uk.
² Plastic Surgery Department, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd., E1 1FR, London, UK. juan.berner@kellogg.ox.ac.uk.
³ Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.
⁴ Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
⁵ BG Klinik Ludwigshafen, Ludwigshafen Am Rhein, Germany.
⁶ Ruprecht Karl University of Heidelberg, Heidelberg, Germany.
⁷ Sección de Cirugía Plástica y Reconstructiva. Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁸ The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁹ Imperial College Healthcare NHS Trust, London, UK.
¹⁰ Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

PMID: 35819519
PMCID: PMC10276057
DOI: 10.1007/s00590-022-03324-w

Standardising the management of open extremity fractures: a scoping review of national guidelines

Juan Enrique Berner et al. Eur J Orthop Surg Traumatol. 2023 Jul.

. 2023 Jul;33(5):1463-1471.

doi: 10.1007/s00590-022-03324-w. Epub 2022 Jul 10.

Authors

Juan Enrique Berner^{1

2}, Stephen R Ali^{3

4}, Patrick A Will^{5

6}, Rodrigo Tejos⁷, Jagdeep Nanchahal⁸, Abhilash Jain^{9

10}

Affiliations

¹ Kellogg College, University of Oxford, Oxford, UK. juan.berner@kellogg.ox.ac.uk.
² Plastic Surgery Department, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Rd., E1 1FR, London, UK. juan.berner@kellogg.ox.ac.uk.
³ Reconstructive Surgery and Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK.
⁴ Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
⁵ BG Klinik Ludwigshafen, Ludwigshafen Am Rhein, Germany.
⁶ Ruprecht Karl University of Heidelberg, Heidelberg, Germany.
⁷ Sección de Cirugía Plástica y Reconstructiva. Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁸ The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
⁹ Imperial College Healthcare NHS Trust, London, UK.
¹⁰ Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

PMID: 35819519
PMCID: PMC10276057
DOI: 10.1007/s00590-022-03324-w

Abstract

Introduction: Open extremity fractures can be life-changing events. Clinical guidelines on the management of these injuries aim to standardise the care of patients by presenting evidence-based recommendations. We performed a scoping systematic review to identify all national clinical practice guidelines published to date.

Materials and methods: A PRISMA-compliant scoping systematic review was designed to identify all national or federal guidelines for the management of open fractures, with no limitations for language or publication date. EMBASE and MEDLINE database were searched. Article screening and full-text review was performed in a blinded fashion in parallel by two authors.

Results: Following elimination of duplicates, 376 individual publications were identified and reviewed. In total, 12 clinical guidelines were identified, authored by groups in the UK, USA, the Netherlands, Finland, and Malawi. Two of these focused exclusively on antibiotic prophylaxis and one on combat-related injuries, with the remaining nine presented wide-scope recommendations with significant content overlap.

Discussion: Clinical practice guidelines serve clinicians in providing evidence-based and cost-effective care. We only identified one open fractures guideline developed in a low- or middle-income country, from Malawi. Even though the development of these guidelines can be time and resource intensive, the benefits may outweigh the costs by standardising the care offered to patients in different healthcare settings. International collaboration may be an alternative for adapting guidelines to match local resources and healthcare systems for use across national borders.

Keywords: Guidelines; Lower extremity; Lower limb; Open fractures; Plastic surgery; Trauma.

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Conflict of interest statement

JN co-authored and edited the 2009 and 2020 BAPRAS/BOA guidelines. All other authors have no conflict of interest.

Figures

**Fig. 2**
Diagram showing the overlap in contents covered by the guidelines identified in this systematic scoping review

See this image and copyright information in PMC

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Düzgün S, Özdemir MT, Manti N, Ülgen NK, Akkurt MO. Düzgün S, et al. J Clin Med. 2025 Feb 21;14(5):1436. doi: 10.3390/jcm14051436. J Clin Med. 2025. PMID: 40094922 Free PMC article.

References

1. Feder G, Grol R, Eccles M, Grimshaw J. Using clinical guidelines. BMJ. 1999;318:728–730. doi: 10.1136/bmj.318.7185.728. - DOI - PMC - PubMed
1. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines. Potential benefits, limitations, and harms of clinical guidelines. Br Med J. 1999;318:527–530. doi: 10.1136/bmj.318.7182.527. - DOI - PMC - PubMed
1. Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008;122:1796. doi: 10.1097/PRS.0b013e31818d69c3. - DOI - PMC - PubMed
1. Bosse MJ, MacKenzie EJ, Kellam JF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–1931. doi: 10.1056/NEJMoa012604. - DOI - PubMed
1. Rees S, Tutton E, Achten J, et al. Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting. BMJ Open. 2019;9:31261. doi: 10.1136/bmjopen-2019-031261. - DOI - PMC - PubMed

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[1] Feder G, Grol R, Eccles M, Grimshaw J. Using clinical guidelines. BMJ. 1999;318:728–730. doi: 10.1136/bmj.318.7185.728. - DOI - PMC - PubMed

[2] Feder G, Grol R, Eccles M, Grimshaw J. Using clinical guidelines. BMJ. 1999;318:728–730. doi: 10.1136/bmj.318.7185.728. - DOI - PMC - PubMed

[3] Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines. Potential benefits, limitations, and harms of clinical guidelines. Br Med J. 1999;318:527–530. doi: 10.1136/bmj.318.7182.527. - DOI - PMC - PubMed

[4] Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines. Potential benefits, limitations, and harms of clinical guidelines. Br Med J. 1999;318:527–530. doi: 10.1136/bmj.318.7182.527. - DOI - PMC - PubMed

[5] Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008;122:1796. doi: 10.1097/PRS.0b013e31818d69c3. - DOI - PMC - PubMed

[6] Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008;122:1796. doi: 10.1097/PRS.0b013e31818d69c3. - DOI - PMC - PubMed

[7] Bosse MJ, MacKenzie EJ, Kellam JF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–1931. doi: 10.1056/NEJMoa012604. - DOI - PubMed

[8] Bosse MJ, MacKenzie EJ, Kellam JF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–1931. doi: 10.1056/NEJMoa012604. - DOI - PubMed

[9] Rees S, Tutton E, Achten J, et al. Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting. BMJ Open. 2019;9:31261. doi: 10.1136/bmjopen-2019-031261. - DOI - PMC - PubMed

[10] Rees S, Tutton E, Achten J, et al. Patient experience of long-term recovery after open fracture of the lower limb: a qualitative study using interviews in a community setting. BMJ Open. 2019;9:31261. doi: 10.1136/bmjopen-2019-031261. - DOI - PMC - PubMed

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Standardising the management of open extremity fractures: a scoping review of national guidelines

Affiliations

Standardising the management of open extremity fractures: a scoping review of national guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

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