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. 2025 Jun 23;35(1):267.
doi: 10.1007/s00590-025-04382-6.

A retrospective review of outcomes in open tibial fractures following the implementation of BAPRAS/BOA guidelines

Ariella J Smith  1 , Alexis J Zimbulis  2 , Vincent V G An  1 , Jobe Shatrov  1 , Brahman Sivakumar  1   3 , Michael Symes  1   4 , Andrew Ellis  1
Affiliations

A retrospective review of outcomes in open tibial fractures following the implementation of BAPRAS/BOA guidelines

Ariella J Smith et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: Surgical wound management consisting of careful debridement remains a key principle in the management of open fractures. There remains limited recent literature regarding outcomes of debridement within 24 h compared to within six hours. This study evaluates implementation of the British Association of Plastic and Reconstructive and Aesthetic Surgery/British Orthopaedic Association (BAPRAS/BOA) guidelines on time to debridement of open lower limb fractures and assesses the impact on patient outcomes.

Methods: Single centre retrospective cohort study evaluating operative management of adult patients with open tibial fractures at a level one trauma centre.

Results: Seventy-one patients with 72 open diaphyseal tibial fractures were included. Surgery occurred within six hours in 52.1% of patients, and all Gustilo 3C injuries were debrided within six hours in keeping with guidelines. No patients underwent debridement after 24 h. Twelve patients developed infection with only four requiring surgical intervention. Five patients developed non-union. There was no difference in complication rates between injuries debrided within six hours compared to between 6 and 24 h in patients with injuries classified as Gustilo grades 1-3B.

Conclusion: Despite implementation of BAPRAS/BOA guidelines, many patients with open tibial fractures still proceeded to surgery within six hours, with overall low complication rates and no difference in outcome between groups. These findings support BAPRAS/BOA recommendations regarding time to surgery, suggesting that debridement within six hours of injury does not correlate with improved outcomes.

Keywords: Complications; Open tibia fractures; Surgery timing; Time to debridement.

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Conflict of interest statement

Declarations. Conflict of interest: The authors also certify that they have no relevant financial or non-financial conflicts of interests or competing interests to disclose. Ethical approval: This study was approved by the local institutional ethics committee. A waiver of consent was granted due to the research being retrospective and of low/negligible risk.

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