ReviewEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025
Open lower limb fracture reconstruction in the elderly population: the experience of a major trauma centre.
Review in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeManagement of the elderly patients presenting with open lower limb fractures is challenging due to physiological changes and pre-existing co-morbidities. The aim of this study was to assess the compliance with the British Orthopaedic Association's Standards for Trauma Number 4 (BOAST 4) guidelines in this patient group.
methodsThe study included a retrospective analysis of all the patients aged > 65 years old admitted with open lower limb fracture between 2017 and 2019 to a major trauma centre (MTC) in East of England.
resultsOur study included 91 patients presenting with lower limb trauma. The most common injury was a Gustilo and Anderson grade IIIB (39.6%). 30.8% of the study population received antibiotics within 1 h, 89% had debridement and bone stabilization within 24 h. Mean time to definitive soft tissue coverage was 3 days, with 66% of the study group having their fracture fixed and soft tissue coverage within 72 h. 52% had direct wound closure, with 9% having an incisional topical negative pressure wound therapy, 17% had a local flap and 5% patients had a free flap. The most common complication was wound dehiscence. The wounds closed without an incisional topical negative pressure wound therapy have shown a dehiscence rate of 15.4%, compared to 0% in the patients who had one.
conclusionOur study suggests that BOAST 4 compliance in the population > 65 years is comparable to the younger population. It is likely that the lower energy injury profile enables early definitive management even in the presence of age related co-morbidities.
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