Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007-2014

Area of Science:

• Orthopaedic Surgery
• Trauma Management
• Public Health Policy

Background:

• Open lower-limb fractures in motorcyclists and pillion passengers present significant management challenges.
• The 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons standards for open fractures (BOAST 4) aimed to improve outcomes.
• Assessing the impact of BOAST 4 on trauma care is crucial for patient outcomes.

Purpose of the Study:

• To identify demographics of motorcyclists and pillion passengers with open lower-limb fractures.
• To evaluate the impact of the revised 2009 BOAST 4 guidelines on treatment timelines and patient movement.
• To analyze changes in skeletal stabilization and soft-tissue coverage for these trauma patients.

Main Methods:

• Retrospective cohort study using Trauma Audit and Research Network (TARN) data.
• Longitudinal analysis comparing pre-BOAST 4 (2007-2009) and post-BOAST 4 (2010-2014) periods in England.
• Analysis of demographics, time to skeletal stabilization, time to soft-tissue coverage, and patient transfer to major trauma centers.

Main Results:

• A total of 1628 patients (93% male, median age 30.5 years) were analyzed.
• Post-BOAST 4, skeletal stabilization increased (49% vs 65%) but time to stabilization significantly increased (7.33 vs 14.3 hours).
• Soft-tissue coverage proportion increased (26% vs 43%), but time to coverage remained unchanged (62.3 vs 63.7 hours); transfers to major trauma centers increased (12.5% vs 41%).

Conclusions:

• The 2009 BOAST 4 revision did not reduce time to soft-tissue coverage for open lower-limb fractures in motorcyclists.
• Time to skeletal stabilization has increased since the BOAST 4 implementation.
• There has been a notable increase in patient transfers to specialized trauma centers following the BOAST 4 guidelines.