Open lower limb fracture reconstruction in the elderly population: the experience of a major trauma centre

Management 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.

The 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.

Our 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.

Our 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.