Let's Be Realistic with Rurality: Timely Surgical Management of Open Fractures in Rural and Remote Patients

Background: Rurality in Western Australia presents challenges in the management of open fractures for the state's trauma centre. Open fractures are associated with high morbidity, and the BOA Standards for Trauma and Orthopaedics (BOAst) guidelines recommend timelines for surgical management to minimise complications. This study aimed to describe the timelines to surgical management for rural patients with severe open fractures and to identify system-level factors contributing to delays. Methods: A retrospective single-centre study was conducted on all rural patients with open fractures requiring fixation and soft-tissue coverage between January 2020 and December 2023. Data was collected from the trauma registry and electronic medical records, including injury characteristics, transfer details, timing of surgical management, and complications. Results: Fifteen rural patients met the inclusion criteria. The median time to initial debridement from first healthcare presentation was 27.6 h. The mean transfer time to the trauma centre was 14.5 h, and the median time to definitive fixation and soft tissue coverage was 159.7 h. Identified modifiable factors to minimise delays on arrival to the trauma hospital include prioritisation of rural patients at the time of arrival, accessibility to an orthoplastics theatre, and minimising the total number of debridements prior to definitive reconstruction. Conclusions: Substantial delays in the surgical management of rural patients with open fractures were observed, largely related to interhospital transfer and system-level factors at the tertiary centre. These delays limit the feasibility of compliance with the BOAst guidelines and highlight the need for context-specific strategies to improve the timely care of this high-risk population.