Fix and Flap for Open Fractures....What's the Standard?

Description

In this presentation delivered by Dr. Michael Kelly, the focus is on the concepts of "fix and flap" in managing open fractures, particularly those involving the tibia. Dr. Kelly emphasizes the importance of a collaborative approach with plastic surgeons, as he works closely with them in his daily practice. He discusses the need for standards in treating open fractures, highlighting that while there are unofficial ones aimed at avoiding complications and restoring function, patient expectations have evolved towards wanting to return to pre-injury conditions, regardless of scarring or complications from skin grafts.



The talk then transitions to discussing the management of open tibial fractures, comparing surgical, fixation, and flap procedures to those used in hip replacements, noting inconsistencies in treatment protocols and outcomes. The presenter references UK guidelines and studies, revealing that while infection rates for open tibial fractures can reach 32% due to delays in treatment, they have improved significantly in systems adhering to established standards that aim for timely debridement and reconstructive procedures within a 72-hour window.



Throughout the presentation, Dr. Kelly articulates specific case studies, statistics, and anecdotal experiences to underscore the critical importance of timely, effective interventions, and the collaborative practices that lead to better patient outcomes. He advocates for the integration of debridement and flap coverage in managing severe cases of open fractures as a standardized approach to improve healing and functional recovery. The presentation concludes with a call to adopt these standards nationally and internationally to reduce infection rates and treatment complexities.

DOI: 10.1302/3114-250978

Specialties