Abstract
Background
Open limb fractures are a time-critical orthopaedic emergency that present to jurisdictional
ambulance services. This study describes the demographic characteristics and epidemiological
profile of these patients
Methods
We undertook a retrospective analysis of all patients that presented to Queensland
Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna,
tibia/fibula or femur) over a two-year period (January 2018 – December 2019).
Results
Overall, 1020 patients were included. Patients were mainly male (65.9%) and middle-aged
(age 41 years, IQR 22–59). Fractures predominately occurred in the lower extremities
(64.9%) with transport crashes the primary mechanism of injury (47.8%). The location
of the fracture varied depending on the cause of injury, with femur fractures associated
with motorcycle crashes, and fractures to the radius/ulna attributed to falls of greater
than one metre (p = 0.001). The median prehospital episode of care was 83 min (IQR 62–144) with aeromedical
air ambulance involvement and the attendance of a critical care paramedic or emergency
physician, both independent factors that increased this time interval.
Conclusion
Open limb fractures are a relatively infrequent injury presentation encountered by
ambulance clinicians. The characteristics of these patients is consistent with previously
described national and international out-of-hospital trauma cohorts
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Australasian Emergency CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Management of open fractures and subsequent complications.J Bone Jt Surg Am. 2007; 89: 1535-1586
- Gustilo-Anderson classification.Clin Orthop Relat Res. 2012; 470: 3270-3274
- Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence.Injury. 2015; 46: 8-19
- Risk factors for infectious complications after open fracture’s a systematic review and meta-analysis.Int Orthop. 2017; 2017: 1965-1982
- How common are vascular injuries in open tibial fractures? A prospective longitudinal cohort study.Eur J Orthop Surg Trauma. 2019; 29: 1119-1124
Ambulance Victoria. Clinical practice guidelines ambulance and MICA paramedics. 〈https://www.ambulance.vic.gov.au/wp-content/uploads/2019/03/Clinical-Practice-Guidelines-2018-Edition-1.8.pdf〉.
Queensland Ambulance Service. Clinical practice guidelines – trauma/limb injury. 〈https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Limb%20injury.pdf〉.
- Joint Royal Colleges Ambulance Liaison Committee.JRCALC clinical guidelines. 5th ed. Class Professional Publishing, Bridgwater2019: 2019
- A trial of wound irrigation in the initial management of open fracture wounds.N Engl J Med. 2015; 373: 2629-2641
- Acute management of open fractures: an evidence-based review.Orthopaedics 2015. 2015; 38: 1025-1033
- Prevention of infection in open fractures: where are the pendulums now?.Injury. 2020; 51: 57-63
- Wound irrigation for open fractures.JBJS Rev. 2020; 8
National Institute for Health and Care Excellence. Fractures (complex) assessment and management - methods, evidence and recommendations. 〈https://www.nice.org.uk/guidance/ng37/evidence/full-guideline-pdf-2359957649〉.
British Orthopedic Association. BOAST – open fractures. 〈https://www.boa.ac.uk/uploads/assets/3b91ad0a-9081–4253-92f7d90e8df0fb2c/29bf80f1–1cb6–46b7-afc761119341447f/open%20fractures.pdf〉.
- The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma.J Bone Jt Surg Am. 2010; 92: 7-156
- Aust Demogr Stat. 2019; (December) (December) (December)
- Epidemiology of oxytocin administration in out-of-hospital births attended by paramedics.Prehosp Emerg Care. 2020; 25: 412-417
Schultz B.V., Doan T.N., Bosley E., Rogers B., Rashford S. Prehospital study of survival outcomes from out-of-hospital cardiac arrest in ST-elevation myocardial infarction in Queensland, Australia (the PRAISE study). Eur Heart J Acute Cardiovasc Care 2020; European Heart Journal: Active Cardiovascular Care; 2020.
Queensland Ambulance Service. Clinical practice procedures – assessment/paediatric. 〈https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Limb%20injury.pdf〉.
World Health Organisation. International statistical classification of diseases and related health problems – 10th revision. 〈https://icd.who.int/browse10/Help/Get/home/en〉.
- Aust Stat Geogr Stand (ASGS) Remote Struct. 2018;
- Epidemiology of out-of-hospital cardiac arrests that occur secondary to chemical asphyxiants: a retrospective series.Resuscitation. 2022; 175: 113-119
- Age and the distribution of major injury across a national trauma system.Age Aging. 2020; 49: 218-226
- Age-related trends in injury and injury severity presenting emergency departments in New South Wales Australia: Implications for major trauma surveillance and trauma systems.Injury. 2017; 48: 171-176
- Injury trends and mortality in adult patients with major trauma in New South Wales.Med J Aust 2012. 2012; 197: 233-237
- Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia.Emerg Med Austral 2018. 2018; 30: 827-833
- Trauma incidents attended by emergency medical services in Victoria, Australia.Prehosp Disaster Med. 2008; 23: 20-28
- The epideiomology of open fractures in adults. A 15-year review.Injury. 2012; 43: 891-897
- Incidence of distal ulna fractures in a Swedish county: 74/100,000 person-years, most of them treated non-operatively.Acta Orthop. 2020; 91: 104-108
- A review of common motorcycle collision mechanisms of injury.EFFORT Open Rev. 2020; 5: 544-548
- Type II open tibia fractures – immediate antibiotic prophylaxis minimizes infection.J Orthop Trauma. 2015; 29: 1-6
- Delay of antibiotic administration greater than 2 h predicts surgical site infection in open fractures.Injury. 2020; 51: 1999-2003
- Time to intravenous antibiotic administration (TIbiA) in severe open tibial fractures: Impact of change to national guidance.Injury. 2020; 51 (1086-90)
- Wound irrigation in orthopaedic open fractures: a review.Surg Infect. 2021; 22: 245-252
- Irrigation fluids used for the prevention and treatment of orthopaedic infections.J Bone Jt Surg Am. 2020; 102: 76-84
- Does wound irrigation in the prehospital environment affect infection rates? – a review of literature.Austral J Para. 2015; 12: 4
- Pressure dynamics of various irrigation techniques commonly used in the emergency department.Ann Emerg Med. 1994; 24: 36-40
- A meta-analysis of prehospital care times for trauma.Prehosp Emerg Care. 2009; 10: 198-206
- Prehospital interventions: time wasted or time saved? An observational cohort study of management in initial trauma care.Emerg Med J. 2008; 25: 444-449
- Prehospital antibiotic prophylaxis for open fractures: practicality and safety.Prehosp Emerg Care. 2019; 23: 385-388
- Helicopter emergency medical services crew administration of antibiotics for open fractures.Air Med J. 2013; 32: 74-79
Article info
Publication history
Published online: January 06, 2023
Accepted:
January 2,
2023
Received in revised form:
December 25,
2022
Received:
October 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
Crown Copyright © 2023 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia. All rights reserved.
