Scottish Open Fractures of Tibia (SOFT) audit; a multi-centre retrospective review of ortho-plastic management of tibial shaft fractures at major trauma centres (MTCs) in Scotland

Abstract

Aims

Open fractures of the tibia are associated with significant complications, for which attempts have been made to standardise and optimise their management.

In the UK, this standard is the British Orthopaedic Association Standards for Trauma (BOAST) guidelines. The Scottish Open Fracture of Tibia (SOFT) Audit is a national review of open tibial shaft fractures across all four Scottish Trauma Networks, which aims to provide a definite review of ortho-plastic care for open tibial shaft fractures in Scotland.

Methods

A retrospective audit of all adult patients who sustained open tibial shaft fractures in Scotland from June 2021 to June 2023 was performed. The primary outcome measure was compliance with BOAST guidelines. Secondary outcome measures included infection, return to theatre, soft-tissue failure, and amputation.

Results

196 open tibial shaft fractures were identified. Common complications included infection (24 %), return to theatre (17 %), soft-tissue failure (9.7 %) and amputation (7.1 %). Complete compliance with BOAST guidelines was documented in 8.8 % of cases. Significant variation was seen between geographical regions of Scotland. No significance was seen between compliance to BOAST guidelines and any of the secondary outcome measures. Multivariate analysis identified Grade 3 Gustilo-Anderson injuries as significantly associated with post-operative infection, post-operative infection significantly associated with return to theatre, and return to theatre significantly associated with soft-tissue failure and/or amputation.

Conclusion

This study demonstrates in Scotland there is scope for improvement in cohesion with national guidance including timing of antibiotic delivery, combined ortho-plastics approach, and soft-tissue cover within 72 h of definitive fixation.