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Eur J Trauma Emerg Surg. 2019 Feb;45(1):99-106. doi: 10.1007/s00068-017-0874-7. Epub 2017 Nov 27.

Treating open lower limb fractures successfully; thoughts and current practice on therapy and centralization in The Netherlands.

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Research fellow Orthopedic Hand Service, Orthopedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Trauma Surgery, Haaglanden Medical Center, The Hague, The Netherlands.
Department of Orthopedic and Trauma Surgery, Haaglanden Medisch Centrum, The Hague, The Netherlands.
Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Kennisinstituut van de Federatie Medisch Specialisten, Utrecht, The Netherlands.
Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Orthopedic Surgery, Noordwest Ziekenhuis Groep, Alkmaar, The Netherlands.
Emergency Department, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Trauma Surgery, VU Medical Centre, Amsterdam, The Netherlands.
Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.



The British Orthopedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) updated the evidence-based guidelines for the treatment and care of open lower limb fractures (BOAST 4). Following this, a Dutch version has been developed. The main points are multidisciplinary care, planning, and treatment of these injuries. Early osteosynthesis (within 7-14 days) combined with soft-tissue coverage results in more efficient care and less complications.


To study the variation in treatment and thoughts among trauma, orthopedic, and plastic surgeons.


In this cross-sectional study 94 surgeons (57 trauma, 23 plastic, and 14 orthopedic surgeons) working at 46 centers completed an online questionnaire, consisting of 5 demographic, 14 hospital-related, 8 BOAST 4-related, and 2 centralization-related questions.


There was a strong agreement among surgeons about the best moment for multidisciplinary consultation, which was before initial debridement, while in practice, this often does not occur. All surgeons agreed that the initial debridement should be performed immediately by any surgeon, but not solely by trainees. Plastic surgeons responded that the definitive stabilization and wound cover should not exceed 7 days, while half of the trauma and orthopedic surgeons agreed that it should not exceed 14 days. Finally, most surgeons agreed that Gustilo 3 fractures should be centralized. However, there was disagreement on the need for centralization of Gustilo 2 fractures.


Surgeons agree on better and earlier multidisciplinary treatment of open lower limb fractures and the centralization of Gustilo 3 fractures.


Multidisciplinary treatment; National survey; Open lower limb fractures

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