Introduction:

Open fractures are characterized by the exposure of fractured bone through a laceration in the surrounding soft tissue. Effective management requires prompt administration of prophylactic antibiotics, debridement, irrigation, and fracture fixation. Despite adequate treatment, complications such as amputation, infection, and non-union remain common. The rates in which these complications occur vary between the severity of the open fracture. Publication of international guidelines for open fracture management, such as the BOAST-4 and NICE-guidelines, are decreasing the complication rates. This review aims to report updated rates of common complications following treatment of long bone open fractures.

Methods:

A systematic search was conducted in PubMed, EMBASE and SCOPUS (October 2024). The review includes studies published studies regarding open fractures from the past decade. Other inclusion criteria are: Adult population, use of a classification system (Gustilo-Anderson), all fracture fixation methods and tissue transfers, and antibiotic treatment. Studies that did not stratify complications for different open fracture severity were excluded. The outcomes assessed were infection, delayed or non-union, re-operations and secondary amputation. In total 6294 articels were screened, with 273 studies in full-text screening currently. A meta-analysis will be performed to provide reliable information about the incidence of complications.

Results:

This review is ongoing. The study team anticipates substantial results by April 2025.

Conclusion:

The current known complication rates of open fractures are due an update, because of the implementation of international guidelines during the last decade. With this review, we expect to confirm persistent high rates of postoperative complications in patients with long bone open fractures. However, amputation rates are expected reduce because increasing knowledge in reconstructive surgery.

The first two authors (Lodewijks and van der Broeck) contributed equally to this abstract.

The third and fourth authors (van de Schoot and Cools) also contributed equally to this abstract.