Open Fractures – What Is the Evidence, and How Can We Improve?

Open fractures can have devastating consequences, including chronic infections and amputations, leaving patientswith life-changing disabilities. Prompt and appropriate treatment can spare patients the sequelae of open fracturesand the long-term economic burden these injuries often inflict. The British Orthopaedic Association Standards forTrauma and Orthopaedics (BOAST-4) guideline outlines the acute management of patients with open fracturesand is often considered the gold standard for open fracture management in the UK. In an era of evidence-basedmedicine, clinicians are continually mindful of the science behind current guidelines and practices. This article aimsto critique the evidence underpinning the BOAST-4 guidelines and suggest improvements based on contemporaryliterature. Antibiotic delivery in the prehospital setting, the type and duration of antimicrobial therapy, timing for theconversion from external to internal fixation, and the differentiation between adult and paediatric open fractureswere among the many pertinent topics critiqued, and evidence-based improvements suggested.Level of evidence: V