THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?

Shazil Jamal; Yahya Ibrahim; Kashif Akhtar

doi:10.1302/1358-992X.2021.16.007

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THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?

The British Orthopaedic Research Society (BORS) Annual Meeting 2021, held online, 13–14 September 2021.

Shazil Jamal
Yahya Ibrahim
Kashif Akhtar

THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?

Jamal S, Ibrahim Y, Akhtar K. THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?. Orthop Procs. 2021;103-B(SUPP_16):7-7. doi:10.1302/1358-992X.2021.16.007

Jamal, Shazil, et al. “THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?.” Orthopaedic Proceedings, vol. 103-B, no. SUPP_16, 2021, pp. 7-7., https://doi.org/10.1302/1358-992X.2021.16.007

Jamal, S., Ibrahim, Y., & Akhtar, K. (2021). THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?. Orthopaedic Proceedings, 103-B(SUPP_16), 7-7. https://doi.org/10.1302/1358-992X.2021.16.007

Jamal, S., Ibrahim, Y. and Akhtar, K. (2021) “THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?.” Orthopaedic Proceedings, 103-B(SUPP_16), pp. 7-7. Available at: https://doi.org/10.1302/1358-992X.2021.16.007

Jamal, Shazil, Yahya Ibrahim, and Kashif Akhtar. “THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?.” Orthopaedic Proceedings 103-B, no. SUPP_16 (2021): 7-7. https://doi.org/10.1302/1358-992X.2021.16.007

Jamal S, Ibrahim Y, Akhtar K. THE EVIDENCE BASE FOR 2017 BOAST-4 GUIDANCE ON OPEN FRACTURE MANAGEMENT: ARE WE DUE AN UPDATE?. Orthop Procs. 2021 Dec 1;103-B(SUPP_16):7-7. https://doi.org/10.1302/1358-992X.2021.16.007

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Abstract

Objective

Open fracture management in the United Kingdom and several other countries is guided by the British Orthopaedic Association's Standards for Trauma Number 4 (BOAST-4). This is updated periodically and is based on the best available evidence at the time. The aim of this study is to evaluate the evidence base forming this guidance and to highlight new developments since the last version in 2017.

Methods

Searches have been performed using the PubMed, Embase and Medline databases for time periods a) before December 31, 2017 and from 01/01/2018–01/02/2021. Results have been summarised and discussed.

Results

Several contentious issues remain within the 2017 guideline. Antibiotic guidance, the use of antibiotic impregnated PMMA beads and intramedullary devices, irrigation in the emergency department, time to theatre and the use of negative pressure dressings and guidance regarding the management of paediatric injuries have all demonstrated no clear consensus.

Conclusion

The advent of the BOAST-4 guideline has been of huge benefit, however the refinement and improvement of this work remains ongoing. There remains a need for further study into these contentious issues previously listed.