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

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