Incidence and quality of care for open fractures in England during 2008-2019: a cohort study using data collected by the Trauma Audit and Research Network

This study estimated trends in incidence of open fractures and the adherence to clinical standards for open fracture care in England. Longitudinal data collected by the Trauma Audit and Research Network were used to identify 38,347 patients with open fracture and a subgroup of 12,170 with severe open fracture of the tibia during 2008-2019 in England. Incidence rates per 100,000 person-years and 95% confidence intervals (CI) were calculated. Clinical care was compared with the BOAST and National MTC audit standards. Sixty percent of all open fractures occurred in men, the median age was 48. During 2012-2019, the overall incidence in England was 6.94 per 100,000 person-years. In men the highest incidence observed was in those aged 20-29 years,11.50 per 100,000 person-years; in women incidence increased with age peaking at 32.11 per 100,000 person-year. Amongst those with severe open fracture of the tibia, there was a bimodal distribution in men, peaking at 20-29 years (3.71/100,000) and greater than 90 years of age (2.84/100,000 person-years) respectively; amongst women incidence increased with age to a peak of 9.91 per 100,000 person years. There has been variable improvement with time in the clinical care standards for patients with severe open fracture of the tibia. The median time to debridement was 13.0 hours (IQR 6.4-20.9); almost two thirds of patients underwent definitive soft tissue coverage within 72 hours during 2016-2019. This is the first time the incidence of all open fractures has been studied using data from a national audit in England. Whilst most open fractures occurred in young men, the incidence increased with age in women to a much greater level than observed in older men. The degree of missing data in the national audit is startling and limits the certainty of inferences drawn concerning open fracture care.