Single-Centre Study: Managing Lower Limb Open Fractures in Accordance   with the Bapras Guidelines

Objective: To evaluate the management of lower limb open fractures, specifically Gustilo-Anderson class III fractures, and assess adherence to British Association of Plastic, Reconstructive, and Aesthetic Surgeons (BAPRAS) guidelines. Study Design: Retrospective observational study. Place and Duration of Study: PNS Shifa Hospital, Karachi Pakistan, from Aug 2021 to Feb2023. Methodology: Adult patients with Gustilo-Anderson class III fractures were included, with a minimum follow-up time of 6 months. Patients with polytrauma and severe life-threatening injuries were excluded. Comprehensive medical records review was conducted, and outcome measures including infection rates, wound healing, complications, functional recovery, and patient satisfaction were assessed. Results: The study involved 20 patients (age: 22-65, mean 40.30±12.22). Initial debridement was on admission day. Time from debridement to soft tissue coverage was at mean 19.95±8.21 days, shorter for milder damage treatable with SSGs and local flaps, longer for microvascular flaps. Internal fixation occurred at 44.25±7.77 days post soft tissue coverage. Mean hospital stay was 67.00±14.82 days. Conclusion: Despite challenges such as resource limitations and delayed presentations, the study highlights the importance of tailored treatment approaches in managing lower limb open fractures. Although deviations from strict timing recommendations were noted, favorable outcomes were achieved, emphasizing the need for continuous evaluation and adaptation of treatment protocols. Multidisciplinary collaboration remains crucial in optimizing patient care.