SRS23 - Open lower limb fractures in major trauma: a retrospective analysis of patient injuries, outcomes, and care pathways

Abstract Aims This study aims to characterise the presentation and care of patients with open lower limb fractures managed via major trauma pathway. Secondary aims seek to identify clinical variables associated with increased length of stay (LOS) and in-hospital mortality. Methods This is a retrospective cohort study of adult and paediatric patients presenting to St Mary’s Major Trauma Centre with open lower limb fractures between January 2020 and April 2025. Data were extracted from the Major Trauma Registry Database. Data collected involved concomitant patient injuries and fracture grading. Results A total of 674 patients were included, of which 68.55% were male, with a median age of 41 years. The most common mechanism of injury was a fall from <2 metres (32.64%). BOAST grade 3B was the most frequent open fracture subtype. Associated injuries included chest (n = 67), pelvis (n = 49), and spine (n = 47). 539 patients had isolated limb injuries identified at the time of major trauma assessment. Twelve patients (1.78%) died in hospital. Multivariable logistic regression identified major haemorrhage (OR 6.87, P = 0.089) and pelvic injury (OR 5.91, P = 0.129) as clinically relevant predictors of mortality, although not statistically significant. LOS was significantly longer in higher BOAST grades (P < 0.001). Conclusions While most open fracture patients in the major trauma system had isolated orthoplastic injuries, a subset presented with life-threatening trauma. Pathway efficiency could be improved by refining triage decisions, supported by tools that differentiate complex polytrauma from isolated injuries at presentation, reducing strains on major trauma services while maintaining rapid access to specialist orthoplastic care.