Today's perspectives and challenges in moving management of patients with open tibial fractures forward in the Netherlands.

Abstract

Management of open crural fractures is challenging and requires close interdisciplinary collaboration. Dutch guidelines recommend soft tissue coverage, ideally within 72 h, no later than 1-week post-injury. The guideline does not recommend centralization or volume per center. This poses significant challenges in clinical practice. This study assessed current practice in the Netherlands regarding case volume, organization of care and timing of procedures, while also exploring barriers and facilitators for fracture fixation and soft tissue closure (fix and flap) within 72 h. A national survey was conducted among plastic and orthopedic trauma surgeons, covering January-December 2024. The 54-item questionnaire addressed caseload, logistics, timing of coverage, and perceived challenges. All Dutch level 1 trauma centers were represented. All 11 of the level 1 centers in the Netherlands responded, in addition we got a response from 13 specialists working in level 2 centers. Eighteen Orthopedic trauma surgeons and 24 plastic surgeons responded. In 63% of centers, at least 10 open tibial fractures were managed annually; 28% reported treating over 20 open tibial fractures per year. Soft tissue coverage was performed within 72 h in only 6% of cases, and within one-week post-injury in 59% of cases. Although 59% of respondents regarded early soft tissue coverage sufficiently supported by evidence, numerous barriers were identified, including limited theater availability and inadequate prioritization of open fractures. Soft tissue coverage within 72 h for open tibial fractures is rarely achieved, mainly due to limited theater availability and prioritization issues. Differences in orthopedic trauma- and plastic surgeons' perspectives highlight coordination challenges. Reserved theater time, stronger evidence, and centralization of care could improve adherence. As early soft tissue coverage may reduce complications, hospital stay, and costs, our results warrant further research and active implementation.