Pain after trauma has received relatively little research attention compared with surgical techniques and functional outcomes, but is important to patients. We aimed to describe nerve dysfunction and pain characteristics using tibial fractures as a model. We hypothesized that early nerve dysfunction was associated with neuropathic and chronic pain. Adult patients with isolated open or closed tibial diaphyseal fractures were prospectively observed for 1-year in 5 Major Trauma Centres. Nerve dysfunction was assessed using Semmes-Weinstein monofilaments, acute pain with the visual numerical rating scale (VNRS), neuropathic pain with the doleur neuropathique-4 score and quality of life (QOL) using the EQ-5D score.Introduction
Materials and Methods
St Mary's Hospital, the major trauma centre for West London, treated 168 patients with lower limb open fractures in 2011 & 2012. This audit compared antibiotic administration in the emergency department against the current BOAST IV guidelines. The choice, timing, dose, and documentation of antibiotic administration was collected from the casualty cards and the transfer documentation for any patient initially seen at another hospital. The severity of the injury (as the Gusitollo-Anderson classification) after the initial debridement and any infectious complications that presented before discharge were also recorded. The results showed a higher compliance with the BOAST IV guidelines for those patients directly admitted rather than transferred to the major trauma centre. In direct admissions the recommended antibiotics were either not given or not adequately documented in 7% of cases. In those patients transferred from another emergency department the documentation was inadequate in 27% of cases. The likely causes of these results are discussed alongside the unit's bone infection rates.
