Background:
High-energy compound limb fractures present significant reconstructive challenges, requiring coordinated orthoplastic management. Early debridement, skeletal stabilisation, and timely soft tissue coverage are key to reducing deep infection and non-union. International guidelines, including those from BAPRAS, recommend debridement within 24 hours and definitive fixation with soft tissue coverage ideally within 72 hours, and no later than 7 days. This study evaluates outcomes of complex extremity trauma managed at Hutt Hospital and audits adherence to these standards.
Methods:
A retrospective review was conducted using a database of free flaps performed for coverage of acute Gustilo Anderson Grade 3 compound fractures of the extremities at Hutt Hospital between 2023 and 2025. Extremity injuries without associated fractures were excluded. Patient demographics, injury characteristics, operative timing, and outcomes (infection, union, and weightbearing status) were collected from clinical records.
Results:
Thirteen patients were identified (76.9% male), with 12 lower limb and 1 upper limb injuries. Debridement within 24 hours was performed in 84.6% of cases. Definitive soft tissue coverage occurred within 72 hours in 30.8% and within 7 days in 53.8%. A combined “fix-and-flap” approach was utilised in 69.2%. There was one partial flap failure requiring revision anastomosis, which was successfully salvaged. Deep infection occurred in 23.1% of patients, exclusively in those receiving coverage beyond 7 days. Limb salvage was achieved in all cases. Earlier coverage (<7 days) demonstrated a trend toward earlier union and weightbearing, although this was not statistically significant due to the small sample size.
Conclusion:
Orthoplastic management at Hutt Hospital achieves high limb salvage and flap success rates. However, timely soft tissue coverage remains inconsistent relative to international benchmarks. Delayed coverage was possibly associated with increased infection risk and delayed union. These findings support efforts to optimise early coordinated care and highlight the need for a national multicentre orthoplastic trauma registry in New Zealand.