Summary of similarities/differences in trauma management
| UK | USA and/or Canada | |
|---|---|---|
| Wound debridement | After initial debridement at R3, wounds are further inspected and debrided as necessary | Wounds are inspected and debrided every 48 h for 3–4 times, then every 72 h till closure |
| Pulsed lavage is not used | Pulsed lavage is used but only when wound is clean | |
| Initial fracture management | Most appropriate stabilisation, that is, plaster cast, traction, external fixator | All fractures have monolateral external fixators applied in E3 |
| Antibiotic cement beads used as temporary spacers in initial open fracture management | Antibiotic cement beads used | |
| Open tibial fractures | Most appropriate fixation, that is, AO locking plate, unreamed IM nail, monolateral external fixator, Ilizarov or TSF | All monolateral external fixators are converted to TSFs |
| Bone graft and BMP-2 | No early use of BMP-2 | Liberal early use of BMP-2 |
| Delayed bone grafting using synthetic, autologous or allograft | Delayed bone grafting using synthetic, autologous or allograft | |
| Large amounts of autologous graft obtained from intramedullary femur canal by Reamer/Irrigator/Aspirator (Synthes, Inc., USA) | ||
| Soft tissue reconstruction | Appropriate reconstruction technique used, for example, SSG, pedicled flap, free flap by plastic surgeons | High failure rate of free flaps. Move to use more pedicled flaps. Techniques performed by orthopaedic surgeons |
| Wound closure | No standardised closure method, surgeon-dependent | Modified Allgöwer-Donati suture pattern used |
| Topical negative pressure dressings | Previously not available at R3 till 2011, now used extensively. Used extensively at R4 | Applied universally at E3 for transfer to E4 and E5. Use continued at E5 |
| ‘Incisional’ VAC dressing used to protect postoperative wound suture line | ||
| Modified Ertl Procedure | Not used | Reintroduced at WRAMC but in spite of theoretical benefits, higher complication rate |
BMP-2, bone morphogenetic protein-2; E3, 4, 5, Echelon 3, 4, 5; IM, intramedullary; R3, 4, Role 3, 4; SSG, split skin graft; TSF, Taylor spatial frame; VAC, vacuum assisted closure; WRAMC, Walter Reed Army Medical Center.