We want to share the collective global knowledge about open fractures with everyone, to improve access to surgical care for patients with open fractures and fracture-related infections (FRIs) and reduce mortality.

Worldwide, injuries cause more deaths than HIV, TB and malaria combined.

The need for the Basics of Open Fractures Initiative

Globally, there are not enough health workers trained in the management of open fractures. Patients are unnecessarily left with impaired function or even death from complications.

The problem of open fractures is complex, due to the combination of both bone and soft tissue damage generally caused by a high-energy trauma.

To date, there is no global guideline for the treatment of open fractures that emphasizes universal treatment principles with a focus on adaptations needed for different resource settings.

There are guidelines available online that are valuable. However, we experienced in several countries, especially in LMICs that healthcare workers are still struggling on how to apply the guidelines to treat their open fractures patients. Examples are the British Orthopedic BAPRAS open fractures guideline¹ from the UK and Malawian Orthopedic Association / AO Alliance guideline².

The British BOA/BAPRAS guideline defines high standards for orthoplastic open fracture care, but was developed within a highly specialised healthcare system with ready access to orthopaedic trauma and plastic surgical expertise. The Malawi Orthopaedic Association/AO Alliance guideline represents an important step towards adapting these principles to a resource-limited setting. However, its 17 recommendations primarily define what should be done rather than providing detailed practical guidance on how these principles can be applied in daily clinical practice. This distinction is particularly important in low-resource settings, where open fractures are frequently managed by clinicians with limited access to specialist orthoplastic expertise. Decisions regarding adequate debridement, fracture stabilisation, timing and method of wound closure, soft-tissue reconstruction and referral require not only guidelines, but also practical clinical knowledge and understanding of the underlying treatment principles.

There are more shortcomings: The authors of the Malawi guideline acknowledge the lack of a plastic surgeon in their expert panel. Furthermore, they recommended that implementation of the guideline should be accompanied by education, training and feedback. Subsequent implementation studies in Malawi have demonstrated improvements in knowledge following introduction of the guidelines, but limited changes in actual clinical management and patient outcomes^3,4.

Basics of Open Fractures was therefore developed not to replace existing guidelines, but to bridge the gap between recommendations and clinical practice. It translates internationally accepted principles of open fracture care into accessible, practical and step-by-step educational guidance that can be applied by healthcare professionals working in different healthcare systems and resource settings

We recognized the need for a more practical tool that guides healthcare workers on what to do when confronted with an open fracture.

A specific dilemma is diagnosis of fracture related infection (FRI) in open fracture patients. This common complication an open fracture is often already present in resources limited settings in patients that present late in the hospital, sometimes several days or even weeks after the injury happened. How does that affect the diagnosis and treatment of an open fracture?

We created this website, through literature reviews and expert experiences in several countries, including the Netherlands, Uganda, Sierra Leone, Tanzania, United Kingdom and Spain.

Our approach

We developed our BASICS of global surgery teaching strategy based on the following principle:

The treatment principles for surgical conditions are universal while the local context defines how to apply these universal treatment principles in different settings worldwide.

Our aim is to support training of healthcare workers globally, with the focus on settings with the highest need. Apart from on the practical guidance on this Wiki page, we also provide hands-on courses known as the Basics of Open Fractures course, developed and provided by an international team.

A community of specialists, doctors, residents, global health practitioners and students from around the world, working together to develop teaching initiatives for global surgery.

About the project

We have been working to help improve open fractures care both in high-resource settings and in resource-limited settings by providing training for healthcare workers. But we realized that to make a bigger impact we needed to make essential information widely and continuously available online.

The evolution of multidisciplinary open fracture care
Today's recommended approach to open fracture management, involving a plastic surgeon for the soft tissues and a trauma,- or orthopeadic surgeon for the bone problem, has evolved from the way the specialties developed in high-income countries. The high resources settings 'orthoplastic' model exists because it is believed that specific expertise from the two different specialties need to be brought into the operation room by two different specialists that both have specific qualities to obtain good outcomes, especially if they work as a dedicated multidisciplinary team. In many settings worldwide, this approach is not possible because of lack of specialists, one doctor needs to be able to address both bone and soft tissues. For them, the basic knowledge and skills need to be available.

That is why we created this Basics of Open Fractures platform:

To be able to teach everyone the basic principles of the treatment of open fractures.

We spread our knowledge and experience on open fractures through our:

1 Wiki

The Wiki page on the website collates information on the treatment of open fractures and fracture related infections (FRI) in different resource settings. It is designed for course participants and trainers and is freely accessible to other clinicians and students looking for information on the basics of open fracture management. It is primarily meant as practical tool, composed with both evidence based background as well expert advices from the field. It is a dynamic process, where feedback is used to continuously improve the content.

2 Case examples

We share case stories from doctors and their patients with appropriate follow up. We explain the treatment, the challenges and the lessons learned, from both the doctor's and the patient's perspective, providing a unique insight into care.

3 Courses

As one of our BASICS of global surgery courses, we provide the Basics of Open Fractures Courses. These hands-on courses have been provided in the Netherlands, Tanzania, Uganda, Germany and Sierra Leone. Participants are healthcare workers that need to take care of patients with open fracture and/or fracture related infections in their hospitals. They can be specialists, specialists in training and/or the general doctors. Based on the local demand, specialized nurses, physiotherapist and anesthetists can also participate with the aim of training a complete team to care for a patient with an open fracture.

Learn more about our initiative