Infections can set in after surgery for complex fractures of the lower leg, and surgeons lack solid evidence on whether applying antibiotics directly to the bone during the operation helps prevent them. Complex fractures—those that shatter a joint surface or tear through muscle and skin—carry a high risk of infection that is difficult to treat once established. Despite some hospitals already using antibiotic-loaded bone graft substitutes, no high-quality trial has proven they work. This project will first measure how common these infections actually are, then survey UK hospitals to see how they currently use prophylactic antibiotics. Finally, the researcher will run a small multicentre feasibility study comparing standard care with the antibiotic bone substitute, testing whether a full-scale randomised trial is possible. If the feasibility study succeeds, it will pave the way for a definitive trial that could give surgeons a proven tool to cut infection rates. That would mean fewer repeat surgeries, shorter hospital stays, and better long-term recovery for patients with severe leg fractures—a direct improvement in orthopaedic care that affects thousands of people each year.
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Background Infections following the surgical management of fractures are serious complications, significantly affecting patients' recovery and their quality of life. The risk of infection is particularly high in complex fractures, which are fractures that involve a joint surface or those that are associated with significant soft tissue damage. Once an infection is established, they are difficult to treat. There are some new techniques to reduce the risk of infection in this high-risk group, including the application of local antibiotics, however, there remains a lack of high-quality evidence to support them clinically. This lack of evidence is recognised by both patients and health care providers and the need for high quality research on reducing infections in complex fractures is the top priority in the James Lind Alliance Priority Setting Partnership. Aim The aim of this project is to develop our understanding of infection in complex fractures of the lower limb and determine the feasibility of performing a randomised trial to identify if local antibiotics reduce the risk infection. Objectives To estimate the risk of infection in complex fractures of the lower limb (Work Package 1) To identify UK hospitals that manage complex fractures of the lower limb and the current use of prophylactic antibiotics. (Work Package 2) To assess the feasibility of performing a randomised control trial to see if applying local antibiotic loaded bone graft substitute reduces infection. (Work Package 3) Methods and timeline for delivery In my first year of this fellowship, I will perform a systematic review to identify the risk of surgical site infections in complex fractures of the lower limb. I will also perform a national service evaluation, which will extend into my second year of the fellowship, to identify the current use of prophylactic antibiotics in these injuries and explore differences in patient demographics at the different treating hospitals. Following this, I will then perform a multicentre randomised feasibility study, comparing standard treatment with local antibiotics attached to a bone substitute to determine if a larger randomised control trial is feasible. Anticipated impact and dissemination This project will contribute towards our knowledge and understanding of surgical site infections in complex fractures. This is important not only for patients, but for healthcare providers and healthcare systems. The first element of the project will provide an overview of the risk of surgical site infection in patients following surgery for complex fractures. The second element of the proposal will provide insight into how complex fractures are currently being managed in the UK and highlight hospitals that treat patient's representative of the UK population. The third element of the project will determine if a large-scale randomised control trial can be performed to identify if applying antibiotic loaded bone graft substitute reduces the risk of surgical site infection in patient with complex fractures. The results will be disseminated to patients, the public and health care providers through open access journals, national and international conferences, charities, bulletins, and social media platforms.
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