Treatments for broken bones

The NIHR-funded WOLLF study set out to find the best wound dressing for open fractures.

Published: 16 June 2019

Broken bones and infection

A broken bone, or fracture of the lower limb, is a common injury.

In the UK general population, the risk of an open long-bone fracture is approximately 11.5 per 100,000 people, per year. In severe cases, the risk of an open fracture becoming infected can be as high as 27%.

Open fractures require urgent surgery to clean the wound, remove dead tissue and stabilise the broken bone. However, despite the surgery, there is still a risk of wound healing complications such as infection.

As well as affecting the recovery of the patient, infections can also increase healthcare costs due to longer hospital stays or extra treatments.

Treating fractures

One of the factors which may improve wound healing after an open fracture is the choice of dressing applied to the wound at the end of surgery.

Standard dressings have a non-stick surface which is applied to the wound covered with a waterproof layer.

Negative Pressure Wound Therapy (NPWT) is an alternative dressing for open fractures. The device creates a vacuum using a suction pump which removes blood and fluid that may collect in a wound.

However, NPWT dressings and the vacuum machines are considerably more expensive than traditional wound dressings, and while popular with surgeons and patients, there was little information about its effectiveness prior to the Wound Management of Open Lower Limb Fractures (WOLLF) study.

Research into wound dressings

As part of the NIHR-funded WOLLF study, 460 patients across 24 major trauma hospitals took part in research comparing NPWT with standard dressings for open fractures of the lower limb.

Results of WOLLF research

The findings of the research showed that there was no evidence that NPWT reduced patients' disability after 12 months, and therefore the research doesn’t support this particular treatment for severe open fractures.

As a direct result of these findings, NICE updated its clinical guidelines for the assessment and management of complex fractures.

Given that NPWT dressings and the vacuum machines are considerably more expensive than traditional wound dressings (with NPWT costing on average £84 compared with approximately £4 for standard dressings), the research and subsequent change in guidelines are expected to lead to considerable cost-savings for the NHS.

Funding of the WOLLF study

The £2.18m trial was funded by the NIHR Health Technology Assessment Programme and supported by the NIHR Oxford Biomedical Research Centre, the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford, and the NIHR Clinical Research Network, who helped to gather patients' consent to take part in the trial.

Patient story

Dominic Burton, a demonstration car driver from Banbury, was enrolled onto the study in 2013 after sustaining an injury to his right leg following a forklift truck accident at work.

Dominic said: “I knew I probably wouldn’t be coming home in the next couple of days and was feeling a bit low at that point, and I thought about how the trial might help someone else who found themselves in the same position as me, so I said it was absolutely fine.”

Dominic was given a standard dressing and was in hospital for just over 3 weeks before he was discharged.

Patients taking part in the trial were required to complete questionnaires during the year after sustaining their injuries, to allow the research team to assess their level of disability, rate of infection and quality of life. This aspect of the research supported Dominic’s 18-month recovery in additional ways.

“By asking about my personal wellbeing in addition to my physical injury, the questionnaire made me think a bit differently. I don’t think I would have even considered some of the questions had I not been asked them as part of the trial.

“Being on the trial heightened my interest, so I learned more about the type of injury I had and the long-term effects of it.”