Chapter 3.4 - Specialistic center

Open fractures of the lower limbs are complex trauma that, like polytrauma and other complex fractures, bene- fit from a specialized and multidisciplinary approach to optimize treatment and shorten recovery time. A combined “orthoplastic” approach has been shown to improve outcomes and reduce complications. Pa- tients admitted directly to an orthoplastic center undergo fewer operations than those who are initially treated in an orthopedic unit and then transferred to a specialistic center.1 In addition, secondary referral to a spe- cialistic center is associated with increased rates of osteomyelitis, non-consolidation of fracture and hardware removal, and the delay of definitive fixation and soft tissue coverage contributes to an increased rate of compli- cations and poorer prognosis.2 Patients’ centralization to a trauma-specialized center is not only effective in terms of health and recovery time, but also cost-effective for patients and public health care. In this chapter, characteristics of a reference specialistic center and criteria for referral will be discussed.