Priority 1 from the Complex Fractures PSP

UNCERTAINTY: What is the best way to reduce the risk of infection after complex fractures?  (JLA PSP Priority 1)
Overall ranking 1
JLA question ID 0105/1
Explanatory note Infection may cause significant morbidity and mortality in patients with complex fractures. 

All studies referenced in NG37 were of low quality and high risk of bias.

There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds.

No other relevant trial evidence Cochrane/PUBMED since 2015

Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma The WHIST Randomized Clinical Trial

NICE Guideline 37 Fractures (complex): assessment and management

Health Research Classification System category Injuries and accidents
Extra information provided by this PSP
Original uncertainty examples how can we reduce the risk of infection after complex fractures ~ Long term infection risk following nails, plates, frames (after 2-5 years) ~ Prevention and treatment of nosocomial infections ~ I had an infection in two of the wounds after the first two ops to fix the ankle. Took 6 months to heal. When metal removed after 12 months wounds healed within a month.
Submitted by 2 x Surgeon/Doctor, 1 x Carer for a patient, 1 x Patient, 3 x Unknown 
PSP information
PSP unique ID 0105
PSP name Complex Fractures
Total number of uncertainties identified by this PSP. 58  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 8th June 2021