Trauma BOASTs

These BOASTs are short standards documents that are trauma-related and produced by the BOA’s Trauma Committee. They are downloadable from our website and can be printed for display in hospitals. You can find our full list of Trauma BOASTs below.

Management of Metastatic Bone Disease (MBD)

• June 2022
• Patients presenting with suspected MBD should be managed along a defined pathway from presentation to rehabilitation. Low energy fractures in the non-osteoporotic population, antecedent pain, night pain, absence of injury, and insidious pain are suspicious for underlying malignancy.

Management of Anterior Cruciate Ligament Injury in the Skeletally Immature Patient

• May 2022
• The scope of this guidance is to provide recommendations for the assessment and management of skeletally immature patients with suspected Anterior Cruciate Ligament injuries.

The Management of Children with Acute Musculoskeletal Infection

• May 2022
• Musculoskeletal infection in children can be life threatening and lead to long-term disability. It necessitates prompt diagnosis and timely management. There needs to be an awareness of the spectrum of disease, which includes septic arthritis, osteomyelitis, discitis and pyomyositis. The presence of cellulitis, in particular, may indicate infection of deeper structures. Defined pathways with appropriate expertise and infrastructure are therefore required to ensure optimum management and minimise long-term consequences on growth and child development.

Peripheral Nerve Injury

• December 2021
• All clinicians undertaking musculoskeletal care may be involved in the management of peripheral nerve injury, either as a complication of surgery or as the result of primary trauma. The consequences of a missed peripheral nerve injury carry considerable impact for the patient. Achieving the best result will require that first the injury is identified and then that the management is directed and delivered by
  the right clinician at the right time. Establishing pathways which lead to early identification and timely management of injured nerves is key to optimal patient outcome.

Early Management of the Paediatric Forearm Fracture

• May 2021
• The most common site of fractures in children is the forearm. Casting is the gold standard of care for most fractures as children have a capacity to remodel following fracture union, permitting the bones to heal with a greater degree of angulation or displacement than could be accepted in an adult without long-term consequences. The wrist is more tolerant of angulation and displacement than the forearm shaft. For the majority of forearm fractures that exceed remodelling potential, early closed reduction by manipulation, avoiding the need for admission and general anaesthesia is the treatment of choice.

Cervical Spine Clearance in the Trauma Patient 

• May 2021
• Following blunt trauma, particularly if associated with impaired cognition, the potential for an unstable cervical spine is generally recognised and the patient is protected appropriately. 

Diagnosis & Management of Arterial Injuries Associated With Extremity Fractures and Dislocations

• Updated December 2020
• Rapid, accurate diagnosis of arterial injuries to the extremities is crucial for optimum outcome with immediate referral to, and joint management with, a surgeon capable of performing vascular repair.

Supracondylar Fractures in the Humerus in Children

• Updated October 2020
• Supracondylar fractures of the distal humerus are the most common fractures about the elbow seen in children. 

Fracture Related Infections (FRI) 

• September 2019
• Co-morbidities, associated local soft tissue injury, open wounds and the use of implants all increase the vulnerability to infection of patients with surgically managed fractures. 

The Care of the Older or Frail Orthopaedic Trauma Patient

• May 2019
• The care of orthopaedic trauma in the older or frail patient is dependent on coordinated multidisciplinary working to manage the physical injury, co-morbidities and rehabilitation, including measures to prevent further injury.

The Management of Patients with Pelvic Fractures

• January 2018
• Pelvic fractures must be managed within a trauma system with defined referral pathways. They can be associated with significant haemorrhage, urological injury and other injuries. Specialist units, based at Major Trauma Centres, should have the ability to provide multidisciplinary care for these patients as well as specialist orthogeriatric care for those sustaining fragility fractures.

The Management of Distal Radial Fractures

• December 2017
• Fractures of the distal radius are common and result from both high and low energy trauma. The aim of treatment is to optimise functional recovery rather than to achieve specific radiological parameters.

Open Fractures

• December 2017
• Open fractures may require timely multidisciplinary management. The consequences of infection, can be great both for the individual patient and the community. Trauma networks and hospitals require the appropriate pathways and infrastructure, to manage these patients, to enable optimum recovery and to minimise the risk of infection.

The Management of Ankle Fractures

• August 2016
• Ankle fractures are common and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. This should optimise functional recovery and reduce the chance of development of post-traumatic arthritis. 

Rehabilitation and Communication with Trauma Patients

• August 2016
• Rehabilitation is the process of restoration of a patient to their pre-injury state. A rehabilitation Prescription starts by identifying the components of the injury and the interventions required. These interventions may include acute management, surgery and therapies. Trauma can be a sudden and life changing event that may have a devastating effect on patients, their families and friends. Since the advent of trauma networks, the most appropriate care may require transfer and treatment away from the nearest hospital. It is recognised that recovery from injury requires multidisciplinary coordinated care including good communication and rehabilitation from the time of injury.

The Management of Urological Trauma Associated with Pelvic Fractures

• August 2016
• Urological trauma is rare and the incidence of severe urethral trauma is 1/million population/year. The majority of cases are due to blunt high-energy trauma with associated multi-system injuries and 80% of these cases are associated with pelvic fractures. Urological injuries are potentially fatal and can result in severe long-term disability. 

Spinal Clearance in the Trauma Patient

• January 2015
• All patients involved in significant blunt trauma must be assumed to have an unstable injury to their spine. Immobilisation with full spinal precautions for prolonged periods creates difficulties in intensive care units. Spinal immobilisation is associated with pressure sores and pulmonary complications and is not recommended for more than 48 hours. Audits in the UK suggest poor implementation of spinal clearance policies.

Diagnosis and Management of Compartment Syndrome of the Limbs

• July 2014
• Acute compartment syndrome of a limb is due to raised pressure within a closed fascial compartment causing local tissue ischaemia and hypoxia. In clinical practice, it is most often seen after tibial and forearm fractures, high-energy wrist fractures and crush injuries. Other important causes include restrictive dressings or casts, prolonged immobilization and reperfusion of ischaemic limbs. Early diagnosis and treatment is vital to avoid severe disability. Pulses are normally present in compartment syndrome. Absent pulses are usually due to systemic hypotension, arterial occlusion or vascular injury.

Fracture Liaison Services

• April 2014
• Fracture Liaison Services (FLS) provide secondary prevention for fragility fractures (defined as a fracture following a fall from standing height or less). These services systematically and proactively identify patients in secondary and/or primary care who have suffered a fragility fracture and assess the patient’s risk of future fragility fracture in a timely fashion. FLS then provide advice and/or therapy to reduce that risk. There is now good evidence that these services are cost-effective and can result in a reduction in the incidence of fragility fractures in the local population.

The Management of Traumatic Spinal Cord Injury

• January 2014
• Spinal cord injury resulting in neurological deficit is a rare but potentially devastating injury. Compromise to the spinal cord may be due to trauma, vascular injury or other disease process and can result in immediate or insidious onset of neurological symptoms including loss or reduction of voluntary motor function, sensory impairment, bowel or bladder dysfunction and loss of autonomic function. The incidence in the United Kingdom is estimated at 12-16 per million population with about 75% of cases due to trauma. Appropriate management from the time of diagnosis of cord injury has been shown to have significant effect on the long-term outcome for patients and reduce short and long-term complications.

Fracture Clinic Services

• August 2013
• These guidelines are for the standard of care patients should expect following significant, acute soft tissue or bone injury that requires specialist treatment from a Trauma and Orthopaedic Surgeon in the outpatient setting (fracture clinic). They provide standards that can be audited to evaluate the quality of an outpatient fracture service. They cannot be comprehensive as local facilities and geography will require variation in the configuration of these services. However, the British Orthopaedic Association believes that these are the care standards that all patients in the United Kingdom can expect.