Availability and quality assessment of Clinical Practice Guidelines on orthoplastic surgery treatment of open fractures of the lower limb using AGREE II tool: A systematic review

Introduction: Orthoplastic surgery, which combines orthopedic and plastic surgery principles, plays a crucial role in the treatment of open fractures of the lower limb. Clinical Practice Guidelines (CPGs) are valuable tools for standardizing and improving patient care. Objective: To assess the availability and quality of international CPGs for orthoplastic treatment of open fractures of the lower limb. A secondary objective was to provide a detailed analysis of the specific recommendations by comparing them among different CPGs. Methods: A systematic review was conducted in 2023 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines across major medical databases and gray literature. Inclusion criteria focused on guidelines specific to orthoplastic surgery for lower limb open fractures. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, a widely accepted instrument for guideline assessment, was utilized to evaluate the methodological rigor and transparency of the selected guidelines. Results: Three orthoplasty CPGs have been identified, 2 of which were judged reliable according to the AGREE II methodology. Orthoplastic recommendations are no more than 7 per CPG. Consistent agreement was observed on the timing of debridement, the importance of early fixation, and definitive coverage. Conclusion: CPGs are critical to set up clinical pathways that are safe and evidence-based. Only 3 international CPGs address orthoplastic treatment of open lower limb fractures, 2 of which are judged reliable according to methodology. Therefore, it becomes essential to develop and disseminate high-quality, evidence-based guidelines, which are critical to improving patient outcomes and standardizing clinical practice worldwide.