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1. Wound Surface Area as a Risk Factor for Flap Complications among Patients with Open Fractures

Author

Bernhard Flatøy, Dominique M. Rouleau, Ripley Worman, Eric Ritchie, Brian Drew, Hilde Apold, J. Adam Smitherman, Kyle J. Jeray, P Beaumont, Kim Madden, Arjun Patil, Karine Tardif, Brad Pilkey, Cathrine Aga, Alexandre Denault, Fathima Adamsahib, Joseph O'Neill, James R. Ringler, Claude T. Moorman, Brian Mullis, Håvard Furunes, Jason Stoneback, Paul A. Martineau, S. Brennan McClure, Karyn Moon, Greg Etherington, Rejean Dumais, Ivan S. Tarkin, Stephanie L. Tanner, Terry Axelrod, Joy M. Bradford-Johnson, Chantal Théorêt, Ellen Langslet, Ali Al-Ashtari, Valda Frizzell, Ria De Gorter, Michel Malo, M.M. (Molly M.) Moore, Andrew R. Evans, Ramnov Andreson, Lauren C. Leffler, Nigar Sultana, Michelle Arakgi, Richard Freeman, Scott E Porter, John Murnaghan, Lisa K. Cannada, Joseph Alderete, Desmond Kwok, Michael D. McKee, Deepali Nassikars, Michael J. Bosse, Richard Jenkinson, Kevin Kuhn, Michael H. Weber, David R. Goetz, Robert Marien, Eric Lenczner, Katrine Milner, Gregory J. Della Rocca, Ajay Gupta, Farhad Moola, Torben Ianssen, Saam Morshed, Meir Marmor, Stephen P. Kingwell, Chetan Metha, Michael Connally, J. David Amirault, François Vézina, Oliver Muller, Joseph R. Hsu, Catherine Coady, Grant E. Garrigues, Diane Nam, Lori Kramer Clark, Taylor Vlack, J. Scott Broderick, Bang Hoang, Rebecca G. Snider, Anne Christine Brekke, Richard T. Laughlin, Ida Sletten, Lisa Buckingham, Jason Vourazeris, Gordon H. Guyatt, Darius Viskontas, Asgeir Amundsen, Travis C. Burns, Elton R Edwards, Edward J. Harvey, David Stephen, Eugene Wai, Michael R. Jabara, Andrea Garza, Austin D. Hill, Kevin R. Gurr, Stephen D. Walter, David J. Bielema, Karl D Shively, John Sadler, Mark D Macleod, Geir Aasmund Hjorthaug, Anthony Beardmore, Markku T Nousiainen, Vivek V. Jabade, Rani Rai, Kelly Trask, Julia Lee, Rena L. Stewart, Paula McKay, Emil H. Schemitsch, Sheila Sprague, Allen Diane, Sebastian Rodriguez-Elizalde, Ryan T. Bicknell, Nicolas Patenaude, Kevin L. Kirk, Paul Tornetta, Joshua A. Baumfeld, Christopher S. Bailey, Douglas G. Altman, Monica Kunz, Robert E. Turcotte, Kristen Walick, David P. Zamorano, Vinod Arora, Bernard Laliberté, Max Talbot, Jerald R. Westberg, Tore Fjalestad, Benjamin B. Barden, Chetan Prabhakar Puram, Andrew Gong, Shalini Ramasunder, Petter Iversen, R. Lee Murphy, Jean François Joncas, Timothy J. Miller, Raymond A. Pensy, Michael J. Maughon, Lori Wood, Robert G. McCormack, Dmitry Tuder, Veronica M R Wadey, Timothy Carey, Kristoff Reid, Patrick Henry, Anthony S. Rhorer, Marc André Magalhaes-Grave, Vinit Yadav, Michael J. Prayson, John Clarke-Jenssen, Vera Halvorsen, Kerry Tai, Narayan J. Karne, Stéphane Leduc, Kathryn Hornbuckle, Melissa M. Earles, Joel S. Finkelstein, Robin R. Richards, Joseph Cox, Tor Nicolaysen, Lisa Blackrick, Arthur Kreitenberg, Aaron T. Creek, Debra L. Sietsema, Peder Bogsti, Mark Glazebrook, Donna Lopez, Martin Bédard, Michael L. Beckish, Jonathan Kwong, Peter A. Siska, John A. Tanksley, Brett D. Crist, François Cabana, Mary Fan, Annie Deshaies, Debra Bartley, Nurit Shadmi, Wesley G. Lackey, Henry Ahn, Rachel M. Reilly, Linda K. Anderson, Dustin M. Price, Frede Frihagen, Brian E. Brigman, David Nelles, Mickey S Cho, Jeff Anglen, Kevin K. Kruse, Melanie MacNevin, Jonathan L. Foret, Jan Egil Brattgjerd, John F. Tilzey, Garland K. Gudger, Steve Rocha, G. Yves Laflamme, Kelly L. Apostle, Utku Kandemir, Aaron Nauth, Ivan Wong, Brian J. Miller, Rudy Reindl, Krishan Rajaratnam, Marie Eve Roger, William D. Fisher, Ash Moaveni, Patrick Yoon, David Sanders, Julia Foxall, Otis Wang, Shea A. Bielby, Maria Manson, Yvonne M. Murtha, Nikoletta Leontaritis, Russell Miller, Terrence J. Endres, Andrew H. Schmidt, Laurie Barron, David Alexander, Dennis W. Mann, H. Michael Lemke, Benjamin S. Koch, Gilbert Ortega, Nikia Hawkins Malone, Rina L. Harman, A. Navaladi Shankar, Parag Sancheti, Mauri Zomar, Dave Brown, Matthan Mammen, Dana J. Farrell, Piotr A Blachut, John D. Adams, Zoe Murdoch, Tom Treseder, Scott T. Watson, Fredrik Nilsen, Matthew Denkers, Wade Gofton, Jennifer Downey, Raymond Topp, Garth Johnson, Sissel Knuts, Raman Johal, Prerana N. Patel, Harvinder Bedi, Milena R. Vicente, Michael Tanzer, Markus Bischoff, Anders Lippert, Pascale Lévesque-Bernier, Hélène Côté, Brian Jolley, Gilbert Moatshe, Christina Tieszer, Richard C. Mather, Roman Trimba, Mohit Bhandari, Henry M Broekhuyse, Janos P. Ertl, Patrick M. Osborn, Michael Biddulph, Neeraj Jain, Grant W. Bennett, Gerard P. Slobogean, Samuel B. Adams, Kelly M. Sullivan, Atul Patil, Warren Kactmas, Mahesh Bhatia, Murat Pekmezci, Siraj Sayeed, David S. Ruch, Lawrence K. O'Malley, Jonas Rydinge, Michael Charlton, Michael S. Kain, Vivek Tyagi, Kathleen Markley, Rajiv Gandhi, Pierre Ranger, Mathias Russ, Dale Williams, Peter Jarzem, Lauren A. Nastoff, Craig Donohue, Gunnar B. Flugsrud, Bernard LaRue, Shelley MacDonald, Trevor Stone, Amy Svotelis, Stéphane Pelet, Mark J. Lemos, Michael Gross, Dean C. Taylor, Matthew Ross, Luc Petitclerc, Robert K. Lark, Jane E. Walker, Pierre Lavallée, Wesley Ghent, Fraser J. Leversedge, C. Glen Richardson, Deanna Lawson, Martin Tynan, Eric Meinberg, Stephen Doig, Jason A. Lowe, Veronica Place, Tim Dwyer, Jeffrey T. Leary, J Andrew I Trenholm, Andrew Chia, William M. Oxner, Richard Holtby, Thomas F. Varecka, Justin W. Langan, Ted Tufescu, Melanese Leonard, Lu Ton, Jeremy A. Hall, S. Samuel Bederman, Steve Csongvay, Bertrand Perey, Adam Dowrick, Stephen H. Finley, Steven A. Olson, Katherine M. Bedigrew, James P. Stannard, Phelan Shea, Leslie Dillender, Dory Boyer, Damian Rispoli, Ashley Carr, Steven Papp, Trigg McClellan, Clifford B. Jones, Erik Nott, Nitin N. Bhatia, Deeba Pourmand, Kelly A Lefaivre, Michael J. Dunbar, Peter J O'Brien, Luc Bédard, Chad P. Coles, Doug Li, Drew Bednar, Albert Yee, Bill Ristevski, Tod Gerlinger, Benoit Benoit, Aaron R. Campbell, Mette Renate Andersen, James P. Waddell, Jean Lamontagne, David A. Volgas, Diane Heels-Ansdell, Andrew J. Marcantonio, Alison P. Toth, David R. Pichora, Min Zhan, Harsha Malempati, Lars Nordsletten, Richard W. Gurich, Kiran M. Doshi, Robert J. Teasdall, Earl R. Bogoch, Matthew D. Karam, David M. Conner, Hans J. Kreder, Guri Ranum Ekås, Dylan J. Watson, Linda Lépine, Tanya Nix, Chris Graham, Tigist Belaye, Are Haukåen Stødle, Aravin Duraikannan, John Magne Hoseth, Nathan N O'Hara, Erick G. Torres, Elise Berg Vesterhus, Anthony E. Johnson, William Min, Michael Ford, Leslie Barnes, Jessica Goldstein, Anil Rai, Samuel G. Agnew, Thomas M. Schaller, Hamish Curry, S. Matthew Hollenbeck, Lorra M. Sharp, Fiona Howells, Abdel Lawendy, Donald Gajewski, Richard Coughlin, Max Esser, Chard Harbour, Stéphane Ricard, Gerald Reardon, Luc Lemire, Julie Fournier, Raely Moon, Brad Petrisor, James R. Ficke, Greg Berry, David Johnston, Allan Hammond, Jennifer T. Hidy, K. Rai, Daniel B. Whelan, Marius Molund, John S. Garfi, Greg Maytok, R. Saravana, Eugene Ek, Matthew Robinson, Emily Keener, Mark Burman, Frédéric Balg, Jeffrey O. Anglen, Fiona Houghton, Stacee W. Clawson, Morten Smedsrud, Claire Sage, Ross Leighton, Timothy R. Daniels, Lyle T. Jackson, Susan Liew, Neelam Jhangiani, Anoop Dubey, Richard M. Wilk, Robert D. Zura, Julian Sernik, Kim Hemlock, and Michael P. Bolognesi

Subjects
Adult, Male, medicine.medical_specialty, Soft Tissue Injuries, Limb salvage, Treatment outcome, Aftercare, Wound surface, Surgical Flaps, Fractures, Open, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Medicine and Health Sciences, medicine, Humans, 030212 general & internal medicine, Risk factor, Aged, integumentary system, business.industry, Open surgery, Trauma center, Middle Aged, Limb Salvage, Surgery, Logistic Models, Treatment Outcome, 030220 oncology & carcinogenesis, Shock (circulatory), Female, medicine.symptom, business
Abstract

Copyright © 2018 by the American Society of Plastic Surgeons. Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

Published
2018
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2. Getting What You Need From the Hospital to Succeed as a Traumatologist

Author

Clifford B. Jones and Samuel G. Agnew

Subjects
Employment, medicine.medical_specialty, Career Choice, business.industry, Mentors, General Medicine, medicine.disease, United States, Orthopedics, Hospital Administration, Job Description, Traumatology, Emergency medicine, medicine, Orthopedics and Sports Medicine, Surgery, Medical emergency, Orthopaedic trauma, business
Abstract

Currently, the market for orthopaedic trauma surgeons is varied. The market consists of university employed, university private, medical group employed, medical group private, private employed, private contracted, and private. Each option has its positives and negatives. The orthopaedic trauma surgeon needs to determine which setting is appropriate for his/her given needs and wants. An experienced mentor(s) is invaluable for advice and guidance. The surgeon then needs to find an administrative leader to initiate, implement, and evaluate certain processes to succeed.

Published
2013
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3. Orthopaedic Trauma Career and Employment Horizons

Author

Samuel G. Agnew and Bryan J. Warren

Subjects
Employment, medicine.medical_specialty, media_common.quotation_subject, Hospitals, Community, Traumatology, Business model, Destinations, Organizational Objectives, Medicine, Orthopedics and Sports Medicine, Orthopaedic trauma, media_common, Medical education, Career Choice, business.industry, General Medicine, Career Mobility, Identification (information), Orthopedics, Service (economics), Workforce, Orthopedic surgery, Surgery, business
Abstract

The trauma opportunities: The numbers are 260 verified sites (American College of Surgeons), 1100 Centers performing as Regional or Community Trauma Centers currently in the continental 48 states, and 3256 hospitals performing in-patient orthopaedic surgery. Orthopaedic trauma surgeons still represent10% of the total national surgeon complement. This component speaks to the demand side. Presently, there are60 Traumatology Fellows annually. This represents the supply side that has the potential to graduate in 2013 and beyond. These individuals face a wide variety of career options not previously available to past generations, but one has to know the business model differentiators to be successful: employed-employee (most common, least sustainable historically); employed-partner; partner-contract for service; partner-private practice; private practice-hospital partner (least common, most productive).

Published
2012
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5. Hospital-Based Employment of Orthopaedic Surgeons—Passing Trend or New Paradigm?

Author

Sam G. Agnew, Martin W. Roche, and Kevin J. Bozic

Subjects
Employment, medicine.medical_specialty, media_common.quotation_subject, Specialty, MEDLINE, Competition (economics), Nursing, Cultural diversity, Humans, Medicine, Orthopedics and Sports Medicine, Market share, Personnel Selection, media_common, Personnel Administration, Hospital, business.industry, General Medicine, United States, Hospital-Physician Relations, Futures studies, Negotiation, Orthopedics, Family medicine, Accountability, Surgery, business
Abstract

Hospital employment of physicians in the United States has passed through periods of intense activity and decline over the past several decades. In the early 1990s, many hospitals sought to acquire primary-care physician practices, with the goal of increasing market share by controlling referrals of patients enrolled in managed-care plans and increasing negotiating leverage with managed-care organizations. In general, these employment relationships were hastily developed, with very little foresight and planning regarding the goals and responsibilities of each party. Furthermore, the importance of physician leadership, accountability, and cultural differences between hospitals and physician practices were grossly underestimated. As a result, most of these relationships resulted in financial losses and were divested by the end of the decade1-3. Since the year 2000, there has been an increasing trend toward the acquisition and employment of specialist physicians by hospitals. According to a recent survey of members of the American Academy of Orthopaedic Surgeons (AAOS), more than three times as many orthopaedic surgeons are employed by hospitals today as compared with when they entered into practice4. Physician recruiting agencies note that hospitals are among their fastest-growing clients and now comprise the largest percentage of their physician recruiting activity. Specialist physicians, including orthopaedic surgeons, are among the most common hospital-based physician recruitments5. Multiple factors are driving this trend. Hospitals are seeking increased alignment of their interests and goals with those of specialist physicians for many reasons, including the desire to gain and/or preserve market share in a particular specialty area, such as orthopaedics; to neutralize competition from physician owners of imaging and physical therapy facilities, ambulatory surgery centers, and specialty hospitals; to stabilize their medical staff; and to meet urgent clinical needs, including emergency call and indigent care. Furthermore, alignment with specialist physicians may allow hospitals …

Published
2012
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6. The Role of the Unreamed Tibial Nail

Author

M. Brad Henley, Robin Peter, and Samuel G. Agnew

Subjects
business.industry, Preliminary report, Dentistry, Medicine, Orthopedics and Sports Medicine, Surgery, Tibial nail, General Medicine, business
Published
1993
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7. LOWER EXTREMITY FRACTURE FIXATION IN HEAD-INJURED PATIENTS

Author

Galen V. Poole, John A. Griswold, Samuel G. Agnew, and Jimmy D. Miller

Subjects
Adult, Lung Diseases, medicine.medical_specialty, Time Factors, Adolescent, Critical Care and Intensive Care Medicine, Head trauma, Fixation (surgical), Fracture Fixation, Internal, Fractures, Bone, Injury Severity Score, Risk Factors, Fracture fixation, Medicine, Craniocerebral Trauma, Humans, Femur, Glasgow Coma Scale, Tibia, Child, Aged, Retrospective Studies, business.industry, Multiple Trauma, Head injury, Infant, Middle Aged, medicine.disease, Surgery, Blunt trauma, Child, Preschool, Lower extremity fracture, business, Leg Injuries
Abstract

Compared with nonsurgical management or delayed repair, early fracture fixation can reduce the incidence of pulmonary complications in patients with long-bone fractures of the lower extremities. Blunt trauma victims often have multiple nonskeletal injuries that might influence the risk of pulmonary complications, and when head injuries are present it has been a common practice to delay nonemergent operations for several days to protect the injured brain. We conducted a retrospective review of 114 patients with multiple trauma whose injuries included head trauma and a fracture of the neck or shaft of the femur or shaft of the tibia to determine if delayed stabilization of lower extremity fractures increased the risk of pulmonary complications or reduced the risk of cerebral complications. Forty-six patients underwent surgical fixation of their fractures within 24 hours of injury (early fixation), 26 patients had their fractures repaired more than 24 hours after injury (late fixation), and 42 patients did not undergo surgical fracture fixation. The risk of pulmonary complications was not related to the timing of surgical fracture fixation but was strongly influenced by the severity of injuries to the head and to the chest (p less than 0.001). Furthermore, a delay in fracture fixation did not protect the injured brain; the risk of CNS events was determined by the severity of the head injury (p less than 0.0001). Early fracture fixation in patients with head injury may be appropriate because it simplifies patient care and does not seem to worsen the head injury, but it does not prevent pulmonary complications in these high-risk patients.

Published
1991
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8. Open Reduction and Internal Fixation of Complex Tibial Plateau Fractures

Author

V. M. Santoro, Samuel G. Agnew, Stephen K. Benirschke, M. B. Henley, and Keith A. Mayo

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, medicine, Internal fixation, Orthopedics and Sports Medicine, Surgery, General Medicine, Plateau (mathematics), business, Reduction (orthopedic surgery)
Published
1991
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