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1. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Flavia K Borges, Mohit Bhandari, Ernesto Guerra-Farfan, Ameen Patel, Alben Sigamani, Masood Umer, Maria E Tiboni, Maria del Mar Villar-Casares, Vikas Tandon, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Victoria RA Avram, Mitchell Winemaker, Mmampapatla T Ramokgopa, Wojciech Szczeklik, Giovanni Landoni, Chew Yin Wang, Dilshad Begum, John D Neary, Anthony Adili, Parag K Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Paweł Ślęczka, Richard J Jenkinson, Aamer Nabi Nur, Gavin CA Wood, Robert J Feibel, Stephen J McMahon, Alen Sigamani, Ekaterine Popova, Bruce M Biccard, Iain K Moppett, Patrice Forget, Paul Landais, Michael H McGillion, Jessica Vincent, Kumar Balasubramanian, Valerie Harvey, Yaiza Garcia-Sanchez, Shirley M Pettit, Leslie P Gauthier, Gordon H Guyatt, David Conen, Amit X Garg, Shrikant I Bangdiwala, Emilie P Belley-Cote, Maura Marcucci, Andre Lamy, Richard Whitlock, Yannick Le Manach, Dean A Fergusson, Salim Yusuf, PJ Devereaux, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean Cyr Yombi, Nassim Touil, Maike Reul, Jigme Tshering Bhutia, Carol Clinckaert, Dirk De Clippeleir, Justin de Beer, Diane L Simpson, Andrew Worster, Kim A Alvarado, Krysten K Gregus, Kelly H Lawrence, Darryl P Leong, Philip G Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J Wood, Daniel M Tushinski, David AJ Wilson, Clive Kearon, David D Cowan, Vickas Khanna, Amna Zaki, Janet C Farrell, Anne Marie MacDonald, Steven CW Wong, Arsha Karbassi, Douglas Steven Wright, Harsha Shanthanna, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D Macleod, David W Sanders, Edward Vasarhelyi, Debra Bartley, George K Dresser, Christina Tieszer, Steven Shadowitz, Jacques S Lee, Stephen Choi, Hans J Kreder, Markku Nousiainen, Monica R Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David JG Stephen, Diane Nam, Patrick DG Henry, Stephen M Mann, Melanie T Jaeger, Marco LA Sivilotti, Christopher A Smith, Christopher C Frank, Heather Grant, Leone Ploeg, Jeff D Yach, Mark M Harrison, Aaron R Campbell, Ryan T Bicknell, Davide D Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J Hadden, Brian P-J Chen, Stephanie A Coupal, Lisa M McLean, Hemant R Shirali, Syed Y Haider, Crystal A Smith, Evan Watts, David J Santone, Kevin Koo, Allan J Yee, Ademilola N Oyenubi, Aaron Nauth, Emil H Schemitsch, Timothy R Daniels, Sarah E Ward, Jeremy A Hall, Henry Ahn, Daniel B Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P Coles, Kelly Trask, Shelley MacDonald, J Andrew I Trenholm, William Oxner, C Glen Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J White, Loretta Olivieri, Stephen B Hunt, Thomas R Turgeon, Eric R Bohm, Sarah Tran, Stephen M Giilck, Tom Hupel, Pierre Guy, Peter J O'Brien, Andrew W Duncan, Gordon A Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan Manuel Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Sebastien Beroud, Jean Marie Fayet, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag Kantilal Sancheti, Chetan Vijay Pradhan, Atul Ashok Patil, Chetan Prabhakar Puram, Madhav Pandurang Borate, Kiran Bhalchandra Kudrimoti, Bharati Anil Adhye, Himanshu Vijaykumar Dongre, Bobby John, Valsamma Abraham, Ritesh Arvind Pandey, Arti Rajkumar, Preetha Elizabeth George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, AM Georgekutty, Ahamad Shaheel Sulthan, S Adinarayanan, Deep Sharma, Satish Prasad Barnawal, Srinivasan Swaminathan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Jagdish Menon, Niranjan M, Varghese Zachariah K, Santosh Angad Hiremath, Madhusudhan NC, Abhijit Jawali, Kingsly Robert Gnanadurai, Carolin Elizabeth George, Tatarao Maddipati, Mary KP KP, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem Haridas Menon, Mandeep S Dhillon, Devendra K Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth Nabhirajappa Bilchod, Surya Udai Singh, Uttam Vaidya Gattu, Ravi Prabhakar Dashputra, Prashant Vitthal Rahate, Maurizio Turiel, Giuseppe De Blasio, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Eleonora Colnaghi, Vincenzo Salini, Giuseppe Denaro, Luigi Beretta, Giacomo Placella, Giuseppe Giardina, Mirko Binda, Anna Marcato, Luca Guzzetti, Fabio Piccirillo, Maurizio Cecconi, HM Khor, Hou Yee Lai, CS Kumar, KH Chee, PS Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL Ngim, Huck Wee Boon, Im Im Chin, Ydo V Kleinlugtenbelt, Ellie BM Landman, Elvira R Flikweert, Herbert W Roerdink, Roy B.G. Brokelman, Hannie F Elskamp-Meijerman, Maarten R Horst, Jan-Hein MG Cobben, Anila Anjum, Pervaiz Mehmood Hashmi, Tashfeen Ahmed, Haroon Ur Rashid, Mujahid Jamil Khattak, Rizwan Haroon Rashid, Riaz Hussain Lakdawala, Shahryar Noordin, Naveed Muhammed Juman, Robyna Irshad Khan, Muhammad Mehmood Riaz, Syedah Saira Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad Naqi Khan, Eraj Khurshid Khan, Kholood Abid Janjua, Sajjad Hassan Orakzai, Abdus Salam Khan, Khawaja Junaid Mustafa, Mian Amjad Sohail, Muhammad Umar, Siddra Ahmed Khan, Muhammad Ashraf, Muhammad Kashif Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla Thomas Ramokgopa, Gregory Bodley Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad Nasir Iqbal, Ryan Jonathan Campbell, Matimba Lenny Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B Nejthardt, Sean Chetty, Rubendren Naidoo, Miriam Garrido Clua, Vicente Molero-Garcia, Joan Minguell-Monyart, Jordi Selga Marsa, Juan A Porcel-Vazquez, Jose-Vicente Andres-Peiro, Marc Aguilar, Jaume Mestre-Torres, Maria J Colomina, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pedro Martinez-Ripol, MA Gonzalez Posada, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Pere Torner, Monsant Jornet-Gibert, Jorge Serrano-Sanz, Jaume Cámara-Cabrera, Mònica Salomó-Domènech, Christian Yela-Verdú, Anna Peig-Font, Laura Ricol, Anna Carreras-Castañer, Luis Martínez-Sañudo, Susana Herranz, Carlos Feijoo-Massó, Mònica Sianes-Gallén, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javiera Abarca, Cristina Estrada, Marga Novellas, Mercè Torra, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, JL Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J Aguado, Gonzalo Martinez-Municio, Ricardo León, Silvia Santiago-Maniega, Ana Zabalza, Gregorio Labrador, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Jose Manuel Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam Adel Kadry, Surendini Thayaparan, Ihab Abdlaziz, Arash Aframian, Arjuna Imbuldeniya, Souad Bentoumi, Sherif Omran, Marcela Paola Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE Mayor, Sally Dillingham, Laura Nicholson, Mohamed Elnaggar, Joby John, Shashi Kumar Nanjayan, Martyn J Parker, Susan O'Sullivan, Meir T Marmor, Amir Matityahu, Robert Trigg McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Gerard Slobogean, Katherine Joseph, Robert O'Toole, Marcus Sciadini, Scott P Ryan, Molly E Clark, Charles Cassidy, Konstantin Balonov, Sergio D Bergese, Laura S Phieffer, Alicia A Gonzalez Zacarias, Andrew J Marcantonio, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R Wells, Sandra N Ofori, Stephen S Yang, Michael K Wang, Emmanuelle Duceppe, Jessica Spence, Javiera P Vasquez, Francesc Marcano-Fernández, Hyungjoo Ham, Carlos Prada, Terence CH Yung, Isidro Sanz Pérez, Michael J Bosch, Michael R Prystajecky, Chinmoy Chowdhury, James S Khan, Steffan F Stella, Behrouz Heidary, Allen Tran, Katarzyna Wawrzycka-Adamczyk, Yu Chiao Peter Chen, Aránzazu González-Osuna, Grzegorz Biedroń, Anna Wludarczyk, Marco Lefebvre, Jaclyn A Ernst, Bas Staffhorst, Jason D Woodfine, Emad M Alwafi, Marko Mrkobrada, Simon Parlow, Robin Roberts, Finlay McAlister, David Sackett, James Wright, (HIP ATTACK, Investigators), Landoni, G., Faculty of Medicine and Pharmacy, Orthopaedics - Traumatology, Supporting clinical sciences, Emergency Medicine, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Postoperative Complications/epidemiology, Male, Internationality, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip, Myocardial Ischemia, Comorbidity, Time-to-Treatment/statistics & numerical data, 030204 cardiovascular system & hematology, law.invention, Fracture Fixation, Internal, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Residence Characteristics, law, Activities of Daily Living, Fracture fixation, Risk of mortality, Medicine and Health Sciences, Fracture Fixation, Internal/methods, Sepsis/epidemiology, 030212 general & internal medicine, Cardiovascular Diseases/mortality, Stroke, Aged, 80 and over, Hip fracture, Residence Characteristics/statistics & numerical data, Infections/epidemiology, General Medicine, Middle Aged, Open Fracture Reduction, Treatment Outcome, Cardiovascular Diseases, Diabetes Mellitus/epidemiology, Female, medicine.medical_specialty, Hip Fractures/epidemiology, Postoperative Hemorrhage, Infections, Early Medical Intervention/methods, Time-to-Treatment, 03 medical and health sciences, Arthroplasty, Replacement, Hip/methods, Early Medical Intervention, Sepsis, Diabetes Mellitus, medicine, Humans, Mortality, Myocardial Ischemia/epidemiology, Aged, Proportional Hazards Models, Postoperative Hemorrhage/epidemiology, Hip Fractures, Proportional hazards model, business.industry, Hemiarthroplasty/methods, Dementia/epidemiology, Delirium, Delirium/epidemiology, medicine.disease, Femoral Neck Fractures, Nursing Homes, Surgery, Open Fracture Reduction/methods, Dementia, Observational study, Hemiarthroplasty, business
Abstract

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Published
2020

2. 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

3. Fracture and Nonaccidental Injury: A Case Report of a Lateral Condylar Fracture in a 13 Month Old

Author

Rodrick Lim, Helen Levin, Gurinder Sangha, and Timothy Carey

Subjects
Child abuse, Pediatrics, medicine.medical_specialty, Fractures, Multiple, Radiography, Primary care, Condyle, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Battered Child Syndrome, medicine, Risk of mortality, Humans, 030212 general & internal medicine, Child Abuse, business.industry, Infant, General Medicine, Emergency department, Surgery, Pediatrics, Perinatology and Child Health, Emergency Medicine, Female, business, Emergency Service, Hospital
Abstract

Pediatric nonaccidental injury (NAI) is an important entity that is commonly seen in a variety of medical settings. These children often present to the emergency department or primary care physicians as the first point of contact after an NAI. There is a major risk associated with nonrecognition of an NAI, including a 35% chance of subsequent injury and a 5% to 10% risk of mortality. Therefore, it is essential for physicians to be vigilant when assessing injuries compatible with NAI, especially in infants and young children who are not able to independently express themselves. As fracture is the second most common manifestation of NAI, practitioners should be vigilant to recognize unusual fractures in atypical age ranges to aid in its diagnosis. Here, we present a novel case of a lateral condylar fracture in an almost 13-month-old-child that has not been previously associated with NAI.

Published
2016

4. Prevalence of Radiographic Findings Consistent With Femoroacetabular Impingement in Military Personnel With Femoral Neck Stress Fractures

Author

John Bojescul, Timothy Carey, Timothy Biega, David L. Oliver, and Christian Key

Subjects
Male, medicine.medical_specialty, Fractures, Stress, Radiography, Risk Factors, Femoracetabular Impingement, medicine, Humans, Femoroacetabular impingement, Retrospective Studies, Femoral neck, Stress fractures, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Magnetic resonance imaging, Retrospective cohort study, General Medicine, medicine.disease, Femoral Neck Fractures, Surgery, Military Personnel, medicine.anatomical_structure, Cohort, Female, Stress, Mechanical, business
Abstract

A femoral neck stress fracture is a serious condition that affects military personnel and endurance athletes. There is increasing evidence that femoroacetabular impingement contributes to significant hip pathology. This study investigates the prevalence of radiographic abnormalities associated with impingement in military personnel treated for femoral neck stress fractures. The radiographs of 69 consecutive soldiers being treated for a femoral neck stress fracture identified on magnetic resonance imaging were reviewed for radiographic signs of femoroacetabular impingement. In the cohort, the average incidence of a crossover sign was 51% (27/53). The incidence of a center edge angle greater than 40° was 47% (25/53). The alpha angle was greater than 50° in 55% (29/53). In conclusion, it appears that young patients with femoral neck stress fractures have a high prevalence of radiographic abnormalities suggestive of hip impingement. Hip impingement may lead to abnormal stress across the femoral neck, predisposing individuals to stress fractures.

Published
2013

5. Does Participation in a Randomized Clinical Trial Change Outcomes? An Evaluation of Patients Not Enrolled in the SPRINT Trial

Author

Pamela Leece, Diane Heels-Ansdell, Marc F. Swiontkowski, Rudolf W. Poolman, Kevin R. Gurr, Sheila Sprague, Michael J. Bosse, Mohit Bhandari, Tashay Mignott, Bruce D. Browner, Paul Tornetta, K. Kellie Leitch, Stuart Bailey, Carol Lin, Lisa Buckingham, Peter J O'Brien, Alan L. Jones, David W. Sanders, Mark D Macleod, Natalie Sidorkewicz, Jesse A. Berlin, Claire Bombardier, Charlene Bartha, Gordon H. Guyatt, Ken Konito, Helena Viveiros, Julie Agel, Timothy Carey, Brenda Gillespie, David Sanders, Emil H. Schemitsch, Natalie Ansell, Stephen D. Walter, Amsterdam Movement Sciences, Surgery, Other Research, Emergency Department, Orthopedic Surgery and Sports Medicine, and Other departments

Subjects
Male, medicine.medical_specialty, Canada, Nonunion, law.invention, Intramedullary rod, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Fracture fixation, Medicine and Health Sciences, Prevalence, Medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, reamed, Netherlands, Randomized Controlled Trials as Topic, business.industry, Patient Selection, General Medicine, Odds ratio, tibia fracture, Middle Aged, medicine.disease, unreamed, Confidence interval, United States, Surgery, Fracture Fixation, Intramedullary, Clinical trial, Tibial Fractures, Treatment Outcome, Sprint, nonunion, 030220 oncology & carcinogenesis, Female, Patient Participation, business, human activities
Abstract

© Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved. Objectives: To determine the extent to which knowledge from clinical trial protocols is transferred to nonparticipating patients. Design: Retrospective review of prospectively collected data from a large clinical trial. Setting: Six level-1 international trauma centers. Methods: We compared rates and timing of reoperation in a subset of patients enrolled in the Study to Prospectively evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) to concurrent patients who were eligible but not enrolled. This was a retrospective review of prospectively collected trial data. The records of 6 of the original SPRINT centers were searched for non-SPRINT patients who underwent intramedullary nailing of a closed tibial fracture. The rate and timing of reoperation were compared. A P < 0.05 was considered significant. Results: One hundred fourteen non-SPRINT patients were compared with 328 patients enrolled in SPRINT from those same sites. There were 7 reoperations (6.1%) in non-SPRINT patients versus 18 (5.2%) in SPRINT patients [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.41 to 3.13; P 0.811]. There was no difference in the time to reoperation between the SPRINT and non-SPRINT patients (6.2 vs. 6.8 months, 95% CI of the difference -3.8 to 2.6; P 0.685) or in the proportion of patients who underwent reoperation before 6 months (29% vs. 43%; OR 1.75; 95% CI 0.18 to 15.41; P 0.647). Conclusions: Patients not enrolled in SPRINT had similarly low rates of reoperation for nonunion, and the average time to reoperation for both groups was longer than 6 months. A 6-month waiting period may have allowed slow-to-heal fractures adequate time to heal, thereby reducing the rate of diagnosis of nonunion. As such, this waiting period could contribute to lower-than-expected reoperation rates for nonunion. It is possible that clinical trials may beneficially influence the care of nonenrolled patients.

Published
2016

6. Anterior cruciate ligament augmentation for rotational instability following primary reconstruction with an accelerated physical therapy protocol

Author

Timothy Carey, John Bojescul, David L. Oliver, Terry L. Mueller, and Josh E Pniewski

Subjects
Adult, Joint Instability, Male, Reoperation, medicine.medical_specialty, Anterior cruciate ligament reconstruction, Rotation, medicine.medical_treatment, Anterior cruciate ligament, Arthroscopy, Young Adult, medicine, Humans, Rating system, Anterior Cruciate Ligament, Physical Therapy Modalities, medicine.diagnostic_test, Anterior Cruciate Ligament Reconstruction, business.industry, Joint instability, General Medicine, Lower Extremity Functional Scale, musculoskeletal system, Combined Modality Therapy, Surgery, Accelerated rehabilitation, surgical procedures, operative, medicine.anatomical_structure, Treatment Outcome, Physical therapy, Female, Augment, business
Abstract

The purpose of the present study is to present the results of anterior cruciate ligament (ACL) augmentation for patients having rotational instability despite an intact vertical graft in lieu of conventional revision ACL reconstruction. ACL augmentation surgery with a horizontal graft was performed to augment a healed vertical graft on five patients and an accelerated rehabilitation protocol was instituted. Functional outcomes were assessed by the Lower Extremity Functional Scale (LEFS) and the Modified Cincinnati Rating System (MCRS). All patients completed physical therapy within 5 months and were able to return to full military duty without limitation. LEFS and MCRS were significantly improved. ACL augmentation with a horizontal graft provides an excellent alternative to ACL revision reconstruction for patients with an intact vertical graft, allowing an earlier return to duty for military service members.

Published
2013

7. Changes in dendritic cell phenotype after a new high-dose weekly schedule of interleukin-2 therapy for kidney cancer and melanoma

Author

Mary Dunn, Dawn Goetz, Adil Daud, Mayer Fishman, Scott J. Antonia, Ingo Fricke, Timothy Carey, P. Urbas, Ronald C. DeConti, Daohai Yu, Steven E. Finkelstein, Dmitry I. Gabrilovich, and Megan Gratz

Subjects
Interleukin 2, Oncology, Adult, Male, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Immunology, Biomarkers, Pharmacological, Immunophenotyping, Internal medicine, medicine, Immunology and Allergy, Humans, Myeloid Cells, Neoplasm Metastasis, Antigen-presenting cell, Melanoma, Aged, Pharmacology, business.industry, Cancer, Antineoplastic Protocols, Cell Differentiation, Immunotherapy, Dendritic Cells, Middle Aged, medicine.disease, Prognosis, Kidney Neoplasms, Cytokine, Treatment Outcome, Feasibility Studies, Interleukin-2, Female, business, Kidney cancer, medicine.drug, Kidney disease
Abstract

High-dose intravenous interleukin-2 (IL-2) therapy (14 doses/course, 2 courses/cycle) for metastatic melanoma or kidney cancer induces infrequent, although major responses. In this trial, we evaluated a new schedule (dose of 600,000 IU/kg, 8 h between doses, 5 doses/course, 4 courses at weekly intervals/cycle) of high-dose IL-2, in which we inserted more planned breaks while maintaining high cumulative dose delivery, and investigated the relationship between dendritic cells (DC) and response to treatment. Target dose delivery was attained: median IL-2 cumulative dose per patient was 11.4 and 10.8 million units/kg (cycles 1 and 2, respectively). Major responses were observed in patients with kidney cancer (n=20; 3 complete and 2 partial responses) and melanoma (n=16; 1 partial response). Adverse events appeared comparable with those typically associated with high-dose IL-2. From this data set, we introduce the hypothesis-generating observation that patients who had more favorable outcomes had high pretreatment DC-to-myeloid-derived suppressor cell (MDSC) ratios, similar to the ratio observed in healthy individuals. However, even in patients with the most favorable outcome, after treatment, there were IL-2-induced changes in the DC-to-MDSC ratio, specifically increases in MDSCs. This modified IL-2 schedule is a feasible option, with a more uniform dose delivery over the treatment cycle, a similar toxicity profile, and observed complete, durable response in patients with renal cancer. Pretreatment assessment of DC phenotypic or maturational status may be a starting point to predicting response to high-dose IL-2 cytokine immunotherapy in patients with melanoma and kidney cancer.

Published
2010

8. Predicting gender differences as latent variables: summed scores, and individual item responses: a methods case study

Author

Ricardo, Pietrobon, Marcus, Taylor, Ulrich, Guller, Laurence D, Higgins, Danny O, Jacobs, and Timothy, Carey

Subjects
Male, Models, Statistical, Outcome Assessment, Psychometrics, Statistical Models, Research, Gender, lcsh:Computer applications to medicine. Medical informatics, Disability Evaluation, Sex Factors, Low-back pain, Back Pain, Research Design, Data Interpretation, Statistical, Sickness Impact Profile, Surveys and Questionnaires, Outcome Assessment, Health Care, Confidence Intervals, North Carolina, Humans, Regression Analysis, lcsh:R858-859.7, Female, Forecasting, Probability
Abstract

Background Modeling latent variables such as physical disability is challenging since its measurement is performed through proxies. This poses significant methodological challenges. The objective of this article is to present three different methods to predict latent variables based on classical summed scores, individual item responses, and latent variable models. Methods This is a review of the literature and data analysis using "layers of information". Data was collected from the North Carolina Back Pain Project, using a modified version of the Roland Questionnaire. Results The three models are compared in relation to their goals and underlying concepts, previous clinical applications, data requirements, statistical theory, and practical applications. Initial linear regression models demonstrated a difference in disability between genders of 1.32 points (95% CI 0.65, 2.00) on a scale from 0–23. Subsequent item analysis found contradictory results across items, with no clear pattern. Finally, IRT models demonstrated three items were demonstrated to present differential item functioning. After these items were removed, the difference between genders was reduced to 0.78 points (95% CI, -0.99, 1.23). These results were shown to be robust with re-sampling methods. Conclusions Purported differences in the levels of a latent variable should be tested using different models to verify whether these differences are real or simply distorted by model assumptions.

Published
2004

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