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287 results on '"Marchand, Lucas S."'

55. Reformatting of Computed Tomography Scans Parallel to the S1 End Plate Increases Visualization of Trans Sacral Pathway in the First Sacral Segment, Especially With Dysmorphism

Author

Kellam, Patrick J., primary, O'Neill, Dillon C., additional, Daryoush, Joshua R., additional, Dekeyser, Graham J., additional, Steffenson, Lillia N., additional, Gary, Joshua L., additional, Higgins, Thomas F., additional, Kellam, James F., additional, Rothberg, David L., additional, Sciadini, Marcus, additional, Warner, Stephen, additional, Working, Zachary, additional, Marchand, Lucas S., additional, and Haller, Justin M., additional

Published
2022
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56. Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients

Author

Dubina, Andrew G., primary, Morcos, George, additional, O'Hara, Nathan N., additional, Manzano, Givenchy W., additional, Vallier, Heather A., additional, Farooq, Hassan, additional, Natoli, Roman M., additional, Adams, Donald, additional, Obremskey, William T., additional, Wilkinson, Brandon G., additional, Hogue, Matthew, additional, Haller, Justin M., additional, Marchand, Lucas S., additional, Hautala, Gavin, additional, Matuszewski, Paul E., additional, Pechero, Guillermo R., additional, Gary, Joshua L., additional, Doro, Christopher J., additional, Whiting, Paul S., additional, Chen, Michael J., additional, DeBaun, Malcolm R., additional, Gardner, Michael J., additional, Reynolds, Alan W., additional, Altman, Gregory T., additional, Obey, Mitchel R., additional, Miller, Anna N., additional, Haase, Douglas, additional, Wise, Brent, additional, Wallace, Austin, additional, Hagen, Jennifer, additional, O'Donnell, Jeffrey, additional, Gage, Mark, additional, Johnson, Nicholas R., additional, Karunakar, Madhav, additional, Dynako, Joseph, additional, Morellato, John, additional, Panton, Zachary A., additional, Gitajn, I. Leah, additional, Haase, Lucas, additional, Ochenjele, George, additional, Roddy, Erika, additional, Morshed, Saam, additional, Sagona, Abigail E., additional, Caton, Tyler D., additional, Weaver, Michael J., additional, Westberg, Jerald R., additional, Miguel, Jose San, additional, and O'Toole, Robert V., additional

Published
2022
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70. Effect of Vitamin D3 Supplementation on Acute Fracture Healing: A Phase II Screening Randomized Double‐Blind Controlled Trial.

Author

Slobogean, Gerard P., Bzovsky, Sofia, O'Hara, Nathan N., Marchand, Lucas S., Hannan, Zachary D., Demyanovich, Haley K., Connelly, Daniel W., Adachi, Jonathan D., Thabane, Lehana, and Sprague, Sheila

Subjects
FRACTURE healing, DIETARY supplements, FEMORAL fractures, CHOLECALCIFEROL, VITAMIN D, TIBIAL fractures
Abstract

Nearly half of adult fracture patients are vitamin D deficient (serum 25‐hydroxyvitamin D [25(OH)D] levels <20 ng/mL). Many surgeons advocate prescribing vitamin D supplements to improve fracture healing outcomes; however, data supporting the effectiveness of vitamin D3 supplements to improve acute fracture healing are lacking. We tested the effectiveness of vitamin D3 supplementation for improving tibia and femur fracture healing. We conducted a single‐center, double‐blinded phase II screening randomized controlled trial with a 12‐month follow‐up. Patients aged 18–50 years receiving an intramedullary nail for a tibia or femoral shaft fracture were randomized 1:1:1:1 to receive (i) 150,000 IU loading dose vitamin D3 at injury and 6 weeks (n = 27); (ii) 4000 IU vitamin D3 daily (n = 24); (iii) 600 IU vitamin D3 daily (n = 24); or (iv) placebo (n = 27). Primary outcomes were clinical fracture healing (Function IndeX for Trauma [FIX‐IT]) and radiographic fracture healing (Radiographic Union Score for Tibial fractures [RUST]) at 3 months. One hundred two patients with a mean age of 29 years (standard deviation 8) were randomized. The majority were male (69%), and 56% were vitamin D3 deficient at baseline. Ninety‐nine patients completed the 3‐month follow‐up. In our prespecified comparisons, no clinically important or statistically significant differences were detected in RUST or FIX‐IT scores between groups when measured at 3 months and over 12 months. However, in a post hoc comparison, high doses of vitamin D3 were associated with improved clinical fracture healing relative to placebo at 3 months (mean difference [MD] 0.90, 80% confidence interval [CI], 0.08 to 1.79; p = 0.16) and within 12 months (MD 0.89, 80% CI, 0.05 to 1.74; p = 0.18). The study was designed to identify potential evidence to support the effectiveness of vitamin D3 supplementation in improving acute fracture healing. Vitamin D3 supplementation, particularly high doses, might modestly improve acute tibia or femoral shaft fracture healing in healthy adults, but confirmatory studies are required. The Vita‐Shock trial was awarded the Orthopaedic Trauma Association's (OTA) Bovill Award in 2020. This award is presented annually to the authors of the most outstanding OTA Annual Meeting scientific paper. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

Published
2023
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74. A pragmatic randomized trial evaluating pre-operative aqueous antiseptic skin solutions in open fractures (Aqueous-PREP): statistical analysis plan.

Author

O'Hara, Nathan N., Heels-Ansdell, Diane, Bzovsky, Sofia, Dodds, Shannon, Thabane, Lehana, Bhandari, Mohit, Guyatt, Gordon, Devereaux, P. J., Slobogean, Gerard P., Sprague, Sheila, on behalf of the PREP-IT Investigators, Harris, Anthony D., Mullins, C. Daniel, Wells, Jeffrey, Wood, Amber, Della Rocca, Gregory J., Hebden, Joan, Jeray, Kyle J., Marchand, Lucas S., and O'Hara, Lyndsay M.

Subjects
RESEARCH, BACTERICIDES, RESEARCH methodology, WATER, EVALUATION research, POVIDONE-iodine, COMPARATIVE studies, RANDOMIZED controlled trials, COMPOUND fractures, SURGICAL site infections, CHLORHEXIDINE
Abstract

Background: Approximately 1 in 10 patients with a surgically treated open fracture will develop a surgical site infection. The Aqueous-PREP trial will investigate the effect of 10% povidone-iodine versus 4% chlorhexidine in aqueous antiseptic solutions in reducing infections after open fracture surgery. The study protocol was published in April 2020.Methods and Design: The Aqueous-PREP trial is a pragmatic, multicenter, open-label, randomized multiple period cluster crossover trial. Each participating cluster is randomly assigned in a 1:1 ratio to provide 1 of the 2 study interventions on all eligible patients during a study period. The intervention periods are 2 months in length. After completing a 2-month period, the participating cluster crosses over to the alternative intervention. We plan to enroll a minimum of 1540 patients at 14 sites.Results: The primary outcome is surgical site infection guided by the Centers for Disease Control and Prevention's National Healthcare Safety Network reporting criteria (2017). All participants' surgical site infection surveillance period will end 30 days after definitive fracture management surgery for superficial infections and 90 days after definitive fracture management surgery for deep incisional or organ/space infections [1]. The secondary outcome is an unplanned fracture-related reoperation within 12 months of the fracture.Conclusion: This manuscript serves as the formal statistical analysis plan (version 1.0) for the Aqueous-PREP trial. The statistical analysis plan was completed on February 28, 2022. [ABSTRACT FROM AUTHOR]

Published
2022
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75. Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control

Author

DuBose, Joseph J., primary, Burlew, Clay Cothren, additional, Joseph, Bellal, additional, Keville, Meghan, additional, Harfouche, Melike, additional, Morrison, Jonathan, additional, Fox, Charles J., additional, Mooney, Jennifer, additional, O’Toole, Robert, additional, Slobogean, Gerard, additional, Marchand, Lucas S., additional, Demetriades, Demetrios, additional, Werner, Nicole L., additional, Benjamin, Elizabeth, additional, and Costantini, Todd, additional

Published
2021
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79. Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Author

Pechero, Guillermo, primary, Pfaff, Branden, additional, Rao, Mayank, additional, Pogorzelski, David, additional, McKay, Paula, additional, Spicer, Ella, additional, Howe, Andrea, additional, Demyanovich, Haley K., additional, Sietsema, Debra L., additional, McTague, Michael F., additional, Ramsey, Lolita, additional, Holden, Martha, additional, Rudnicki, Joshua, additional, Wells, Jeff, additional, Medeiros, Michelle, additional, Slobogean, Gerard P., additional, Sprague, Sheila, additional, Wells, Jeffrey, additional, Bhandari, Mohit, additional, O'Toole, Robert V., additional, D'Alleyrand, Jean-Claude, additional, Eglseder, Andrew, additional, Johnson, Aaron, additional, Langhammer, Christopher, additional, Lebrun, Christopher, additional, Manson, Theodore, additional, Nascone, Jason, additional, Paryavi, Ebrahim, additional, Pensy, Raymond, additional, Pollak, Andrew, additional, Sciadini, Marcus, additional, Degani, Yasmin, additional, O'Hara, Nathan N., additional, Joseph, Katherine, additional, Camara, Megan, additional, Harris, Anthony D., additional, Mullins, Daniel C., additional, Thabane, Lehana, additional, Wood, Amber, additional, Della Rocca, Gregory J., additional, Hebden, Joan, additional, Jeray, Kyle J., additional, Marchand, Lucas, additional, O'Hara, Lyndsay M., additional, Zura, Robert, additional, Gardner, Michael J., additional, Blasman, Jenna, additional, Davies, Jonah, additional, Liang, Stephen, additional, Taljaard, Monica, additional, Devereaux, P.J., additional, Guyatt, Gordon H., additional, Heels-Ansdell, Diane, additional, Marvel, Debra, additional, Palmer, Jana, additional, Friedrich, Jeff, additional, Grissom, Ms Frances, additional, Gitajn, I. Leah, additional, Morshed, Saam, additional, Petrisor, Bradley A., additional, Mossuto, Franca, additional, Joshi, Manjari G., additional, Fowler, Justin, additional, Rivera, Jessica, additional, Talbot, Max, additional, Dodds, Shannon, additional, Garibaldi, Alisha, additional, Li, Silvia, additional, Nguyen, Uyen, additional, Rojas, Alejandra, additional, Scott, Taryn, additional, Del Fabbro, Gina, additional, Szasz, Olivia Paige, additional, Demyanovich, Haley, additional, Little, Kelly, additional, Mullins, C. Daniel, additional, Kettering, Eric, additional, Hale, Diamond, additional, Petrisor, Brad A., additional, Johal, Herman, additional, Ristevski, Bill, additional, Williams, Dale, additional, Denkers, Matthew, additional, Rajaratnam, Krishan, additional, Al-Asiri, Jamal, additional, Leonard, Jordan, additional, Marcano-Fernández, Francesc A., additional, Gallant, Jodi, additional, Persico, Federico, additional, Gjorgjievski, Marko, additional, George, Annie, additional, Natoli, Roman M., additional, Gaski, Greg E., additional, McKinley, Todd O., additional, Virkus, Walter W., additional, Sorkin, Anthony T., additional, Szatkowski, Jan P., additional, Baele, Joseph R., additional, Mullis, Brian H., additional, Hill, Lauren C., additional, Hudgins, Andrea, additional, Osborn, Patrick, additional, Pierrie, Sarah, additional, Martinez, Eric, additional, Kimmel, Joseph, additional, Adams, John D., additional, Beckish, Michael L., additional, Bray, Christopher C., additional, Brown, Timothy R., additional, Cross, Andrew W., additional, Dew, Timothy, additional, Faucher, Gregory K., additional, Gurich, Richard W., additional, Lazarus, David E., additional, Millon, S. John, additional, Palmer, M. Jason, additional, Porter, Scott E., additional, Schaller, Thomas M., additional, Sridhar, Michael S., additional, Sanders, John L., additional, Rudisill, L. Edwin, additional, Garitty, Michael J., additional, Poole, Andrew S., additional, Sims, Michael L., additional, Walker, Clark M., additional, Carlisle, Robert M., additional, Hofer, Erin Adams, additional, Huggins, Brandon S., additional, Hunter, Michael D., additional, Marshall, William A., additional, Ray, Shea Bielby, additional, Smith, Cory D., additional, Altman, Kyle M., additional, Bedard, Julia C., additional, Loeffler, Markus F., additional, Pichiotino, Erin R., additional, Cole, Austin A., additional, Maltz, Ethan J., additional, Parker, Wesley, additional, Ramsey, T. Bennett, additional, Burnikel, Alex, additional, Colello, Michael, additional, Stewart, Russell, additional, Wise, Jeremy, additional, Moody, M. Christian, additional, Tanner, Stephanie L., additional, Snider, Rebecca G., additional, Townsend, Christine E., additional, Pham, Kayla H., additional, Martin, Abigail, additional, Robertson, Emily, additional, Miclau, Theodore, additional, Kandemir, Utku, additional, Marmor, Meir, additional, Matityahu, Amir, additional, McClellan, R. Trigg, additional, Meinberg, Eric, additional, Shearer, David, additional, Toogood, Paul, additional, Ding, Anthony, additional, Donohoe, Erin, additional, Murali, Jothi, additional, Belaye, Tigist, additional, Berhaneselase, Eleni, additional, Paul, Alexandra, additional, Garg, Kartik, additional, Gary, Joshua L., additional, Warner, Stephen J., additional, Munz, John W., additional, Choo, Andrew M., additional, Achor, Timothy S., additional, “Chip” Routt, Milton L., additional, Pechero, Guillermo, additional, Miller, Adam, additional, Hagen, Jennifer E., additional, Patrick, Matthew, additional, Vlasak, Richard, additional, Krupko, Thomas, additional, Sadasivan, Kalia, additional, Koenig, Chris, additional, Bailey, Daniel, additional, Wentworth, Daniel, additional, Van, Chi, additional, Schwartz, Justin, additional, Dehghan, Niloofar, additional, Jones, Clifford B., additional, Tracy Watson, J., additional, McKee, Michael, additional, Karim, Ammar, additional, Talerico, Michael, additional, Williams, Alyse, additional, Dykes, Tayler, additional, Obremskey, William T., additional, Jahangir, Amir Alex, additional, Sethi, Manish, additional, Boyce, Robert, additional, Stinner, Daniel J., additional, Mitchell, Phillip, additional, Trochez, Karen, additional, Rodriguez, Andres, additional, Gajari, Vamshi, additional, Rodriguez, Elsa, additional, Pritchett, Charles, additional, Boulton, Christina, additional, Lowe, Jason, additional, Wild, Jason, additional, Ruth, John T., additional, Taylor, Michel, additional, Seach, Andrea, additional, Saeed, Sabina, additional, Culbert, Hunter, additional, Cruz, Alejandro, additional, Knapp, Thomas, additional, Hurkett, Colin, additional, Lowney, Maya, additional, Prayson, Michael, additional, Venkatarayappa, Indresh, additional, Horne, Brandon, additional, Jerele, Jennifer, additional, Clark, Linda, additional, Marcano-Fernández, Francesc, additional, Jornet-Gibert, Montsant, additional, Martínez-Carreres, Laia, additional, Martí-Garín, David, additional, Serrano-Sanz, Jorge, additional, Sánchez-Fernández, Joel, additional, Sanz-Molero, Matsuyama, additional, Carballo, Alejandro, additional, Pelfort, Xavier, additional, Acerboni-Flores, Francesc, additional, Alavedra-Massana, Anna, additional, Anglada-Torres, Neus, additional, Berenguer, Alexandre, additional, Cámara-Cabrera, Jaume, additional, Caparros-García, Ariadna, additional, Fillat-Gomà, Ferran, additional, Fuentes-López, Ruben, additional, Garcia-Rodriguez, Ramona, additional, Gimeno-Calavia, Nuria, additional, Graells-Alonso, Guillem, additional, Martínez-Álvarez, Marta, additional, Martínez-Grau, Patricia, additional, Pellejero-García, Raúl, additional, Ràfols-Perramon, Ona, additional, Peñalver, Juan Manuel, additional, Domènech, Mònica Salomó, additional, Soler-Cano, Albert, additional, Velasco-Barrera, Aldo, additional, Yela-Verdú, Christian, additional, Bueno-Ruiz, Mercedes, additional, Sánchez-Palomino, Estrella, additional, Guerra-Farfan, Ernesto, additional, Tomas-Hernandez, Jordi, additional, Teixidor-Serra, Jordi, additional, Molero-Garcia, Vicente, additional, Selga-Marsa, Jordi, additional, Porcel-Vasquez, Juan Antonio, additional, Andres-Peiro, Jose Vicente, additional, Minguell-Monyart, Joan, additional, Garcia-Sanchez, Yaiza, additional, Nuñez-Camarena, Jorge, additional, Tauste-Rubio, Eladia, additional, Gonzalez-Amigo, Marta, additional, Romeo, Nicholas M., additional, Vallier, Heather A., additional, Breslin, Mary A., additional, Fraifogl, Joanne, additional, Wilson, Eleanor S., additional, Wadenpfuhl, Leanne K., additional, Halliday, Paul G., additional, Viskontas, Darius G., additional, Apostle, Kelly L., additional, Boyer, Dory S., additional, Moola, Farhad O., additional, Perey, Bertrand H., additional, Stone, Trevor B., additional, Lemke, H. Michael, additional, Zomar, Mauri, additional, Fan, Chen “Brenda”, additional, Payne, Kyrsten, additional, Phelps, Kevin, additional, Bosse, Michael, additional, Karunakar, Madhav, additional, Kempton, Laurence, additional, Sims, Stephen, additional, Hsu, Joseph, additional, Seymour, Rachel, additional, Churchill, Christine, additional, Bartel, Claire, additional, Mayberry, Robert Miles, additional, Brownrigg, Maggie, additional, Girardi, Cara, additional, Mayfield, Ada, additional, Hymes, Robert A., additional, Schwartzbach, Cary C., additional, Schulman, Jeff E., additional, Malekzadeh, A. Stephen, additional, Holzman, Michael A., additional, Ahn, James S., additional, Panjshiri, Farhanaz, additional, Das, Sharmistha, additional, English, Antoinisha D., additional, Haaser, Sharon M., additional, Cuff, Jaslynn A.N., additional, Pilson, Holly, additional, Carroll, Eben A., additional, Halvorson, Jason J., additional, Babcock, Sharon, additional, Goodman, J. Brett, additional, Holden, Martha B., additional, Bullard, Debra, additional, Williams, Wendy, additional, Higgins, Thomas F., additional, Haller, Justin M., additional, Rothberg, David L., additional, Marchand, Lucas S., additional, Neese, Ashley, additional, Russell, Mark, additional, Olsen, Zachary M., additional, Coe, Marcus, additional, Dwyer, Kevin, additional, Mullin, Devin S., additional, Reilly, Clifford A., additional, DePalo, Peter, additional, Hall, Amy E., additional, Heng, Marilyn, additional, Harris, Mitchel B., additional, Smith, R. Malcolm, additional, Lhowe, David W., additional, Esposito, John G., additional, Bansal, Mira, additional, Bergin, Patrick F., additional, Russell, George V., additional, Graves, Matthew L., additional, Morellato, John, additional, Champion, Heather K., additional, Johnson, Leslie N., additional, McGee, Sheketha L., additional, Bhanat, Eldrin L., additional, Mehta, Samir, additional, Donegan, Derek, additional, Ahn, Jaimo, additional, Horan, Annamarie, additional, Dooley, Mary, additional, Kuczinski, Ashley, additional, Iwu, Ashley, additional, Potter, David, additional, VanDemark, Robert, additional, Hollinsworth, Troy, additional, Weaver, Michael J., additional, von Keudell, Arvind G., additional, Allen, Elizabeth M., additional, Jaeblon, Todd, additional, Beer, Robert, additional, Gage, Mark J., additional, Reilly, Rachel M., additional, and Sparrow, Cindy, additional

Published
2021
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80. Immediate Weight Bearing of Plated Both-Bone Forearm Fractures Using Eight Cortices Proximal and Distal to the Fracture in the Polytrauma Patient Is Safe

Author

Marchand, Lucas S., primary, Horton, Steven, additional, Mullike, Alexandra, additional, Goel, Ritu, additional, Krum, Nicole, additional, Ochenjele, George, additional, O'Hara, Nathan, additional, O'Toole, Robert V., additional, Eglseder, W. Andrew, additional, and Pensy, Raymond, additional

Published
2021
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81. Analysis of Computed Tomography–Based Technique for Measuring Femoral Anteversion: Implications for Measuring Rotation After Femoral Intramedullary Nail Insertion

Author

McAlister, Ian P., primary, Marchand, Lucas S., additional, Napora, Joshua K., additional, Riedel, Matthew D., additional, Shannon, Steven S., additional, O'Hara, Nathan N., additional, Langhammer, Christopher G., additional, LeBrun, Christopher, additional, Nascone, Jason W., additional, Sciadini, Marcus F., additional, and O'Toole, Robert V., additional

Published
2021
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87. External validation of the clinical indications of computed tomography (CT) of the head in patients with low-energy geriatric hip fractures

Author

Borade, Amrut, primary, Kempegowda, Harish, additional, Maniar, Hemil H., additional, De Giacomo, Anthony, additional, Tornetta, Paul, additional, Bramlett, Kasey, additional, Marcantonio, Andrew J., additional, Marchand, Lucas S., additional, Kubiak, Erik N., additional, Ip, William H., additional, Kellam, James F., additional, Bender, Jay S., additional, Meinberg, Eric G., additional, Kee, James, additional, Renard, Regis, additional, Suk, Michael, additional, and Horwitz, Daniel S., additional

Published
2017
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93. The impact of COVID-19 restrictions on participant enrollment in the PREPARE trial

Author

Pogorzelski, David, McKay, Paula, Weaver, Michael J., Jaeblon, Todd, Hymes, Robert A., Gaski, Greg E., Fraifogl, Joanne, Ahn, James S., Bzovsky, Sofia, Slobogean, Gerard, Sprague, Sheila, Gardner, Michael J., Blasman, Jenna, Davies, Jonah, Liang, Stephen, Taljaard, Monica, Slobogean, Gerard P., Sprague, Sheila, Wells, Jeffrey, Bhandari, Mohit, Slobogean, Gerard P., Bhandari, Mohit, Sprague, Sheila, Harris, Anthony D., Mullins, C. Daniel, Thabane, Lehana, Wells, Jeffrey, Wood, Amber, Della Rocca, Gregory J., Harris, Anthony D., Hebden, Joan, Jeray, Kyle J., Marchand, Lucas S., O'Hara, Lyndsay M., Zura, Robert, Lee, Christopher, Patterson, Joseph, Devereaux, P.J., Guyatt, Gordon H., Thabane, Lehana, Heels-Ansdell, Diane, Marvel, Debra, Palmer, Jana, Wells, Jeffrey, Friedrich, Jeff, Mullins, C. Daniel, O'Hara, Nathan N., Grissom, Ms Frances, Della Rocca, Gregory J., Gitajn, I. Leah, Jeray, Kyle J., Morshed, Saam, O'Toole, Robert V., Petrisor, Bradley A., Mossuto, Franca, Harris, Anthony D., Joshi, Manjari G., D'Alleyrand, Jean-Claude, Fowler, Justin, Rivera, Jessica, Talbot, Max, Sprague, Sheila, Bhandari, Mohit, Pogorzelski, David, Dodds, Shannon, Li, Silvia, Rojas, Alejandra, Del Fabbro, Gina, Szasz, Olivia Paige, Heels-Ansdell, Diane, McKay, Paula, Minea, Alexandra, Murphy, Kevin, Slobogean, Gerard P., O'Hara, Nathan N., Howe, Andrea, Demyanovich, Haley, Mullins, C. Daniel, Medeiros, Michelle, Polk, Genevieve, Kettering, Eric, Mahal, Nirmen, O'Toole, Robert V., D'Alleyrand, Jean-Claude, Eglseder, Andrew, Johnson, Aaron, Langhammer, Christopher, Lebrun, Christopher, Nascone, Jason, Pensy, Raymond, Pollak, Andrew, Sciadini, Marcus, Slobogean, Gerard P., Degani, Yasmin, Demyanovich, Haley K., Howe, Andrea, O'Hara, Nathan N., Phipps, Heather, Hempen, Eric, Holler, Christine, Petrisor, Brad A., Johal, Herman, Ristevski, Bill, Williams, Dale, Denkers, Matthew, Rajaratnam, Krishan, Al-Asiri, Jamal, Gallant, Jodi, Pusztai, Kaitlyn, MacRae, Sarah, Renaud, Sara, Jeray, Kyle J., Adams, John D., Beckish, Michael L., Bray, Christopher C., Brown, Timothy R., Cross, Andrew W., Dew, Timothy, Faucher, Gregory K., Gurich, Richard W., Lazarus, David E., Millon, S. John, Moody, M. Christian, Palmer, M. Jason, Porter, Scott E., Schaller, Thomas M., Sridhar, Michael S., Sanders, John L., Rudisill, L. Edwin, Garitty, Michael J., Poole, Andrew S., Sims, Michael L., Walker, Clark M., Carlisle, Robert, Hofer, Erin A., Huggins, Brandon, Hunter, Michael, Marshall, William, Ray, Shea B., Smith, Cory, Altman, Kyle M., Pichiotino, Erin, Quirion, Julia C., Loeffler, Markus F., Pichiotino, Erin R., Cole, Austin A., Maltz, Ethan J., Parker, Wesley, Ramsey, T. Bennett, Burnikel, Alex, Colello, Michael, Stewart, Russell, Wise, Jeremy, Anderson, Matthew, Eskew, Joshua, Judkins, Benjamin, Miller, James M., Tanner, Stephanie L., Snider, Rebecca G., Townsend, Christine E., Pham, Kayla H., Martin, Abigail, Robertson, Emily, Bray, Emily, Sykes, J. Wilson, Yoder, Krystina, Conner, Kelsey, Abbott, Harper, Natoli, Roman M., McKinley, Todd O., Virkus, Walter W., Sorkin, Anthony T., Szatkowski, Jan P., Mullis, Brian H., Jang, Yohan, Lopas, Luke A., Hill, Lauren C., Fentz, Courteney L., Diaz, Maricela M., Brown, Krista, Garst, Katelyn M., Denari, Emma W., Osborn, Patrick, Fowler, Justin, Pierrie, Sarah, Herrera, Maria, Morshed, Saam, Miclau, Theodore, Marmor, Meir, Matityahu, Amir, McClellan, R. Trigg, Shearer, David, Toogood, Paul, Ding, Anthony, Murali, Jothi, El Naga, Ashraf, Tangtiphaiboontana, Jennifer, Belaye, Tigist, Berhaneselase, Eleni, Pokhvashchev, Dmitry, Obremskey, William T., Jahangir, Amir Alex, Sethi, Manish, Boyce, Robert, Stinner, Daniel J., Mitchell, Phillip, Trochez, Karen, Rodriguez, Elsa, Pritchett, Charles, Hogan, Natalie, Moreno, A. Fidel, Hagen, Jennifer E., Patrick, Matthew, Vlasak, Richard, Krupko, Thomas, Talerico, Michael, Horodyski, Marybeth, Pazik, Marissa, Lossada-Soto, Elizabeth, Gary, Joshua L., Warner, Stephen J., Munz, John W., Choo, Andrew M., Achor, Timothy S., Routt, Milton L. Chip, Kutzler, Michael, Boutte, Sterling, Warth, Ryan J., Prayson, Michael, Venkatarayappa, Indresh, Horne, Brandon, Jerele, Jennifer, Clark, Linda, Boulton, Christina, Lowe, Jason, Ruth, John T., Askam, Brad, Seach, Andrea, Cruz, Alejandro, Featherston, Breanna, Carlson, Robin, Romero, Iliana, Zarif, Isaac, Dehghan, Niloofar, McKee, Michael, Jones, Clifford B., Sietsema, Debra L., Williams, Alyse, Dykes, Tayler, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Teixidor-Serra, Jordi, Molero-Garcia, Vicente, Selga-Marsa, Jordi, Porcel-Vazquez, Juan Antonio, Andres-Peiro, Jose Vicente, Esteban-Feliu, Ignacio, Vidal-Tarrason, Nuria, Serracanta, Jordi, Nuñez-Camarena, Jorge, Mar Villar-Casares, Maria del, Mestre-Torres, Jaume, Lalueza-Broto, Pilar, Moreira-Borim, Felipe, Garcia-Sanchez, Yaiza, Marcano-Fernández, Francesc, Martínez-Carreres, Laia, Martí-Garín, David, Serrano-Sanz, Jorge, Sánchez-Fernández, Joel, Sanz-Molero, Matsuyama, Carballo, Alejandro, Pelfort, Xavier, Acerboni-Flores, Francesc, Alavedra-Massana, Anna, Anglada-Torres, Neus, Berenguer, Alexandre, Cámara-Cabrera, Jaume, Caparros-García, Ariadna, Fillat-Gomà, Ferran, Fuentes-López, Ruben, Garcia-Rodriguez, Ramona, Gimeno-Calavia, Nuria, Martínez-Álvarez, Marta, Martínez-Grau, Patricia, Pellejero-García, Raúl, Ràfols-Perramon, Ona, Peñalver, Juan Manuel, Domènech, Mònica Salomó, Soler-Cano, Albert, Velasco-Barrera, Aldo, Yela-Verdú, Christian, Bueno-Ruiz, Mercedes, Sánchez-Palomino, Estrella, Andriola, Vito, Molina-Corbacho, Matilde, Maldonado-Sotoca, Yeray, Gasset-Teixidor, Alfons, Blasco-Moreu, Jorge, Fernández-Poch, Núria, Rodoreda-Puigdemasa, Josep, Verdaguer-Figuerola, Arnau, Cueva-Sevieri, Heber Enrique, Garcia-Gimenez, Santiago, Viskontas, Darius G., Apostle, Kelly L., Boyer, Dory S., Moola, Farhad O., Perey, Bertrand H., Stone, Trevor B., Lemke, H. Michael, Spicer, Ella, Payne, Kyrsten, Hymes, Robert A., Schwartzbach, Cary C., Schulman, Jeff E., Malekzadeh, A. Stephen, Holzman, Michael A., Gaski, Greg E., Wills, Jonathan, Pilson, Holly, Carroll, Eben A., Halvorson, Jason J., Babcock, Sharon, Goodman, J. Brett, Holden, Martha B., Williams, Wendy, Hill, Taylor, Brotherton, Ariel, Romeo, Nicholas M., Vallier, Heather A., Vergon, Anna, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Marchand, Lucas S., Olsen, Zachary M., McGowan, Abby V., Hill, Sophia, Dauk, Morgan K., Bergin, Patrick F., Russell, George V., Graves, Matthew L., Morellato, John, McGee, Sheketha L., Bhanat, Eldrin L., Yener, Ugur, Khanna, Rajinder, Nehete, Priyanka, Potter, David, VanDemark, Robert, Seabold, Kyle, Staudenmier, Nicholas, Gitajn, I. Leah, Coe, Marcus, Dwyer, Kevin, Mullin, Devin S., Chockbengboun, Theresa A., DePalo, Peter A., Phelps, Kevin, Bosse, Michael, Karunakar, Madhav, Kempton, Laurence, Sims, Stephen, Hsu, Joseph, Seymour, Rachel, Churchill, Christine, Mayfield, Ada, Sweeney, Juliette, Jaeblon, Todd, Beer, Robert, Demyanovich, Haley K., Bauer, Brent, Meredith, Sean, Talwar, Sneh, Domes, Christopher M., Gage, Mark J., Reilly, Rachel M., Paniagua, Ariana, Dupree, JaNell, Weaver, Michael J., von Keudell, Arvind G., Sagona, Abigail E., Mehta, Samir, Donegan, Derek, Horan, Annamarie, Dooley, Mary, Heng, Marilyn, Harris, Mitchel B., Lhowe, David W., Esposito, John G., Alnasser, Ahmad, Shannon, Steven F., Scott, Alesha N., Clinch, Bobbi, Weber, Becky, Beltran, Michael J., Archdeacon, Michael T., Sagi, Henry Claude, Wyrick, John D., Le, Theodore Toan, Laughlin, Richard T., Thomson, Cameron G., Hasselfeld, Kimberly, Lin, Carol A., Vrahas, Mark S., Moon, Charles N., Little, Milton T., Marecek, Geoffrey S., Dubuclet, Denice M., Scolaro, John A., Learned, James R., Lim, Philip K., Demas, Susan, Amirhekmat, Arya, and Cruz, Yan Marco Dela

Abstract

At the initiation of the COVID-19 pandemic, restrictions forced researchers to decide whether to continue their ongoing clinical trials. The PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities) trial is a pragmatic cluster-randomized crossover trial in patients with open and closed fractures. PREPARE was enrolling over 200 participants per month at the initiation of the pandemic. We aim to describe how the COVID-19 research restrictions affected participant enrollment.

Published
2022
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95. Butterfly fragments in diaphyseal tibial fractures heal unpredictably: Should we be adopting other strategies for these high risk fractures?

Author

Myhre, Luke, Steffenson, Lillia, Higgins, Thomas F., Rothberg, David L., Haller, Justin M., and Marchand, Lucas S.

Subjects
*INTRAMEDULLARY fracture fixation, *TIBIAL fractures, *FRACTURE healing, *BUTTERFLIES, *COMPOUND fractures, *INTRAMEDULLARY rods
Abstract

The natural history of diaphyseal tibial butterfly fragments is poorly documented. Numerous studies have analyzed risk factors for nonunions in the tibial shaft with known factors including Gustilo classification, ASA class, and cortical contact. However, the healing potential and ideal management of nonsegmental butterfly fragments in this setting remains unknown. The aim of this study was to determine the nonunion rate of diaphyseal tibial fractures with a butterfly fragment. A performed a retrospective review of patients at a single academic Level 1 Trauma Center from 2000-2020 who underwent intramedullary nailing of tibial shaft fractures. Those with non-segmental butterfly fragments (OTA/AO: 42-B) and minimum 12 month follow up were included. Morphologic measurements of butterfly fragments were performed to measure location, size, and displacement, and mRust scores at final follow up were calculated. Outcome measures were surgery to promote union, and mRust scores. A total of 99 patients were included with 21 patients requiring revision surgery to promote union. Thirty six patients had open fractures and 77% of patients were male with a mean age of 34 (range: 12-80). Average follow up was 19 months (3 months – 12 years). The most common location of the butterfly fragment was the anterior cortex (42%), with a mean length of 7.8cm (SD: 3.3) and width of 1.8cm (SD: 0.5cm). At final follow-up 37% of fractures had persistent lucency without callus at the site of the butterfly while only 31% of fractures had remodeled cortex. Average time to complete healing was 13.3 months. Open fractures with butterfly fragments were more likely to go on to nonunion than closed (44% vs 9.2%, p=<0.001). The length of the butterfly fragment was not different between the union and nonunion groups (7.7 vs 7.5, P=0.42). Open tibial shaft fractures with a butterfly fragment have a high risk of nonunion. Further research may seek to determine if adjunct treatment of butterfly fragments (ie inter-fragmentary compression) in the acute setting could improve healing rates. [ABSTRACT FROM AUTHOR]

Published
2023
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96. Primary Repair of Complete Quadriceps Tendon Rupture with Extensor Mechanism Deficit.

Author

Thorne TJ, Dong W, Higgins TF, Rothberg DL, Haller JM, and Marchand LS

Abstract

Background: Whereas partial quadriceps tendon ruptures may be treated nonoperatively if the extensor mechanism remains functional, complete ruptures require primary operative repair to achieve optimal functional results 1,2 . The 2 most common techniques are the use of transosseous tunnels and the use of suture anchors. The goal of these procedures is to reconstruct and restore mobility of the extensor mechanism of the leg., Description: The patient is positioned supine with the injured leg exposed. A midline incision to the knee is made over the quadriceps tendon defect, exposing the distal quadriceps and proximal patella. Irrigation is utilized to evacuate the residual hematoma, and the distal quadriceps and proximal patella are debrided of degenerative tissue. When utilizing transosseous tunnels, a nonabsorbable suture is passed full-thickness through the medial or lateral half of the quadriceps tendon in a locked, running pattern (i.e., Krackow). A second nonabsorbable suture is passed full-thickness through the other half of the tendon. There should then be 4 loose strands at the distal quadriceps. The anatomic insertion of the quadriceps tendon is roughened with a sharp curet to expose fresh cancellous bone. Three parallel bone tunnels are created along the longitudinal axis of the patella. The knee is placed in full extension, with a bump under the heel in order to provide slight recurvatum at the knee and to allow for a properly tensioned repair. In pairs, the free ends of the sutures are passed through the tunnels. The sutures are tensioned and tied together in pairs at the distal aspect of the patella. Alternatively, when utilizing suture anchors, Arthrex FiberTape is passed full-thickness through the medial or lateral half of the quadriceps tendon in a Krackow pattern. A second FiberTape is passed full-thickness through the other half of the tendon. There should then be 4 loose tails at the distal quadriceps. The 2 tails of the medial FiberTape are placed into a knotless Arthrex SwiveLock anchor; this step is repeated for the 2 lateral tails. The anatomic insertion of the quadriceps tendon is roughened to expose fresh cancellous bone. With use of a 3.5-mm drill, create 2 parallel drill holes along the longitudinal axis of the patella, with sufficient depth to bury the SwiveLock anchor. Unlike in the transosseous tunnel technique, these drill holes do not run the length of the patella. The holes are then tapped. Following irrigation, the anchors are tensioned into the bone tunnels, and extra tape is cut flush to the bone. For both techniques, additional tears in the medial and lateral retinacula are repaired if present., Alternatives: Alternatives include nonoperative treatment with use of a hinged knee brace; operative treatment with use of simple sutures; and augmentation with use of wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape (Ethicon)., Rationale: Primary operative repair of quadriceps tendon ruptures is a well-documented, successful procedure with biomechanical, clinical, and patient-reported data to support its use 3-7 . However, literature comparing the 2 most common surgical techniques remains controversial. Transosseous tunnel repair is the most common technique utilized to repair quadriceps tendon ruptures, but suture anchors have become increasingly popular in the past several years 1,4 . Most studies have reported no significant difference in biomechanical, clinical, and patient-reported outcome measures between these 2 techniques 3,4,8-10 . Decreased operative time and a smaller incision have been suggested as advantages of suture anchors 4,9 . However, this method incurs a higher average cost of surgery and risks a more complex revision in the event of deep infection 9,10 . Simple suture repair is a less commonly utilized technique and is now reserved for midsubstance tendon repairs. Nonoperative treatment of complete quadriceps tendon rupture is exceedingly rare and not recommended because of the profound functional consequences. Relative indications for nonoperative treatment include a patient who is unfit for surgery, is not ambulatory at baseline, or retains full extensor mechanism function. Nonoperative treatment is typically reserved for partial quadriceps ruptures and typically involves early immobilization with a hinged knee brace., Expected Outcomes: Primary repair of quadriceps tendon ruptures, utilizing either the transosseous tunnel or suture anchor technique, yields excellent outcomes. Following surgical treatment, patients have near-full recovery in range of motion, with studies reporting a <5° deficit compared with the contralateral, uninjured limb 3,4,10,11 . The vast majority of patients (>90%) return to pre-injury levels of function and work 3,4,7,11 . The majority of patients also report satisfactory results, as assessed with use of patient-reported outcome measures 3,4,10 . The most commonly reported complications are knee stiffness and quadriceps muscle atrophy, which can both be treated with proper rehabilitation. Even in the event of these complications, however, patients can maintain adequate knee function 2,3 . More severe complications are rare (<3%) and include deep venous thrombosis and/or pulmonary embolism, superficial and/or deep infection, and tendon rerupture 2-4,10-12 . Delayed operative treatment is associated with worse outcomes and increased complication rates 1,3,4,10,11 ., Important Tips: When performing the Krackow stitch, be sure to tension and remove all slack before performing another tissue pass.Surgical repair should be performed as soon as possible from the time of injury in order to minimize risks and to achieve optimal surgical outcomes.If there is concern that the primary construct would be unstable, it can be augmented with wire reinforcement, cancellous screws, the Scuderi technique, the Codivilla technique, tensor fasciae latae reinforcement, and/or MERSILENE tape.Identify and repair patellar retinaculum tears, which are common concomitant injuries in the setting of complete quadriceps rupture., Acronyms and Abbreviations: MRI = magnetic resonance imaging., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A463)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Published
2024
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97. Dual Plating of Distal Femoral Fractures.

Author

Thorne TJ, Nelson CT, Lisitano LSJ, Higgins TF, Rothberg DL, Haller JM, and Marchand LS

Abstract

Background: Dual plating of the distal femur is indicated for the treatment of complex intra-articular fractures, supracondylar femoral fractures, low periprosthetic fractures, and nonunions. The aim of this procedure is anatomical alignment of the articular surface, restoration of the articular block, and prevention of varus collapse., Description: Following preoperative planning, the patient is positioned supine with the knee flexed at 30°. The lateral incision is made first, with a mid-lateral incision that is in line with the femoral shaft. If intra-articular work is needed this incision can be extended by curving anteriorly over the lateral femoral condyle. Next, the iliotibial band is transected in line with its fibers. The vastus lateralis fascia is incised and elevated off the septum, working distal to proximal. Care should be taken to maintain hemostasis when encountering femoral artery perforating vessels. Once there is adequate exposure, several reduction aids can be utilized, including a bump under the knee, Schanz pins, Kirschner wires, and reduction clamps. A lateral precontoured plate is placed submuscularly, and the most proximal holes are filled percutaneously. The medial incision begins distally at the adductor tubercle and is a straight incision made proximally in line with the femoral shaft. The underlying fascia is transected in line with the skin incision, and the vastus medialis is elevated. Care should be taken to avoid the descending geniculate artery, as well as its articular branch and the muscular branch to the vastus medialis. A lateral tibial plateau plate is contoured and placed., Alternatives: Nonoperative treatment of distal femoral fractures is rare, but relative indications for nonoperative treatment include frailty of the patient, lack of ambulatory status, a non-reconstructible fracture, or a stable fracture. These patients are placed in a long-leg cast followed by a hinged knee brace 1 . There are several other surgical fixation options, including lateral plating, retrograde intramedullary nailing, distal femoral replacement, and augmentation of a retrograde nail with a plate., Rationale: Dual plating has several benefits, depending on the clinical scenario. Biomechanical studies have found that dual plating results in increased stiffness and construct strength 2,3 . Additional construct stability can be offered through the use of locking plates, particularly in osteoporotic bone. Taken together, this increased stability and construct strength can allow for earlier weight-bearing, which is particularly important for fractures in the geriatric population. Furthermore, the increased stiffness and construct strength make this procedure a favorable treatment option for nonunion, and it has been shown to result in lower rates of postoperative nonunion compared with lateral plating alone 4-7 . Adjunctive use of a medial plate also has been suggested to prevent varus collapse, particularly with metaphyseal comminution and poor bone quality 2,3,8 . Finally, in the periprosthetic fracture population, dual plating also removes the concern of incompatibility with a retrograde nail., Expected Outcomes: The outcomes of dual plating are promising, given the severity of the injury. When comparing operative to nonoperative treatment outcomes, nonoperatively managed patients had worse functional outcomes and higher rates of complications related to immobility 1 . Dual plating of supracondylar fractures and intra-articular distal femoral fractures yields nonunion rates ranging from 0% to 12.5%, lower than the 18% to 20% reported with lateral locking plates 4-7,9-12 . This reduction in nonunions has been shown to lead to fewer revisions when compared with single-plating techniques 7 . In prior studies, 95% of nonunions treated with the dual-plating technique achieved union postoperatively 11 . One concern when utilizing the medial approach is critical damage to medial vascularity; however, this result has not been reported in the literature, and there is a safe operating window 13 . Despite the benefits of dual plating, there are relatively high rates of infection following dual plating (0% to 16.7%) compared with lateral plating alone (3.6% to 8.5%) 5,14-17 . However, many of these studies are small case series, highlighting that a surgeon's comfort and skill with these procedures is paramount to patient outcomes., Important Tips: Meticulous placement and contouring of lateral and medial plates are required to prevent malreduction of the articular block that creates a "golf-club deformity." 18,19 During the medial approach, be aware of descending geniculate artery-particularly its muscular branch, which is ∼5 cm from the adductor tubercle/medial epicondyle, and its root, which enters the compartment at the adductor hiatus at ∼16 cm 13 ., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A447)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Published
2024
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98. Skin Antisepsis before Surgical Fixation of Extremity Fractures.

Author

Sprague S, Slobogean G, Wells JL, O'Hara NN, Thabane L, Mullins CD, Harris AD, Wood A, Viskontas D, Apostle KL, O'Toole RV, Joshi M, Johal H, Al-Asiri J, Hymes RA, Gaski GE, Pilson HT, Carroll EA, Babcock S, Halvorson JJ, Romeo NM, Matson CA, Higgins TF, Marchand LS, Bergin PF, Morellato J, Van Demark RE 3rd, Potter GD, Gitajn IL, Chang G, Phelps KD, Kempton LB, Karunakar M, Jaeblon T, Demyanovich HK, Domes CM, Kuhn GR, Reilly RM, Gage MJ, Weaver MJ, von Keudell AG, Heng M, McTague MF, Alnasser A, Mehta S, Donegan DJ, Natoli RM, Szatkowski J, Scott AN, Shannon SF, Jeray KJ, Tanner SL, Marmor MT, Matityahu A, Fowler JT, Pierrie SN, Beltran MJ, Thomson CG, Lin CA, Moon CN, Scolaro JA, Amirhekmat A, Leonard J, Pogorzelski D, Bzovsky S, Heels-Ansdell D, Szasz OP, Gallant JL, Della Rocca GJ, Zura RD, Hebden JN, Patterson JT, Lee C, O'Hara LM, Marvel D, Palmer JE, Friedrich J, D'Alleyrand JG, Rivera JC, Mossuto F, Schrank GM, Guyatt G, Devereaux PJ, and Bhandari M

Subjects
Humans, 2-Propanol administration & dosage, 2-Propanol adverse effects, 2-Propanol therapeutic use, Antisepsis methods, Canada, Ethanol, Extremities injuries, Extremities microbiology, Extremities surgery, Preoperative Care adverse effects, Preoperative Care methods, Skin microbiology, Cross-Over Studies, United States, Anti-Infective Agents, Local administration & dosage, Anti-Infective Agents, Local adverse effects, Anti-Infective Agents, Local therapeutic use, Chlorhexidine administration & dosage, Chlorhexidine adverse effects, Chlorhexidine therapeutic use, Iodine administration & dosage, Iodine adverse effects, Iodine therapeutic use, Surgical Wound Infection etiology, Surgical Wound Infection prevention & control, Fractures, Bone surgery, Fracture Fixation
Abstract

Background: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture)., Methods: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications., Results: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups., Conclusions: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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99. Surgical management and weight-bearing recommendations for geriatric distal femur fractures.

Author

Haller JM, Marchand LS, Higgins TF, O'Toole RV, and Reider L

Abstract

Objective: To investigate current practices among orthopaedic trauma surgeons in treating geriatric distal femur fractures and evaluate current postoperative weight-bearing recommendations., Methods: A 26-question survey was emailed to Major Extremity Trauma Research Consortium surgeon members to characterize current practice with different fixation methods for distal femur fractures and the surgeon-directed postoperative weight-bearing recommendations for each approach., Results: Surveys were completed by 123 orthopaedic trauma surgeons with a response rate of 37% (123/332). Retrograde intramedullary nailing (IMN) was commonly performed by 88% of surgeons, and lateral locked plate was commonly performed by 74% of surgeons. Retrograde IMN with a lateral plate was commonly performed by 51% of surgeons. Dual femoral plating was commonly performed by 18% of surgeons and sometimes performed by 39% of surgeons. Surgeons were significantly more likely to allow immediate postoperative weight-bearing for retrograde IMN ( P < 0.001), retrograde IMN with lateral plate ( P < 0.001), and dual plate ( P < 0.001) as compared with locked lateral plate. Most surgeons (79%) would be interested in participating in a randomized controlled trial (RCT) investigating single implant versus dual implant for distal femur fractures and believe that a trial incorporating immediate weight-bearing is important., Conclusion: A variety of implants are commonly used to treat geriatric distal femur fractures. Patients with distal femur fracture commonly have weight-bearing restrictions in the immediate postoperative period. A large proportion of orthopaedic trauma surgeons have clinical equipoise for an RCT to investigate the impact of surgical construct and weight-bearing on geriatric distal femur fracture patient recovery., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Published
2023
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100. Local administration of vancomycin powder in orthopaedic fracture surgery: current practice and trends.

Author

Marchand LS, Sprague S, O'Hara NN, Li CS, O'Toole RV, Joshi M, Viskontas D, Romeo N, Hymes RA, Obremskey WT, Higgins TF, Potter GD, Bergin PF, Gage M, Gary JL, Bhandari M, and Slobogean GP

Abstract

Objectives: Surgical site infections in orthopaedic trauma are a significant problem with meaningful patient and health care system-level consequences. Direct application of antibiotics to the surgical field has many potential benefits in reducing surgical site infections. However, to date, the data regarding the local administration of antibiotics have been mixed. This study reports on the variability of prophylactic vancomycin powder use in orthopaedic trauma cases across 28 centers., Methods: Intrawound topical antibiotic powder use was prospectively collected within three multicenter fracture fixation trials. Fracture location, Gustilo classification, recruiting center, and surgeon information were collected. Differences in practice patterns across recruiting center and injury characteristics were tested using chi-square statistic and logistic regression. Additional stratified analyses by recruiting center and individual surgeon were performed., Results: A total of 4941 fractures were treated, and vancomycin powder was used in 1547 patients (31%) overall. Local administration of vancomycin powder was more frequent in open fractures 38.8% (738/1901) compared with closed fractures 26.6% (809/3040) ( P < 0.001). However, the severity of the open fracture type did not affect the rate at which vancomycin powder was used ( P = 0.11). Vancomycin powder use varied substantially across the clinical sites ( P < 0.001). At the surgeon level, 75.0% used vancomycin powder in less than one-quarter of their cases., Conclusions: Prophylactic intrawound vancomycin powder remains controversial with varied support throughout the literature. This study demonstrates wide variability in its use across institutions, fracture types, and surgeons. This study highlights the opportunity for increased practice standardization for infection prophylaxis interventions., Level of Evidence: Prognostic-III., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Published
2023
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