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1. Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

Author

O’Hara, Nathan N., Frey, Katherine P., Stein, Deborah M., Levy, Joseph F., Slobogean, Gerard P., Castillo, Renan, Firoozabadi, Reza, Karunakar, Madhav A., Gary, Joshua L., Obremskey, William T., Seymour, Rachel B., Cuschieri, Joseph, Mullins, C. Daniel, O’Toole, Robert V., Carlini, Anthony R., Fowler, Brianna E., Taylor, Tara J., Wegener, Stephen T., Weston-Farber, Elias, Herndon, Steven Craig, Marvel, Debra, Jurkovich, Gregory J., Lee, Christopher, Malhotra, Ajai K., Riedel, Matthew D., DeCoster, Thomas A., Vercellotti, Gregory M., Wells, Jeffrey L., Westrick, Edward R., Bosse, Michael J., Christmas, A. Britton, Cunningham, Kyle William, Hsu, Joseph R., Huynh, Toan, Jacobs, David George, Kempton, Laurence B., Sims, Stephen H., Churchill, Christine, Carroll, Eben A., Babcock, Sharon, Miller, Preston R., Pilson, Holly T., Goodman, James Brett, Holden, Martha B., Weaver, Michael J., Esposito, John G., Goldhaber, Samuel Z., Heng, Marilyn, McGovern, Madeline M., Velmahos, George C., von Keudell, Arvind, Rivera, Jessica C., Gitajn, Ida Leah, Schneider, Prism S., Buckley, Richard E., Gallant, Jodi, McKay, Paula, Kleweno, Conor P., Agel, Julie, Natoli, Roman M., Gaski, Greg E., Heincelman, Carrie L., Jang, Yohan, Lopas, Luke A., McKinley, Todd O., Richard, Raveesh Daniel, Sorkin, Anthony T., Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Panjshiri, Farhanaz, Schulman, Jeff E., Ramsey, Lolita, Cuff, Jaslynn A.N., Haut, Elliott R., Warner, Stephen J., Cotton, Bryan A., Guevara, Keyla D., Claridge, Jeffrey A., Vallier, Heather A., Breslin, Mary A., Connelly, Daniel, Ghulam, Qasim M., Haac, Bryce E., LeBrun, Christopher T., Manson, Theodore T., Nascone, Jason, Pensy, Raymond A., Pollak, Andrew N., Udogwu, Ugochukwu N., Burke, Cynthia Elaine, Degani, Yasmin, DeLeon, Genaro A., Hannan, Zachary D., Healey, Kathleen M., Howe, Andrea L., Marinos, Dimitrius P., McKegg, Phillip C., McKibben, Natasha S., Zingas, Nicolas H., Evans, Andrew R., Askam, Brad M., Boulton, Christina, Weinlein, John C., Bergin, Patrick F., Bergin, Patrick F., Kutcher, Matthew E., Morellato, John, Nehete, Priyanka V., Yener, Ugur, Whiting, Paul S., Domes, Christopher, Kuhn, Gabrielle R., Gajari, Vamshi, Moreno-Diaz, Andres Fidel, Rodriguez-Baron, Elsa B., Rodriguez-Buitrago, Andres, Stinner, Daniel J., Trochez, Karen M., DePalo, Peter, Kennedy, Leah C., Lienhard, Karin, Martin, Ryan, Yee, Stephanie C., Leonard, Jordan, Arif, Hikmatullah, Brown, Krista, Deeter, Lakye Lenee, Sardesai, Neil, Bangura, Abdulai T., Demyanovich, Haley K., Eglseder, W. Andrew, Gupta, Jayesh, Isaac, Marckenley, Mulliken, Alexandra, Crisco, MJ., Lueckel, Stephanie N., Brown, Gregory A., Breazeale, Stephen, Fisher, Stephen N., Wild, Jason R., Beebe, Michael J., Khanna, Rajinder M., Brauer, Deborah, and Boyce, Robert H.

Published
2024
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2. Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopedic trauma patients: A secondary analysis of the PREVENT CLOT trial

Author

OʼHara, Nathan N., OʼToole, Robert V., Frey, Katherine P., Castillo, Renan C., Cuschieri, Joseph, Haut, Elliott R., Slobogean, Gerard P., Firoozabadi, Reza, Christmas, A. Britton, Obremskey, William T., Carlini, Anthony R., Gaski, Greg E., Kutcher, Matthew E., Marvel, Debra, Stein, Deborah M., Levy, Joseph F., Wegener, Stephen T., Fowler, Brianna E., Taylor, Tara J., Weston-Farber, Elias, Herndon, Steven Craig, Jr., DeCoster, Thomas A., Jurkovich, Gregory J., Lee, Christopher, Malhotra, Ajai K., Riedel, Matthew D., Wells, Jeffrey L., Altman, Daniel T., Westrick, Edward R., Bosse, Michael J., Karunakar, Madhav A., Cunningham, Kyle W., Huynh, Toan, Jacobs, David G., Kempton, Laurence B., Phelps, Kevin D., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Carroll, Eben A., Babcock, Sharon, Miller, Preston R., Pilson, Holly T., Goodman, James Brett, Weaver, Michael J., Esposito, John G., Goldhaber, Samuel Zachary, Heng, Marilyn, McGovern, Madeline M., Velmahos, George C., von Keudell, Arvind G., Rivera, Jessica C., Gitajn, Ida Leah, Schneider, Prism S., Buckley, Richard E., Johal, Herman S., Gallant, Jodi L., McKay, Paula, Kleweno, Conor P., Agel, Julie, Arif, Hikmatullah, McKinley, Todd O., Natoli, Roman M., Heincelman, Carrie L., Jang, Yohan, Lopas, Luke A., Mullis, Brian H., Richard, Raveesh D., Virkus, Walter, Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Panjshiri, Farhanaz, Schulman, Jeff E., Ramsey, Lolita, Ahn, James, Cuff, Jaslynn A. N., Gary, Joshua L., Warner, Stephen J., Cotton, Bryan A., Vallier, Heather A., Claridge, Jeffrey A., Breslin, Mary A., Cowley, R Adams, Connelly, Daniel, Eglseder, W. Andrew, Haac, Bryce E., Healey, Kathleen Marie, LeBrun, Christopher T., Manson, Theodore, McKibben, Natasha S., Mulliken, Alexandra, Nascone, Jason, Pensy, Raymond A., Pollak, Andrew N., Sciadini, Marcus F., Udogwu, Ugochukwu N., Zingas, Nicolas, Burke, Cynthia Elaine, DeLeon, Genaro A., Hannan, Zachary D., Howe, Andrea L., Marinos, Dimitrius P., McKegg, Phillip C., Evans, Andrew R., Askam, Brad M., Joseph, Bellal, Lowe, Jason, Weinlein, John C., Bergin, Patrick F., Bhanat, Eldrin L., Khanna, Rajinder, Morellato, John, Nehete, Priyanka V., Domes, Christopher, Whiting, Paul S., Goodspeed, David C., Kuhn, Gabrielle R., Guillamondegui, Oscar D., Moreno-Diaz, Andres Fidel, Stinner, Daniel J., Pritchett, Charles, Jr., and Trochez, Karen M.

Published
2024
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3. Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Author

Gitajn, Ida Leah, Werth, Paul M., Carlini, Anthony R., Bosse, Michael J., Gary, Joshua L., Firoozabadi, Reza, Obremskey, William, McKinley, Todd O., Castillo, Renan C., O’Toole, Robert V., Westrick, Edward R., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Tornetta, Paul, III, Weaver, Michael J., Heng, Marilyn, Osborn, Patrick M., Rivera, Jessica C., Murray, Clinton K., Kimmel, Joseph E., Moon, Charles, Hsu, Joseph R., Karunakar, Madhav A., Kempton, Laurence B., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Reilly, Rachel M., Zura, Robert D., Howes, Cameron, Mir, Hassan, Wagstrom, Emily A., Mullis, Brian, Anglen, Jeffrey O., Mullis, Leilani S., Shively, Karl D., Gaski, Greg E., Natoli, Roman M., Sorkin, Anthony, Virkus, Walter, Hymes, Robert A., Holzman, Michael A., Malekzadeh, A. Stephen, Schulman, Jeff E., Schwartzbach, Cary C., Lee, Olivia C., Krause, Peter C., Morandi, Massimo 'Max', Choo, Andrew, Munz, John W., Boutte, Sterling, Galpin, Matthew C., Frisch, H. Michael, Kaufman, Adam M., LeCroy, C. Michael, Smith, Christopher S., Stall, Alec C., Horne, Andrea, Nascone, Jason W., OʼHara, Nathan N., Paryavi, Ebrahim, Sciadini, Marcus F., Degani, Yasmin, Howe, Andrea L., Hayda, Roman, Evans, Andrew R., Sietsema, Debra L., Stawicki, Stanislaw P., Wojda, Thomas, Gardner, Michael J., Bishop, Julius A., Rehman, Saqib, Caroom, Cyrus, Sheridan, Elizabeth, Miclau, Theodore, Morshed, Saam, Higgins, Thomas F., Haller, Justin M., Matuszewski, Paul E., Aneja, Arun, Wright, Raymond D., Jr., Bergin, Patrick F., Bhanat, Eldrin, Graves, Matt L., Morellato, John, Spitler, Clay A., Teague, David, Ertl, William, Ahn, Jaimo, Hesketh, Patrick, Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke, Sanders, Drew T., Weiss, David B., Yarboro, Seth R., Lester-Ballard, Veronica, McVey, Eric D., Dagal, Arman, Githens, Michael, Kleweno, Conor, Agel, Julie, Whiting, Paul S., Simske, Natasha M., Siy, Alexander B., Attum, Basem, Burgos, Eduardo, Gajari, Vamshi, Rodriguez-Buitrago, Andres, Sethi, Manish, Tummuru, Rajesh R., DʼAlleyrand, Jean-Claude G., Allen, Lauren E., Collins, Susan C., Huang, Yanjie, and Taylor, Tara J.

Published
2024
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6. Predicting deep infection in pilon and tibial plateau fractures: a secondary analysis of the VANCO and OXYGEN trials.

Author

Overmann, Archie L., Carlini, Anthony R., O'Toole, Robert V., Castillo, Renan C., O'Hara, Nathan N., Carroll, Eben A., Goodman, James Brett, Holden, Martha B., Miller, Anna N., Spraggs-Hughes, Amanda, Brennan, Michael L., Tornetta III, Paul, Osborn, Patrick M., Rivera, Jessica C., Murray, Clinton K., Kimmel, Joseph E., Bosse, Michael J., Hsu, Joseph R., Karunakar, Madhav A., and Kempton, Laurence B.

Published
2024
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7. Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Exploratory Health-Related Quality of Life and Patient-Reported Functional Outcomes of a Multi-Centre 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

Author

Malekzadeh, A. Stephen, Nauth, Aaron, Perdue, Aaron, Mamun, Abdullah, Wasim, Abeer, Klein, Adam, Brandon, Adrienne, Theriault, Aimee, Garibaldi, Alisha, Liew, Allan, Atrey, Amit, Lialios-Ramfos, Anastasia, Spiguel, André, Howe, Andrea, Howe, Andrea L., Furey, Andrew, Marcantonio, Andrew J., Pollak, Andrew N., Schmidt, Andrew, Dowbenka, Ann, Mak, Anne, Sorkin, Anthony T., Sivananthan, Araby, Buck, Ashley, Okocha, Benita, Frye, Benjamin, Perey, Bertrand, Mohan, Bindu, Eyberg, Blake, Sumner, Bonnie, Fan, Brenda Chen, Lindsey, Brock, Schoonover, Carrie, Schwartzbach, Cary C., Lieder, Charles, Koenig, Chris, Boulton, Christina, LeBrun, Christopher, Jones, Clifford B., Barber, Collin, Donahue, Craig, Ventry, Cyndi, Carter, Cynthia, Williams, Dale, Richardson, Damien, Connelly, Daniel, Mascarenhas, Daniel, Squire, Daniel, Whelan, Daniel, Dias, Danyella, Viskontas, Darius, Roffey, Darren M., Hubbard, David, Stephen, David J.G., Shearer, David, Teague, David, Templeman, David, Walmsley, David, Malish, Dean, Sietsema, Debra L., Heels-Ansdell, Diane, Nam, Diane, Marinos, Dimitrius, Boyer, Dory, McDonough, E. Barry, Bogoch, Earl, Westrick, Edward, Pullenayegum, Eleanor M., Berhaneselase, Eleni, Agustin, Elizabeth, Schemitsch, Emil H., Meinberg, Eric, Baker, Erin, Moola, Farhad, Adamsahib, Fathima, Howells, Fiona, Wells, Garrett, Bal, George K., Reahl, George, Slobogean, Gerard P., Ramonas, Gitana, Guyatt, Gordon, Gaski, Greg E., Rocca, Gregory J. Della, Mueller, Gudrun Mirick, Lemke, H. Michael, Kreder, Hans J., Grant, Heather, Ahn, Henry, Broekhuyse, Henry, Leung, Irene, Goulet, James, Waddell, James, Lowe, Jason, Nascone, Jason W., Schulman, Jeff E., Potter, Jeffrey, Hagen, Jennifer, Hidy, Jennifer T., Westberg, Jerald R., Hall, Jeremy A., Burns, Jessica, Peattie, Jessica, Goodwin, Jill, Gagnier, Joel J., France, John, Iazzetta, John, Lubicky, John P., Garfi, John S., Kwong, Johnathan, Walker, Joseph, Hustedt, Joshua, Rudnicki, Joshua, Foxall, Julia, Robbins, Julie, Sadasivan, Kalia, Ryan, Karen, Walsh, Karen, Moon, Karyn, Polihronidis, Katerina, Ordonio, Katherine, Hatzifilalithis, Katrina, Milner, Katrine, Au, Keegan, Apostle, Kelly, Lefaivre, Kelly, Madden, Kim, Brown, Krista M., Swasey, Krystal, Jeray, Kyle, Deeter, Lakye, Fine, Landon, Parsons, Laura, Hill, Lauren C., Kempton, Laurence B., Thabane, Lehana, Buckingham, Lisa, Sutton, Lisa Giblin, Ramsey, Lolita, Swiontkowski, Marc, Sciadini, Marcus F., Hake, Mark, Richardson, Mark, Nousiainen, Markku, Bernaus, Martí, Heetveld, Martin J., Dietz, Matthew, Menon, Matthew, Patrick, Matthew, Zomar, Mauri, MacNevin, Melanie, Johnson, Melissa, Fuerst, Merryjessica, McKee, Michael D., Duran, Michael, Holzman, Michael, Lucero, Michael, Kain, Michael S.H., Bramer, Michelle A., Vogt, Michelle, Vicente, Milena R., Bhandari, Mohit, Kunz, Monica, Pekmezci, Murat, O'Hara, Nathan N., Harris, Nicole, Simunovic, Nicole, Sultana, Nigar, Dehghan, Niloofar, Clovis, Nina, Chutkan, Norman, Suthar, Paril, Henry, Patrick, Knaus, Paul, Muccino, Paul, Toogood, Paul, Berger, Peter, O'Brien, Peter, Rockwood, Peter, Johnson, Pierce, Guy, Pierre, Blachut, Piotr, Devereaux, PJ, Pritchard (Moon), Raely, Johal, Raman, Tuazon, Ravianne, Pensy, Raymond, Zaidi, Raza, Jenkinson, Richard J., Hymes, Robert A., McCormack, Robert, O'Toole, RobertV., Walker, Robert, Natoli, Roman, Meldrum, Russell, Bicknell, Ryan, DiGiovanni, Ryan, Montalvo, Ryan, Shelhamer, Ryan, Morshed, Saam, McFarland, Sara, Anthony, Sarah, Ward, Sarah, Ahmed, Sarim, Daffner, Scott, Karr, Sean, Mitchell, Sean, Haaser, Sharon, Rye, Sheila, Sprague, Sheila, Davis, Sherri, Weir, Sherry, Bzovsky, Sofia, Brisbane, Sonya, Papp, Steven, Beltz, Susan, Liew, Susan, Mauro, Susan, Murphy, T. Ryan, Moore, Tara, Scott, Taryn, Dykes, Taylor, Manson, Theodore, DiPasquale, Thomas, Belaye, Tigist, Daniels, Timothy, Carter, Tina, Oliver, Todd M., McKinley, Todd O., Salopek, Traci, Stone, Trevor, Caron, Troy, Tufescu, Tudor V., Leviton, Tzivia, Keough, Valisha, Jones, Vicki, Eglseder Jr., W. Andrew, Gofton, Wade, Virkus, Walter W., Ghent, Wesley, Degani, Yasmin, Hannaford, Zeta, Murdoch, Zoe, O'Toole, Robert V., and Della Rocca, Gregory J.

Published
2021
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8. Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement

Author

Dibbern, Kevin, Kempton, Laurence B, Higgins, Thomas F, Morshed, Saam, McKinley, Todd O, Marsh, J Lawrence, and Anderson, Donald D

Subjects
Physical Injury - Accidents and Adverse Effects, Arthritis, Aging, Injuries and accidents, Musculoskeletal, Energy Transfer, Humans, Severity of Illness Index, Software, Tibial Fractures, tibial plateau, tibial pilon, fracture severity, post-traumatic OA, Biomedical Engineering, Clinical Sciences, Human Movement and Sports Sciences, Orthopedics
Abstract

Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated whether clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and 52 tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2-33.2 Joules (J) and 3.6-32.2 J, respectively, and articular fracture edge lengths were 68.0-493.0 mm and 56.1-288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p

Published
2017

9. Objective Metric of Energy Absorbed in Tibial Plateau Fractures Corresponds Well to Clinician Assessment of Fracture Severity

Author

Kempton, Laurence B, Dibbern, Kevin, Anderson, Donald D, Morshed, Saam, Higgins, Thomas F, Marsh, J Lawrence, and McKinley, Todd O

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Injuries and accidents, Musculoskeletal, Biomechanical Phenomena, Humans, Severity of Illness Index, Stress, Mechanical, Tibial Fractures, Tomography, X-Ray Computed, tibial plateau fracture, fracture energy, quantifying fracture severity, Orthopedics, Clinical sciences
Abstract

ObjectivesDetermine the agreement between subjective assessments of fracture severity and an objective computed tomography (CT)-based metric of fracture energy in tibial plateau fractures.MethodsSix fellowship-trained orthopaedic trauma surgeons independently rank-ordered 20 tibial plateau fractures in terms of severity based on anteroposterior and lateral knee radiographs. A CT-based image analysis methodology was used to quantify the fracture energy, and agreement between the surgeons' severity rankings and the fracture energy metric was tested by computing their concordance, a statistical measure that estimates the probability that any 2 cases would be ranked with the same ordering by 2 different raters or methods.ResultsConcordance between the 6 orthopaedic surgeons ranged from 82% to 93%, and concordance between surgeon severity rankings and the computed fracture energy ranged from 73% to 78%.ConclusionsThere is a high level of agreement between experienced surgeons in their assessments of tibial plateau fracture severity, and a slightly lower agreement between the surgeon assessments and an objective CT-based metric of fracture energy. Taken together, these results suggest that experienced surgeons share a similar understanding of what makes a tibial plateau fracture more or less severe, and an objective CT-based metric of fracture energy captures much but not all of that information. Further research is ongoing to characterize the relationship between surgeon assessments of severity, fracture energy, and the eventual clinical outcomes for patients with fractures of the tibial plateau.

Published
2016

10. The 1-Year Economic Impact of Work Productivity Loss Following Severe Lower Extremity Trauma

Author

Levy, Joseph F., Reider, Lisa, Scharfstein, Daniel O., Pollak, Andrew N., Morshed, Saam, Firoozabadi, Reza, Archer, Kristin R., Gary, Joshua L., O’Toole, Robert V., Castillo, Renan C., Quinnan, Stephen M., Kempton, Laurence B., Jones, Clifford B., Bosse, Michael J., MacKenzie, Ellen J., Altman, Gregory T., McAndrew, Christopher M., Reilly, Rachel M., Mullis, Brian H., Mir, Hassan R., Shah, Anjan R., Reisman, William M., Taylor, Benjamin C., Schmidt, Andrew H., McKinley, Todd O., Sorkin, Anthony, Virkus, Walter W., Gaski, Greg E., Konda, Sanjit R., Vallier, Heather A., Frisch, H. Michael, Sheu, Robert G., Toledano, James E., Cannada, Lisa K., Langford, Joshua, Zych, Gregory A., Hutson, James J., Jr., Osborn, Patrick M., Spitler, Clay A., Miclau, Theodore, Wilken, Jason M., Bergin, Patrick F., Teague, David, Moloney, Gele B., Sathy, Ashoke K., Obremskey, William, Carroll, Eben A., Potter, Benjamin K., Carlini, Anthony R., Keita, Maningbe, and Luly, Jason

Published
2022
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11. Patient-Specific Precision Injury Signatures to Optimize Orthopaedic Interventions in Multiply Injured Patients (PRECISE STUDY)

Author

McKinley, Todd O., Gaski, Greg E., Billiar, Timothy R., Vodovotz, Yoram, Brown, Krista M., Elster, Eric A., Constantine, Greg M., Schobel, Seth A., Robertson, Henry T., Meagher, Ashley D., Firoozabadi, Reza, Gary, Joshua L., OʼToole, Robert V., Aneja, Arun, Trochez, Karen M., Kempton, Laurence B., Steenburg, Scott D., Collins, Susan C., Frey, Katherine P., and Castillo, Renan C.

Published
2022
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12. Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center

Author

Braswell, Matthew, Wally, Meghan K., Kempton, Laurence B., Seymour, Rachel B., Hsu, Joseph R., Karunakar, Madhav, Afetse, K. Eddie, Bailey, Gisele, Bosse, Michael, Brownrigg, Maggie, Cuadra, Mario, Dixon, Amy, Girardi, Cara, Grochowski, Erica, Hysong, Alexander, Jolissaint, Josef, Macknet, David, Mayberry, R. Miles, Moody, Patrick, Peterson, Katheryn, Phelps, Kevin D., Pollock, Hannah, Posey, Samuel L., Reid, Risa, Roe, Kris, Scannell, Brian, Sims, Stephen, Stanley, Amber, and Wohler, Andrew D.

Published
2021
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17. Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial.

Author

Joshi, Manjari, O'Toole, Robert V., Carlini, Anthony R., Gary, Joshua L., Obremskey, William T., Murray, Clinton K., Gaski, Greg, Reid, J. Spence, Degani, Yasmin, Taylor, Tara J., Collins, Susan C., Huang, Yanjie, Whiting, Paul S., Patterson, Joseph T., Lee, Olivia C., Castillo, Renan C., Bosse, Michael J., Hsu, Joseph R., Karunakar, Madhav A., and Kempton, Laurence B.

Published
2024
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24. Damage Control

Author

Kempton, Laurence B., Bosse, Michael J., Sethi, Manish K., editor, Jahangir, A. Alex, editor, and Obremskey, William T., editor

Published
2013
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28. Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Exploratory Health-Related Quality of Life and Patient-Reported Functional Outcomes of a Multi-Centre 2 × 2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients

Author

Slobogean, Gerard P., primary, Sprague, Sheila, additional, Bzovsky, Sofia, additional, Scott, Taryn, additional, Thabane, Lehana, additional, Heels-Ansdell, Diane, additional, O'Toole, Robert V., additional, Howe, Andrea, additional, Gaski, Greg E., additional, Hill, Lauren C., additional, Brown, Krista M., additional, Viskontas, Darius, additional, Zomar, Mauri, additional, Della Rocca, Gregory J., additional, O'Hara, Nathan N., additional, Bhandari, Mohit, additional, Malekzadeh, A. Stephen, additional, Nauth, Aaron, additional, Perdue, Aaron, additional, Mamun, Abdullah, additional, Wasim, Abeer, additional, Klein, Adam, additional, Brandon, Adrienne, additional, Theriault, Aimee, additional, Garibaldi, Alisha, additional, Liew, Allan, additional, Atrey, Amit, additional, Lialios-Ramfos, Anastasia, additional, Spiguel, André, additional, Howe, Andrea L., additional, Furey, Andrew, additional, Marcantonio, Andrew J., additional, Pollak, Andrew N., additional, Schmidt, Andrew, additional, Dowbenka, Ann, additional, Mak, Anne, additional, Sorkin, Anthony T., additional, Sivananthan, Araby, additional, Buck, Ashley, additional, Okocha, Benita, additional, Frye, Benjamin, additional, Perey, Bertrand, additional, Mohan, Bindu, additional, Eyberg, Blake, additional, Sumner, Bonnie, additional, Fan, Brenda Chen, additional, Lindsey, Brock, additional, Schoonover, Carrie, additional, Schwartzbach, Cary C., additional, Lieder, Charles, additional, Koenig, Chris, additional, Boulton, Christina, additional, LeBrun, Christopher, additional, Jones, Clifford B., additional, Barber, Collin, additional, Donahue, Craig, additional, Ventry, Cyndi, additional, Carter, Cynthia, additional, Williams, Dale, additional, Richardson, Damien, additional, Connelly, Daniel, additional, Mascarenhas, Daniel, additional, Squire, Daniel, additional, Whelan, Daniel, additional, Dias, Danyella, additional, Roffey, Darren M., additional, Hubbard, David, additional, Stephen, David J.G., additional, Shearer, David, additional, Teague, David, additional, Templeman, David, additional, Walmsley, David, additional, Malish, Dean, additional, Sietsema, Debra L., additional, Nam, Diane, additional, Marinos, Dimitrius, additional, Boyer, Dory, additional, McDonough, E. Barry, additional, Bogoch, Earl, additional, Westrick, Edward, additional, Pullenayegum, Eleanor M., additional, Berhaneselase, Eleni, additional, Agustin, Elizabeth, additional, Schemitsch, Emil H., additional, Meinberg, Eric, additional, Baker, Erin, additional, Moola, Farhad, additional, Adamsahib, Fathima, additional, Howells, Fiona, additional, Wells, Garrett, additional, Bal, George K., additional, Reahl, George, additional, Slobogean, Gerard P., additional, Ramonas, Gitana, additional, Guyatt, Gordon, additional, Rocca, Gregory J. Della, additional, Mueller, Gudrun Mirick, additional, Lemke, H. Michael, additional, Kreder, Hans J., additional, Grant, Heather, additional, Ahn, Henry, additional, Broekhuyse, Henry, additional, Leung, Irene, additional, Goulet, James, additional, Waddell, James, additional, Lowe, Jason, additional, Nascone, Jason W., additional, Schulman, Jeff E., additional, Potter, Jeffrey, additional, Hagen, Jennifer, additional, Hidy, Jennifer T., additional, Westberg, Jerald R., additional, Hall, Jeremy A., additional, Burns, Jessica, additional, Peattie, Jessica, additional, Goodwin, Jill, additional, Gagnier, Joel J., additional, France, John, additional, Iazzetta, John, additional, Lubicky, John P., additional, Garfi, John S., additional, Kwong, Johnathan, additional, Walker, Joseph, additional, Hustedt, Joshua, additional, Rudnicki, Joshua, additional, Foxall, Julia, additional, Robbins, Julie, additional, Sadasivan, Kalia, additional, Ryan, Karen, additional, Walsh, Karen, additional, Moon, Karyn, additional, Polihronidis, Katerina, additional, Ordonio, Katherine, additional, Hatzifilalithis, Katrina, additional, Milner, Katrine, additional, Au, Keegan, additional, Apostle, Kelly, additional, Lefaivre, Kelly, additional, Madden, Kim, additional, Swasey, Krystal, additional, Jeray, Kyle, additional, Deeter, Lakye, additional, Fine, Landon, additional, Parsons, Laura, additional, Kempton, Laurence B., additional, Buckingham, Lisa, additional, Sutton, Lisa Giblin, additional, Ramsey, Lolita, additional, Swiontkowski, Marc, additional, Sciadini, Marcus F., additional, Hake, Mark, additional, Richardson, Mark, additional, Nousiainen, Markku, additional, Bernaus, Martí, additional, Heetveld, Martin J., additional, Dietz, Matthew, additional, Menon, Matthew, additional, Patrick, Matthew, additional, MacNevin, Melanie, additional, Johnson, Melissa, additional, Fuerst, Merryjessica, additional, McKee, Michael D., additional, Duran, Michael, additional, Holzman, Michael, additional, Lucero, Michael, additional, Kain, Michael S.H., additional, Bramer, Michelle A., additional, Vogt, Michelle, additional, Vicente, Milena R., additional, Kunz, Monica, additional, Pekmezci, Murat, additional, Harris, Nicole, additional, Simunovic, Nicole, additional, Sultana, Nigar, additional, Dehghan, Niloofar, additional, Clovis, Nina, additional, Chutkan, Norman, additional, Suthar, Paril, additional, Henry, Patrick, additional, Knaus, Paul, additional, Muccino, Paul, additional, Toogood, Paul, additional, Berger, Peter, additional, O'Brien, Peter, additional, Rockwood, Peter, additional, Johnson, Pierce, additional, Guy, Pierre, additional, Blachut, Piotr, additional, Devereaux, PJ, additional, Pritchard (Moon), Raely, additional, Johal, Raman, additional, Tuazon, Ravianne, additional, Pensy, Raymond, additional, Zaidi, Raza, additional, Jenkinson, Richard J., additional, Hymes, Robert A., additional, McCormack, Robert, additional, O'Toole, RobertV., additional, Walker, Robert, additional, Natoli, Roman, additional, Meldrum, Russell, additional, Bicknell, Ryan, additional, DiGiovanni, Ryan, additional, Montalvo, Ryan, additional, Shelhamer, Ryan, additional, Morshed, Saam, additional, McFarland, Sara, additional, Anthony, Sarah, additional, Ward, Sarah, additional, Ahmed, Sarim, additional, Daffner, Scott, additional, Karr, Sean, additional, Mitchell, Sean, additional, Haaser, Sharon, additional, Rye, Sheila, additional, Davis, Sherri, additional, Weir, Sherry, additional, Brisbane, Sonya, additional, Papp, Steven, additional, Beltz, Susan, additional, Liew, Susan, additional, Mauro, Susan, additional, Murphy, T. Ryan, additional, Moore, Tara, additional, Dykes, Taylor, additional, Manson, Theodore, additional, DiPasquale, Thomas, additional, Belaye, Tigist, additional, Daniels, Timothy, additional, Carter, Tina, additional, Oliver, Todd M., additional, McKinley, Todd O., additional, Salopek, Traci, additional, Stone, Trevor, additional, Caron, Troy, additional, Tufescu, Tudor V., additional, Leviton, Tzivia, additional, Keough, Valisha, additional, Jones, Vicki, additional, Eglseder Jr., W. Andrew, additional, Gofton, Wade, additional, Virkus, Walter W., additional, Ghent, Wesley, additional, Degani, Yasmin, additional, Hannaford, Zeta, additional, and Murdoch, Zoe, additional

Published
2021
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33. Response to Letter to the Editor

Author

Virkus, Walter W., primary, Wetzel, Robert J., additional, McKinley, Todd O., additional, Sorkin, Anthony T., additional, Cheeseman, Jeffery S., additional, Hill, Lauren C., additional, and Kempton, Laurence B., additional

Published
2018
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40. In Response

Author

Kempton, Laurence B., primary, Larson, Timothy B., additional, Montijo, Harvey E., additional, Seymour, Rachel B., additional, Getz, Stanley B., additional, and Bosse, Michael J., additional

Published
2015
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43. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial

Author

O’Toole, Robert V., Joshi, Manjari, Carlini, Anthony R., Murray, Clinton K., Allen, Lauren E., Huang, Yanjie, Scharfstein, Daniel O., O’Hara, Nathan N., Gary, Joshua L., Bosse, Michael J., Castillo, Renan C., Bishop, Julius A., Weaver, Michael J., Firoozabadi, Reza, Hsu, Joseph R., Karunakar, Madhav A., Seymour, Rachel B., Sims, Stephen H., Churchill, Christine, Brennan, Michael L., Gonzales, Gabriela, Reilly, Rachel M., Zura, Robert D., Howes, Cameron R., Mir, Hassan R., Wagstrom, Emily A., Westberg, Jerald, Gaski, Greg E., Kempton, Laurence B., Natoli, Roman M., Sorkin, Anthony T., Virkus, Walter W., Hill, Lauren C., Hymes, Robert A., Holzman, Michael, Malekzadeh, A. Stephen, Schulman, Jeff E., Ramsey, Lolita, Cuff, Jaslynn A. N., Haaser, Sharon, Osgood, Greg M., Shafiq, Babar, Laljani, Vaishali, Lee, Olivia C., Krause, Peter C., Rowe, Cara J., Hilliard, Colette L., Morandi, Massimo Max, Mullins, Angela, Achor, Timothy S., Choo, Andrew M., Munz, John W., Boutte, Sterling J., Vallier, Heather A., Breslin, Mary A., Frisch, H. Michael, Kaufman, Adam M., Large, Thomas M., LeCroy, C. Michael, Riggsbee, Christina, Smith, Christopher S., Crickard, Colin V., Phieffer, Laura S., Sheridan, Elizabeth, Jones, Clifford B., Sietsema, Debra L., Reid, J. Spence, Ringenbach, Kathy, Hayda, Roman, Evans, Andrew R., Crisco, M.J., Rivera, Jessica C., Osborn, Patrick M., Kimmel, Joseph, Stawicki, Stanislaw P., Nwachuku, Chinenye O., Wojda, Thomas R., Rehman, Saqib, Donnelly, Joanne M., Caroom, Cyrus, Jenkins, Mark D., Boulton, Christina L., Costales, Timothy G., LeBrun, Christopher T., Manson, Theodore T., Mascarenhas, Daniel C., Nascone, Jason W., Pollak, Andrew N., Sciadini, Marcus F., Slobogean, Gerard P., Berger, Peter Z., Connelly, Daniel W., Degani, Yasmin, Howe, Andrea L., Marinos, Dimitrius P., Montalvo, Ryan N., Reahl, G. Bradley, Schoonover, Carrie D., Schroder, Lisa K., Vang, Sandy, Bergin, Patrick F., Graves, Matt L., Russell, George V., Spitler, Clay A., Hydrick, Josie M., Teague, David, Ertl, William, Hickerson, Lindsay E., Moloney, Gele B., Weinlein, John C., Zelle, Boris A., Agarwal, Animesh, Karia, Ravi A., Sathy, Ashoke K., Au, Brigham, Maroto, Medardo, Sanders, Drew, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Weiss, David B., Yarboro, Seth R., McVey, Eric D., Lester-Ballard, Veronica, Goodspeed, David, Lang, Gerald J., Whiting, Paul S., Siy, Alexander B., Obremskey, William T., Jahangir, A. Alex, Attum, Basem, Burgos, Eduardo J., Molina, Cesar S., Rodriguez-Buitrago, Andres, Gajari, Vamshi, Trochez, Karen M., Halvorson, Jason J., Miller, Anna N., Goodman, James Brett, Holden, Martha B., McAndrew, Christopher M., Gardner, Michael J., Ricci, William M., Spraggs-Hughes, Amanda, Collins, Susan C., Taylor, Tara J., and Zadnik, Mary

Abstract

IMPORTANCE: Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist. OBJECTIVE: To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections. DESIGN, SETTING, AND PARTICIPANTS: This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers. INTERVENTIONS: A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder. MAIN OUTCOMES AND MEASURES: The primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence. RESULTS: The analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, –3.4%; 95% CI, –6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, –3.7%; 95% CI, –6.7% to –0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, –1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections. CONCLUSIONS AND RELEVANCE: Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02227446

Published
2021
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44. Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma

Author

Castillo, Renan C., Huang, Yanjie, Scharfstein, Daniel, Frey, Katherine, Bosse, Michael J., Pollak, Andrew N., Vallier, Heather A., Archer, Kristin R., Hymes, Robert A., Newcomb, Anna B., MacKenzie, Ellen J., Wegener, Stephen, Hsu, Joseph R., Karunakar, Madhav A., Seymour, Rachel B., Sims, Stephen H., Flores, Eileen, Churchill, Christine, Hak, David J., Henderson, Corey E., Mir, Hassan R., Chan, Daniel S., Shah, Anjan R., Steverson, Barbara, Westberg, Jerald, Gary, Joshua L., Achor, Timothy S., Choo, Andrew, Munz, John W., Porrey, Melissa, Hendrickson, Sarah, Breslin, Mary A., McKinley, Todd O., Gaski, Greg E., Kempton, Laurence B., Sorkin, Anthony T., Virkus, Walter W., Hill, Lauren C., Jones, Clifford B., Sietsema, Debra L., O’Toole, Robert V., Ordonio, Katherine, Howe, Andrea L., Zerhusen, Timothy J., Obremskey, William, Boyce, Robert H., Jahangir, A. Alex, Molina, Cesar S., Sethi, Manish K., Vanston, Susan W., Carroll, Eben A., Drye, Danielle Yemiola, Holden, Martha B., Collins, Susan C., and Wysocki, Elizabeth

Abstract

IMPORTANCE: Numerous studies have demonstrated that long-term outcomes after orthopedic trauma are associated with psychosocial and behavioral health factors evident early in the patient’s recovery. Little is known about how to identify clinically actionable subgroups within this population. OBJECTIVES: To examine whether risk and protective factors measured at 6 weeks after injury could classify individuals into risk clusters and evaluate whether these clusters explain variations in 12-month outcomes. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted between July 16, 2013, and January 15, 2016, among 352 patients with severe orthopedic injuries at 6 US level I trauma centers. Statistical analysis was conducted from October 9, 2017, to July 13, 2018. MAIN OUTCOMES AND MEASURES: At 6 weeks after discharge, patients completed standardized measures for 5 risk factors (pain intensity, depression, posttraumatic stress disorder, alcohol abuse, and tobacco use) and 4 protective factors (resilience, social support, self-efficacy for return to usual activity, and self-efficacy for managing the financial demands of recovery). Latent class analysis was used to classify participants into clusters, which were evaluated against measures of function, depression, posttraumatic stress disorder, and self-rated health collected at 12 months. RESULTS: Among the 352 patients (121 women and 231 men; mean [SD] age, 37.6 [12.5] years), latent class analysis identified 6 distinct patient clusters as the optimal solution. For clinical use, these clusters can be collapsed into 4 groups, sorted from low risk and high protection (best) to high risk and low protection (worst). All outcomes worsened across the 4 clinical groupings. Bayesian analysis shows that the mean Short Musculoskeletal Function Assessment dysfunction scores at 12 months differed by 7.8 points (95% CI, 3.0-12.6) between the best and second groups, by 10.3 points (95% CI, 1.6-20.2) between the second and third groups, and by 18.4 points (95% CI, 7.7-28.0) between the third and worst groups. CONCLUSIONS AND RELEVANCE: This study demonstrates that during early recovery, patients with orthopedic trauma can be classified into risk and protective clusters that account for a substantial amount of the variance in 12-month functional and health outcomes. Early screening and classification may allow a personalized approach to postsurgical care that conserves resources and targets appropriate levels of care to more patients.

Published
2019
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46. "Relationship of Neural Axis Level of Injury to Motor Recovery and Health-Related Quality of Life in Patients with a Thoracolumbar Spinal Injury.".

Author

Kempton, Laurence B. and Herkowitz, Harry N.

Subjects
*SPINAL injuries, *BACK injuries, *NERVOUS system injuries, *WOUNDS & injuries, *QUALITY of life, *SPINE, *PHYSICAL diagnosis, *PROGNOSIS, *MAGNETIC resonance imaging
Abstract

The authors discusses a report within the issue, "Relationship of Neural Axis Level of Injury to Motor Recovery and Health-Related Quality of Life in Patients with a Thoracolumbar Spinal Injury," by Stephen P. Kingwell and colleagues. The study looks at the role of neural axis injury in the prognosis of spinal injury, focusing on the analysis of spinal magnetic resonance imaging (MRI). It is noted that neurological deficits diagnosed with physical examination are not included in the study.

Published
2010
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47. Can researchers trust ICD-10 coding of medical comorbidities in orthopaedic trauma patients?

Author

Arthur R, Mayberry RM, Odum S, and Kempton LB

Abstract

Objectives: The 10th revision of the International Classification of Diseases (ICD-10) coding system may prove useful to orthopaedic trauma researchers to identify and document populations based on comorbidities. However, its use for research first necessitates determination of its reliability. The purpose of this study was to assess the reliability of electronic medical record (EMR) ICD-10 coding of nonorthopaedic diagnoses in orthopaedic trauma patients relative to the gold standard of prospective data collection., Design: Nonexperimental cross-sectional study., Setting: Level 1 Trauma Center., Patients/participants: Two hundred sixty-three orthopaedic trauma patients from 2 prior prospective studies from September 2018 to April 2022., Intervention: Prospectively collected data were compared with EMR ICD-10 code abstraction for components of the Charlson Comorbidity Index (CCI), obesity, alcohol abuse, and tobacco use (retrospective data)., Main Outcome Measurements: Percent agreement and Cohen's kappa reliability., Results: Percent agreement ranged from 86.7% to 96.9% for all CCI diagnoses and was as low as 72.6% for the diagnosis "overweight." Only 2 diagnoses, diabetes without end-organ damage (kappa = 0.794) and AIDS (kappa = 0.798) demonstrated Cohen's kappa values to indicate substantial agreement., Conclusion: EMR diagnostic coding for medical comorbidities in orthopaedic trauma patients demonstrated variable reliability. Researchers may be able to rely on EMR coding to identify patients with diabetes without complications or AIDS. Chart review may still be necessary to confirm diagnoses. Low prevalence of most comorbidities led to high percentage agreement with low reliability., Level of Evidence: Level 1 diagnostic., Competing Interests: No conflicts of interest were declared by the authors. This manuscript received no funding. This manuscript is an original work and has not been previously published and is not under consideration by any other publication., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.)

Published
2024
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48. 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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49. Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial.

Author

O'Toole RV, Joshi M, Carlini AR, Murray CK, Allen LE, Huang Y, Scharfstein DO, O'Hara NN, Gary JL, Bosse MJ, Castillo RC, Bishop JA, Weaver MJ, Firoozabadi R, Hsu JR, Karunakar MA, Seymour RB, Sims SH, Churchill C, Brennan ML, Gonzales G, Reilly RM, Zura RD, Howes CR, Mir HR, Wagstrom EA, Westberg J, Gaski GE, Kempton LB, Natoli RM, Sorkin AT, Virkus WW, Hill LC, Hymes RA, Holzman M, Malekzadeh AS, Schulman JE, Ramsey L, Cuff JAN, Haaser S, Osgood GM, Shafiq B, Laljani V, Lee OC, Krause PC, Rowe CJ, Hilliard CL, Morandi MM, Mullins A, Achor TS, Choo AM, Munz JW, Boutte SJ, Vallier HA, Breslin MA, Frisch HM, Kaufman AM, Large TM, LeCroy CM, Riggsbee C, Smith CS, Crickard CV, Phieffer LS, Sheridan E, Jones CB, Sietsema DL, Reid JS, Ringenbach K, Hayda R, Evans AR, Crisco MJ, Rivera JC, Osborn PM, Kimmel J, Stawicki SP, Nwachuku CO, Wojda TR, Rehman S, Donnelly JM, Caroom C, Jenkins MD, Boulton CL, Costales TG, LeBrun CT, Manson TT, Mascarenhas DC, Nascone JW, Pollak AN, Sciadini MF, Slobogean GP, Berger PZ, Connelly DW, Degani Y, Howe AL, Marinos DP, Montalvo RN, Reahl GB, Schoonover CD, Schroder LK, Vang S, Bergin PF, Graves ML, Russell GV, Spitler CA, Hydrick JM, Teague D, Ertl W, Hickerson LE, Moloney GB, Weinlein JC, Zelle BA, Agarwal A, Karia RA, Sathy AK, Au B, Maroto M, Sanders D, Higgins TF, Haller JM, Rothberg DL, Weiss DB, Yarboro SR, McVey ED, Lester-Ballard V, Goodspeed D, Lang GJ, Whiting PS, Siy AB, Obremskey WT, Jahangir AA, Attum B, Burgos EJ, Molina CS, Rodriguez-Buitrago A, Gajari V, Trochez KM, Halvorson JJ, Miller AN, Goodman JB, Holden MB, McAndrew CM, Gardner MJ, Ricci WM, Spraggs-Hughes A, Collins SC, Taylor TJ, and Zadnik M

Subjects
Adult, Anti-Bacterial Agents administration & dosage, Double-Blind Method, Female, Fracture Fixation, Internal adverse effects, Fractures, Ununited etiology, Humans, Intra-Articular Fractures surgery, Male, Middle Aged, Powders, Probability, Prospective Studies, Surgical Wound Dehiscence etiology, Surgical Wound Infection etiology, Time Factors, Vancomycin administration & dosage, Anti-Bacterial Agents therapeutic use, Gram-Negative Bacterial Infections prevention & control, Gram-Positive Bacterial Infections prevention & control, Surgical Wound Infection prevention & control, Tibial Fractures surgery, Vancomycin therapeutic use
Abstract

Importance: Despite the widespread use of systemic antibiotics to prevent infections in surgically treated patients with fracture, high rates of surgical site infection persist., Objective: To examine the effect of intrawound vancomycin powder in reducing deep surgical site infections., Design, Setting, and Participants: This open-label randomized clinical trial enrolled adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers., Interventions: A standard infection prevention protocol with (n = 481) or without (n = 499) 1000 mg of intrawound vancomycin powder., Main Outcomes and Measures: The primary outcome was a deep surgical site infection within 182 days of definitive fracture fixation. A post hoc comparison assessed the treatment effect on gram-positive and gram-negative-only infections. Other secondary outcomes included superficial surgical site infection, nonunion, and wound dehiscence., Results: The analysis included 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. Within 182 days, deep surgical site infection was observed in 29 of 481 patients in the treatment group and 46 of 499 patients in the control group. The time-to-event estimated probability of deep infection by 182 days was 6.4% in the treatment group and 9.8% in the control group (risk difference, -3.4%; 95% CI, -6.9% to 0.1%; P = .06). A post hoc analysis of the effect of treatment on gram-positive (risk difference, -3.7%; 95% CI, -6.7% to -0.8%; P = .02) and gram-negative-only (risk difference, 0.3%; 95% CI, -1.6% to 2.1%; P = .78) infections found that the effect of vancomycin powder was a result of its reduction in gram-positive infections., Conclusions and Relevance: Among patients with operatively treated tibial articular fractures at a high risk of infection, intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin., Trial Registration: ClinicalTrials.gov Identifier: NCT02227446.

Published
2021
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50. Assessment of axonal growth into collagen nerve guides containing VEGF-transfected stem cells in matrigel.

Author

Kempton LB, Gonzalez MH, Leven RM, Hughes WF, Beddow S, Santhiraj Y, Archibald SJ, El Hassan B, Shott S, and Kerns JM

Subjects
Animals, Axons ultrastructure, Collagen, Drug Combinations, Laminin, Mesenchymal Stem Cells ultrastructure, Mice, Proteoglycans, Rats, Rats, Inbred F344, Recombinant Proteins genetics, Recombinant Proteins metabolism, Tissue Culture Techniques, Tissue Engineering, Tissue Scaffolds, Transfection, Axons physiology, Guided Tissue Regeneration methods, Mesenchymal Stem Cells physiology, Nerve Regeneration physiology, Vascular Endothelial Growth Factor A genetics, Vascular Endothelial Growth Factor A physiology
Abstract

The early events associated with axonal growth into 10-mm nerve gaps were studied histologically in the rat sciatic nerve model to determine if the outgrowth of blood vessels, Schwann cells, and axons could be enhanced. In the first two experimental groups, collagen nerve guides were filled with either saline or Matrigel. Marrow-derived mesenchymal stem cells (MSCs) were added to Matrigel in two other groups, one of which contained cells transfected with VEGF (MSC/VEGF). After 21 days, the injury site was exposed, fixed, sectioned, and volume fractions of the conduit contents were determined by point counting. The bioresorbable collagen conduits appropriately guided the axons and vessels in a longitudinal direction. The volume fraction of axons was significantly greater in the group with saline when compared with all three groups with Matrigel. This measure had a significant positive correlation with actual counts of myelinated axons. The blood vessel volume fraction in the Matrigel group decreased compared with the saline group, but was restored in the MSC/VEGF group. All Matrigel groups had comparable cellularity and showed a distribution of residual Matrigel in acellular zones. The saline group, by contrast, sustained a network of delicate fibroblastic processes that compartmentalized the nerve and its natural matrix as it became infiltrated by axons as minifascicles. In conclusion, the reduction of axonal outgrowth in the Matrigel groups, when compared with the saline group, suggests that Matrigel may impede the early regenerative process even when enriched by the addition of MSCs or VEGF-transfected cells., ((c) 2008 Wiley-Liss, Inc.)

Published
2009
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