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BACKGROUND: Open tibial fractures have a high risk of infection that can lead to severe morbidity. Antibiotics administered locally at the site of the open wound are a potentially effective preventive measure, but there are limited data evaluating aminoglycoside antibiotics. The objective of this study was to assess the feasibility of a clinical trial to test the efficacy of local gentamicin in reducing the risk of fracture-related infection after open tibial fracture. METHODS: This study is a single-center, pilot, masked, randomized controlled trial conducted at the Muhimbili Orthopaedic Institute. Participants were randomized intraoperatively after wound closure to receive gentamicin solution or normal saline solution injected at the fracture site. Follow-ups were completed at 2 weeks, 6 weeks, 3 months, 6 months, 9 months, and 1 year postoperatively. The primary feasibility outcomes were the rate of enrollment and retention. The primary clinical outcome was the occurrence of fracture-related infection. RESULTS: Of 199 patients screened, 100 eligible patients were successfully enrolled and randomized over 9 months (11.1 patients/month). Complete data were recorded at baseline and follow-up for >95% of cases. The rate of follow-up at 6 weeks, 3 months, 6 months, 9 months, and 1 year were 70%, 68%, 69%, 61%, and 80%, respectively. There was no difference in adverse events or any of the measured primary and secondary outcomes. CONCLUSION: This pilot study is among the first to evaluate locally administered gentamicin in open tibial fractures. Results indicate a rigorous clinical trial with acceptable rates of enrollment and follow-up to address this topic is possible in this setting.

Objective: To examine the prevalence of drug use among individuals (age 16+) injured in non-fatal motor vehicle crashes (MVCs) from 2019 to 2023 and assess regional differences based on US Census regions (i.e., West, Midwest, Northeast, and South), and thereby contribute to a comprehensive understanding of drug-related MVCs., Methods: We examined emergency medical services data from 19 US states (January 2019 to December 2023) to determine the annual mean drug use prevalence among individuals (age 16+) injured in non-fatal MVCs. Differences in drug use prevalence were assessed using ANOVA with the Tukey-Kramer test for year-to-year comparisons. Adjusted Poisson regression models with random effect for states were used to compare trends to the baseline (i.e., 2019) and to assess regional differences., Results: Among individuals (age 16+) injured in non-fatal MVCs, 62,310 had reported drug use. ANOVA results showed significant year-to-year differences in the prevalence of drug use among individuals injured in non-fatal MVCs, with an increase from 2019 to 2020 and a subsequent decrease from 2020 to 2023 ( p  < 0.05). Compared to the baseline year of 2019, the prevalence in 2020 was 1.34 times (95% confidence interval [CI]: 1.12, 1.61) the prevalence in 2019. The prevalence in 2022 and 2023 were similar to the 2019 prevalence. Although no significant associations were found between US regions and the overall mean prevalence from 2019 to 2023; there was a difference in the average annual rate of change in prevalence by region, with a 4.0% lower rate in the Midwest compared to the Northeast ( p  < 0.001). This signifies a need to monitor future trends for potential regional differences., Conclusions: Drug use prevalence among individuals (age 16+) injured in non-fatal MVCs increased from 2019 to 2020; then decreased to levels reflecting baseline prevalence in 2019; with no significant regional differences in the overall mean crash-related drug use prevalence. These findings highlight the need for continuous surveillance across the US over an extended period. They also underscore the potential impact of environmental risk factors, such as the COVID-19 pandemic, and the necessity to monitor how drug use prevalence related to non-fatal MVCs changes in the coming years.

Background: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts., Methods: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identified themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted., Results: Responses were categorized into the following themes: 1) being over-worked from increased call volume; 2) increased risk for personal harm when responding to patients; 3) compassion fatigue due to long hours and repeat calls for the same people; 4) conflicting perceptions of the utility of naloxone; 5) the need for better treatment options to respond to opioid crisis on top of COVID-19., Conclusions: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues., Competing Interests: Conflict of interest There are no other competing interests to declare.

Interest in clinical rotations in low- and middle-income countries (LMICs) has grown among high-income country (HIC) orthopaedic residents. This study addresses the following questions: (1) What motivates HIC surgical residents to rotate in LMICs? (2) What is the impact of rotations on HIC residents? (3) What are the LMIC partner perceptions of HIC collaboration?, Materials and Methods: A search strategy of multiple databases returned 3,740 unique articles pertaining to HIC surgical resident motivations for participating in rotations in LMICs or the LMIC host perspective. Data extraction was dually performed using meta-ethnography, the qualitative equivalent of meta-analysis., Results: Twenty-one studies were included in the final analysis. HIC residents were primarily motivated to rotate in LMICs by altruistic intent, with greatest impact on professional development. LMIC partners mostly valued HIC sustained investment and educational opportunities for LMIC partners. From LMIC's perspective, potential harm from collaboration arose from system-level and individual-level discordance between HIC and LMIC expectations and priorities. HIC priorities included the following: (1) adequate operative time, (2) exposure to varied pathology, and (3) mentorship. LMIC priorities included the following: (1) avoiding competition with HIC residents for surgical cases, (2) that HIC groups not undermine LMIC internal authority, (3) that HIC initiatives address local LMIC needs, and (4) that LMIC partners be included as authors on HIC research initiatives. Both HIC and LMIC partners raised ethical concerns regarding collaboration and perceived HIC residents to be underprepared for their LMIC rotation., Discussion: This study synthesizes the available literature on HIC surgical resident motivations for and impact of rotating in LMICs and the LMIC host perception of collaboration. Three improvement categories emerged: that residents (1) receive site-specific preparation before departure, (2) remain in country long enough to develop site-specific skills, and (3) cultivate flexibility and cultural humility . Specific suggestions based on synthesized data are offered for each concept and can serve as a foundation for mutually beneficial international electives in LMICs for HIC orthopaedic trainees., (Copyright © 2020 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)