- Infection and Nonunion Rates in Open Fractures: Description of 6,042 Fractures from the FLOW and PREP-IT Trials. [Journal Article]
- CONCLUSIONS: Open fractures are a substantial problem with complications that include infection and nonunion. The present data are useful for prognosis, research study design, and informing public awareness and policy. These results show that, despite current treatment approaches, the rates of SSI and delayed union/nonunion following treatment of open fractures remain high at 1 year and are not substantially improved from historical rates spanning several decades. Although open fracture sequelae remain a burden for patients, orthopaedic surgeons, and health-care systems, there may be opportunities for improvement in outcomes.
- PMC Free PDF
- Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close: A Propensity Score-Matched Analysis. [Journal Article]J Bone Joint Surg Am. 2025 Jun 18; 107(Suppl 1):51-59.JB
- CONCLUSIONS: Fix-and-close treatment of open fractures of type IIIA and lower was associated with decreased odds of deep SSI within 90 days and reoperation for infection within 1 year without an increased risk of wound complications or nonunion and may be considered even in fractures with embedded contamination provided that adequate debridement is performed.
- Publisher Full Text (DOI)
- Impact of Living in a Food Desert on Complications After Fracture Surgery. [Journal Article]
- CONCLUSIONS: This study found a strong association between residing in a ZIP code containing a food desert and an increased rate of unplanned reoperation, which was primarily driven by delayed union or nonunion and wound-healing complications. Addressing nutritional deficiencies in this population may help to effectively triage the use of health-care resources. Further research should focus on clarifying specific deficiencies and assessing the effectiveness of targeted interventions.
- Publisher Full Text (DOI)
- Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures. [Journal Article]
- CONCLUSIONS: More temporary external fixation for open lower-extremity fractures was performed at hospitals with more surgeons treating fractures. There was no difference in SSI at 90 days or 1 year between patients who did and did not undergo temporary external fixation. Temporary external fixation tended to be used in more critically ill patients and patients with more severe fractures but was not associated with increased unplanned reoperations at 90 days or at 1 year.
- Publisher Full Text (DOI)
- Deep Infections After Open and Closed Fractures. [Journal Article]
- CONCLUSIONS: In patients with SSI, tissue samples yielded high rates of microbial culture results. There was a higher proportion of gram-negative organisms in open fractures. Gram-negative infections were also associated with earlier time to infection. Clinicians should not hesitate to take deep-tissue culture samples in patients with suspected SSI and should be prepared to encounter polymicrobial infections.
- Publisher Full Text (DOI)
- Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures. [Randomized Controlled Trial]J Bone Joint Surg Am. 2025 Jun 18; 107(Suppl 1):36-42.JB
- CONCLUSIONS: Among adult patients who underwent extremity or pelvic fracture surgery, preoperative CHG bathing was not associated with a significant reduction in SSI.
- Publisher Full Text (DOI)
- Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection. [Randomized Controlled Trial]
- CONCLUSIONS: Among extremity fractures that developed FRI, we were unable to detect differences in the rates of AMR between fractures treated with or without local antibiotic prophylactic strategies in our analysis of a randomized trial of various skin preparation solutions for extremity trauma surgery. These findings provide cautious reassurance regarding the safety of local antibiotics but underscore the need for further prospective analysis.
- Publisher Full Text (DOI)
- Outcomes Associated with Choice of Prophylactic Antibiotics in Open Fractures. [Journal Article]
- CONCLUSIONS: Among patients with open fractures, antibiotic prophylaxis with ceftriaxone monotherapy did not provide significant benefits compared with cefazolin monotherapy in preventing infection in Type-I and II fractures. The findings suggest that cefazolin plus gentamicin might reduce the odds of infection in Type-III fractures compared with cefazolin monotherapy, but this difference was not statistically significant.
- Publisher Full Text (DOI)
- Performance of the OTA-OFC3 Classification System for Open Fractures. [Journal Article]
- CONCLUSIONS: Simplifying the OTA-OFC to the new OTA-OFC3 significantly decreased its ability to predict unplanned reoperations and did not improve the ability to predict surgical site infection. These findings indicate that this newly proposed classification system, although clinically simpler, omits important prognostic information captured in the original OTA-OFC. Despite this limitation, the OTA-OFC3 demonstrated prognostic performance similar to that of the commonly used Gustilo-Anderson classification, and it may provide a clinically convenient way to communicate critical OTA-OFC information when all OTA-OFC domains are being assessed for research or quality-improvement purposes.
- Publisher Full Text (DOI)
- A Portfolio of Secondary Analyses from the PREP-IT Trial. [Journal Article]J Bone Joint Surg Am. 2025 Jun 18; 107(Suppl 1):1-3.JB
- Publisher Full Text (DOI)
- Alcohol-Based Versus Aqueous Skin Antisepsis Before Surgical Fixation of Open Fractures: A Combined Analysis of 2 Cluster-Randomized Crossover Trials. [Randomized Controlled Trial]J Bone Joint Surg Am. 2025 Jun 18; 107(Suppl 1):4-11.JB
- CONCLUSIONS: This analysis found no difference in the risk of SSI or reoperation when comparing alcohol-based and aqueous skin preparation solutions. Furthermore, this analysis demonstrated no harm with use of an alcohol-based solution for open fractures, and the PREPARE trial found that skin preparation with 0.7% iodine povacrylex in 74% isopropyl alcohol was associated with a reduced risk of SSI for closed fractures. Given these findings, surgeons may wish to consider streamlining their policy by treating all fractures with a single skin antiseptic, 0.7% iodine povacrylex in 74% isopropyl alcohol.
- Publisher Full Text (DOI)
- Improving Patient Recall Following Operative Orthopaedic Trauma. [Journal Article]J Bone Joint Surg Am. 2024 Nov 20; 106(22):2136-2143.JB
- CONCLUSIONS: Some orthopaedic trauma patients' nonadherence to surgeon recommendations and dissatisfaction with care may be mitigated by postoperative education. This standardized postoperative educational protocol improves orthopaedic trauma patients' recall, adherence to their treatment plan, and satisfaction in a manner requiring minimal time.
- Publisher Full Text (DOI)
- Skin Antisepsis before Surgical Fixation of Extremity Fractures. [Randomized Controlled Trial]
- 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.).
- Publisher Full Text (DOI)
- The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes. [Journal Article]
- CONCLUSIONS: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.
- PMC Free PDF
- Association of Patient-Level and Hospital-Level Factors With Timely Fracture Care by Race. [Multicenter Study]
- CONCLUSIONS: In this cohort study, patients who sought care from an institution with a greater proportion of patients with racial or ethnic minority status or who were uninsured were more likely to experience delays greater than the 24-hour benchmarks regardless of the individual patient race; institutions that treat a less diverse patient population appeared to be more resilient to the mix of insurance status in their patient population and were more likely to meet time-to-surgery benchmarks, regardless of patient insurance status or population-based insurance mix. While it is unsurprising that increased delays were associated with underfunded institutions, the association between institutional-level racial disparity and surgical delays implies structural health systems bias.
- PMC Free PDF