Fractures, Open

SAN FRANCISCO, Feb. 14, 2024 /PRNewswire/ -- The American Academy of Orthopaedic Surgeons (AAOS) presented its 2024 Humanitarian Award to Duane R. Anderson, MD, FAAOS, for his commitment to improving healthcare access for the underserved population in Ethiopia as well as his dedication to training future orthopaedic surgeons. The Humanitarian Award honors members of the AAOS who have distinguished themselves through outstanding musculoskeletal-related humanitarian activities in the United States or abroad. Dr. Anderson was recognized for his ongoing efforts to shaping the healthcare landscape in Ethiopia. "I can't think of anyone who is more selfless, more giving, courageous, creative, and someone who is helping to train the next generation of orthopaedic surgeons in Ethiopia than Dr. Duane Anderson," said Michael P. Leathers, MD, FAAOS, orthopaedic surgeon and sports medicine physician from Sacramento, Calif. Dr. Anderson's humanitarian spirit spans the globe. In 2005, Dr. Anderson departed from a successful orthopaedic practice in Idaho to relocate to Soddo, Ethiopia. There he serves as the chief of orthopaedic surgery at Soddo Christian Hospital, a setting where the demand for orthopaedic care is great. "He treats people who have been involved in orthopedic traumas that would normally be taken to a level 1 trauma center in the U.S., and he does so with compassion and without a fraction of the equipment, tools and resources," Dr. Leathers shared. Since its establishment in January 2005, Soddo Christian Hospital has impacted the lives of more than 331,000 patients and conducted more than 68,000 surgeries. It holds a central role in Ethiopia's healthcare, serving as a training hub for medical professionals across Africa, and is one of 16 surgical resident training sites for the Pan-African Academy of Christian Surgeons (PAACS). The hospital offers comprehensive medical services, including specialized care in medical, surgical, maternity and pediatric areas. Soddo Christian Hospital addresses the healthcare needs of a population of approximately 200,000 in a region marked by high population density and poverty. Despite challenges, Soddo Christian Hospital remains dedicated to serving the community and beyond. In addition to playing a key role in transforming Soddo into a prominent orthopaedic referral center that serves all of Ethiopia, Dr. Anderson has trained many native African orthopaedic surgeons. As a member of the PAACS orthopaedic residency program in Soddo, he is actively involved in expanding the OR facilities through a U.S. Agency for International Development grant. In acknowledgement of Dr. Anderson's efforts to train the surgeons of tomorrow, Dr. Leathers said: "I have seen him treat pelvic fractures and open fractures with courage and creativity that is unmatched. Sometimes there is a working C-arm, but he has perfected—and even taught me and Ethiopian orthopaedic surgery residents—how to place intramedullary rods without the use of X-ray." "I am so grateful to receive the AAOS Humanitarian Award and am truly humbled. I believe God created us to want and need to be appreciated. God also created us for good deeds. It's intrinsic to being a human and a physician," Dr. Anderson shared. On his time in work in Ethiopia, he said, "I have become a better surgeon because of the sheer volume of cases that I did. I was privileged to train some brilliant Ethiopians in orthopaedic surgery. They will now carry on for me. I want to thank AAOS again for the award, and God and my dear wife for helping me the last 18 years." About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal healthcare issues; and it leads the healthcare discussion on advancing quality. Follow the AAOS on Facebook, X, LinkedIn and Instagram.  SOURCE American Academy of Orthopaedic Surgeons

A large multicenter clinical trial found that an antiseptic containing iodine resulted in about one-quarter fewer post-surgical infections in patients with limb fractures compared to another frequently used skin antiseptic. Researchers believe the results of the study of nearly 8,500 patients across the United States and Canada could prevent thousands of surgical-site infections each year. A large multicenter clinical trial co-led by University of Maryland School of Medicine researchers large multicenter clinical trial co-led by University of Maryland School of Medicine researchers found that an antiseptic containing iodine resulted in about one-quarter fewer post-surgical infections in patients with limb fractures compared to another frequently used skin antiseptic. The results of the study of nearly 8,500 patients across the United States and Canada were published today in the New England Journal of Medicine. The study -- which compared the two most commonly used alcohol-based solutions, one with iodine povacrylex, and the other with chlorhexidine gluconate -- may prompt changes in the type of antiseptic orthopaedic surgeons use to prepare the skin to repair fractures. Researchers saw the benefit in patients with closed, or simple fractures, where the skin remains intact, but not in compound fractures with open wounds, although they noted that using the iodine preparation was not harmful to these open-fracture patients. "Our results suggest that the use of iodine povacrylex in alcohol as a preoperative skin antiseptic could prevent surgical-site infections in thousands of patients with closed fractures each year," said co-principal investigator Gerard Slobogean, MD, MPH, an Associate Professor of Orthopaedics and Director of Clinical Research in the Department of Orthopaedics at the University of Maryland School of Medicine (UMSOM). He is also an orthopaedic trauma surgeon at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center (UMMC). Each year, more than a million Americans suffer a broken bone in the arm, leg, or pelvis that requires surgery, and about 3 percent of these patients develop a surgical-site infection. The source of bacteria could be the patient's skin, the injury environment, or from the hospital. Although some guidelines have favored using chlorhexidine gluconate over other iodine products, there has not been a consensus on the most effective agent. Dr. Slobogean and his colleagues believe that the trial, which included 8,485 patients treated at 25 trauma centers, is the largest randomized clinical trial ever conducted to compare the two antiseptics, which allowed them to detect important differences in infection. They said that the findings may also be relevant to other surgical specialties. More than 6,700 patients who had surgery to treat a closed lower extremity or pelvic fracture and 1,700 patients who had surgery to treat an open fracture participated in the study. The R Adams Cowley Shock Trauma Center and University of Maryland Capital Region Health's (UM Capital) trauma center in Largo, Md., were among more than two dozen trauma centers to enroll patients. UMMC and UM Capital are part of the 11-hospital University of Maryland Medical System (UMMS). "The results of this well-designed study provide some long overdue clarity to orthopaedic trauma surgeons with respect to which commonly used antiseptic skin preparation is more effective when preparing for fracture surgery," said study co-author Todd Jaeblon, DO, an Associate Professor of Orthopaedics at UMSOM who treats patients at UM Capital. Of the 3,205 closed-fracture patients who received 0.7% iodine povacrylex in 74% isopropyl alcohol, 77, or 2.4 percent, developed a surgical-site infection. That compares with 108, or 3.3 percent of the 3,272 patients who received 2% chlorhexidine gluconate in 70% isopropyl alcohol. In patients with open fractures, the number of patients who developed infections was similar between the two antiseptics -- 54 patients, or 6.5 percent of 825 patients in the iodine group, and 60 patients, or 7.3% of the 826 patients in the chlorhexidine group. "Extremity fractures and the challenging surgical-site infections that result from them pose a significant health care burden on our nation," said Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and Dean, UMSOM, and Vice President for Medical Affairs, University of Maryland, Baltimore. "This pragmatic trial tested two widely used antiseptics, and its crossover design minimized selection bias. It also enrolled patients from 25 diverse hospitals in the U.S. and Canada, which improved the generalizability of the results; the strength of the study design could serve as a model for other researchers." The PREPARE (Pragmatic Randomized Trial Evaluating Preoperative Alcohol Skin Solutions in Fractured Extremities) trial was jointly led by UMSOM and McMaster University of Hamilton, Ontario. It was funded with $11.2 million from the Patient-Centered Outcomes Research Institute (PCORI), with additional support from the Canadian Institutes of Health Research. "This trial represents a highly successful collaboration between McMaster University, the University of Maryland School of Medicine, and 25 trauma centers across Canada and the United States," said co-principal investigator Sheila Sprague, PhD, an Associate Professor and Research Director at McMaster University. "This multidisciplinary approach allowed us to quickly and efficiently address an important clinical research question that will lead to the prevention of thousands of infections each year. Importantly, our collaborations will continue to grow to address other unanswered questions in orthopaedic trauma surgery." This is the second clinical study co-led by Dr. Slobogean and Dr. Sprague aimed at closing the gaps in the medical literature on the most effective infection-control techniques in orthopaedic surgery. In October 2022, they published the results of the Aqueous-PREP trial in The Lancet. They concluded that the choice of an aqueous antiseptic solution -- either 10% povidone-iodine or 4% chlorhexidine gluconate -- does not alter the risk of surgical-site infection for patients with an open fracture. Both Aqueous-PREP and PREPARE follow a master protocol called PREP-IT (Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) to test infection prevention techniques in trials that will provide crucial evidence to help guide surgical practices. This research was supported by the PREP-IT investigators, which includes a network of over 200 physicians, allied health care professionals, trauma patients, and clinical researchers.

ROSEMONT, Ill., Feb. 10, 2023 /PRNewswire/ -- The 2023 Kappa Delta Elizabeth Winston Lanier Award was presented to the Major Extremity Trauma Research Consortium (METRC) for its multi-disciplinary research platform addressing the challenging issues related to the evaluation, treatment and recovery after severe extremity trauma. This award recognizes research in musculoskeletal disease or injury with great potential to advance patient care. As the largest orthopaedic trauma research enterprise to date, METRC has conducted 34 studies, enrolled over 22,000 patients across 70 sites and published 57 papers, resulting in increased awareness and funding for extremity trauma care. Continue Reading The 2023 Kappa Delta Elizabeth Winston Lanier Award was presented to the Major Extremity Trauma Research Consortium for its multi-disciplinary research platform addressing the challenging issues related to the evaluation, treatment and recovery after severe extremity trauma. To read more about the award, please click here. Highlights from the Research During Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan, military orthopaedic surgeons were challenged with a surge of casualties with complex single or multiple extremity injures. While advanced field care and the use of body armor reduced combat mortality, it increased the injury burden to the unprotected extremities. Critical challenges surfaced, including complex wound management, infection, bone and articular surface loss, blast-related heterotopic ossification, segmental nerve injury, volumetric muscle loss, acute compartment syndrome (ACS) and severe psychological stress that can complicate long-term recovery. At the same time, surgeons at Level I trauma centers across the country were experiencing similar challenges for treating civilian patients with high energy traumas, such as severe leg injuries with open fractures, bone loss, muscle and nerve damage, heavy contamination and compartment syndrome. With lobbying support from the American Academy of Orthopaedic Surgeons (AAOS), the Department of Defense (DOD) requested proposals for an inaugural peer-reviewed consortium grant for Extremity War Injury research in 2008. Rather than submit competing applications, existing trauma research teams from the Lower Extremity Assessment Project (LEAP) study, the Southeast Fracture Consortium and the Orthopaedic Trauma Research Consortium worked together to develop an inclusive and unified approach, assembling top talent from around the country. As a result, METRC was formed, and in 2009 was awarded the DOD grant to establish a clinical research platform infrastructure and initiate prospective clinical research targeted to infection, ACS and bone healing. "By establishing a military-civilian research collaboration, investigators could translate learnings across sectors, research could continue during interwar periods and the research dollars could benefit from an economy of scale by sharing resources and reducing the cost per study, while increasing productivity," said Michael J. Bosse, MD, FAAOS, clinical chair emeritus of METRC. METRC was anchored by a Data Coordinating Center at the Johns Hopkins Bloomberg School of Public Health and initially engaged clinical investigators at 20 Level I trauma centers and the four major military treatment facilities. The success of the Consortium can be attributed to the following framework: Conducting randomized clinical trials and employing a "gaps driven" approach to define research that purposefully identifies challenging surgical and scientific questions Organizing a multi-center approach to conduct timely and clinically impactful research Developing a coordinated, standardized approach to protocol development and data collection Understanding that METRC's growth allows for the design and execution of large pragmatic trials Establishing quality assessment and improvement strategies to learn, evolve and improve from each study Supporting individual participating investigators and academic centers to receive extremity trauma research funding "We knew this initiative would not be successful unless we adopted a culture of collaboration among the researchers at our institutions," said Ellen J. MacKenzie, PhD, METRC founding director of the Coordinating Center. "We worked hard to develop processes that were engaging, made everybody feel included, gave everybody a voice and recognized the collective accomplishments of the team." METRC selected seven research areas that were thought to be of highest importance in both military and civilian high energy trauma patients. These included: Prevention and management of acute and chronic musculoskeletal infections Early acute management of orthopaedic injury Reconstruction surgery and nonsurgical management to improve bone healing Prediction, prevention and amelioration of secondary conditions and long-term physical health effects Management of pain and psychosocial sequelae Rehabilitation interventions to improve functional outcomes and quality of life Amputation and limb salvage outcomes including optimization of prosthetics and orthotic devices The Consortium's research findings include: The Prevent CLOT study, the largest of the METRC research efforts, enrolled over 12,000 patients and showed that low dose aspirin was non-inferior to low-molecular-weight heparin in preventing death and was associated with a low incidence of deep-vein thrombosis and pulmonary embolism in the care of trauma patients with operatively treated extremity fractures or with any pelvic or acetabular fractures.i The VANCO studyii,iii investigated an emerging low-cost topical wound antibiotic technique to reduce fracture-related infections by applying 1,000 mg of topical vancomycin to the wound prior to closure. The study demonstrated a 35% overall reduced risk of infection and a 50% reduction in gram positive infections. A study involving tobramycin targeting gram negative bacteria is currently underway. The Predicting Acute Compartment Syndrome studyiii sought to gain a better understanding of diagnostic standards for ACS, a challenging condition, as it is difficult to diagnose, can occur quickly and potentially lead to amputation or death. While more research is needed, in this study, near-infrared spectroscopy was unreliable for continuous measurement of tissue oxygenation in limbs with tibia fracturesiv and was not able to reliably identify early changes in tissue oxygenation in patients at risk for ACS. Additionally, using a novel approach of having an expert panel review each case to determine whether ACS was present, the research highlighted a high incidence of unnecessary surgery when using a currently accepted standard of care to determine when fasciotomy is necessary (a surgery that is done emergently to reduce muscle pressure to maintain blood flow)v. The OUTLET study provided further analysis of the 2002 LEAP study cohort, which originally found that limb salvage and amputation provided similar outcomes for severe high energy trauma below the distal femur. Following reports of disappointing results from the salvage attempts of those patients with a severely injured distal tibia, ankle and/or foot, the OUTLET study found that for a subset of those with severe and complex foot and ankle injuries, early amputation was associated with a better outcome than the limb salvage patientsvi. "Over the past decade, the Consortium has grown to over 400 investigators, and what's really impressive is the caliber of those who are involved," said Dr. Bosse. "They are the who's who in orthopaedic trauma in North America. Not only are they making game-changing discoveries, but they are training the next generation of residents, fellows and investigators, many of whom have gone on to start METRC-funded research centers." Since 2009, METRC has received $150 million in funding from the DOD, Patient Centered Outcomes Research Institute and National Institutes of Health. "The real advantage of the Consortium has been the ability to leverage our resources across studies, which otherwise couldn't have been conducted had it not been for the large multi-disciplinary team spanning numerous leading trauma centers across the country," said Dr. MacKenzie. "The funding has helped us maintain the infrastructure at the coordinating center and clinical sites to conduct this research, and a continued investment will not only advance the care of injured service members in future conflicts but contribute to the medical readiness of current forces." About the Kappa Delta Awards In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopaedic research. The first annual award, a single stipend of $1,000, was made available to the AAOS in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the AAOS to persons who have performed research in orthopaedic surgery that is of high significance and impact. The sorority has since added two more awards and increased the award amounts to $20,000 each. Two awards are named for the sorority national past presidents who were instrumental in the creation of the awards: Elizabeth Winston Lanier, and Ann Doner Vaughn. The third is known as the Young Investigator Award. For more information about the manuscript submission process, please visit aaos.org/kappadelta. Learn more about the Kappa Delta Foundation, here. About the AAOS With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world's largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level to best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal healthcare issues and it leads the healthcare discussion on advancing quality. Follow the AAOS on Facebook, Twitter, LinkedIn and Instagram. Disclosure Funding and Conflicts of Interest METRC has no conflicts of interests. METRC Grants, Award Numbers, Prime Award Recipients: DoD Consortium Award METRC 1, W81XWH-09-2-0108, Johns Hopkins Bloomberg School of Public Health METRC 2, W81XWH-10-2-0090, Johns Hopkins Bloomberg School of Public Health METRC 3, W81XWH-16-2-0060, Johns Hopkins Bloomberg School of Public Health DoD PRORP SEXTANT, W81XWH-19-2-0062, Carolinas Medical Center Stem Cell, W81XWH-18-2-0055, Johns Hopkins School of Medicine TOBRA, W81XWH-19-1-0848, University of Maryland UNION Biomarkers, W81XWH-19-1-0796, Boston Medical Center VANCO, W81XWH-10-2-0134, University of Maryland Weight Bearing, W81XWH-18-1-0810, Vanderbilt University Medical Center Mobility Tool Kit, W81XWH-18-1-0815, Carolinas Medical Center OXYGEN, W81XWH-12-1-0588, University of Maryland POvIV, W81XWH-10-2-0133, Vanderbilt University Medical Center POvIV II, TBD, Vanderbilt University Medical Center PACS II, W81XWH-20-2-0050, Hennepin County Medical Center PACS-PH, TBD, Hennepin County Medical Center METALS II, W81XWH-15-2-0058, Johns Hopkins Bloomberg School of Public Health NERVE, W81XWH-15-2-0074, Johns Hopkins School of Medicine ProFit; W81XWH-14-1-0563, University of California San Francisco PRIORITI – MTF, W81XWH-12-2-0032, Johns Hopkins Bloomberg School of Public Health REPAIR, W81XWH-15-2-0067, Johns Hopkins Bloomberg School of Public Health NSAIDS, W81XWH-20-2-0063, University of Utah DoD AFIRM Peg Fusion, W81XWH-20-1-0825, Johns Hopkins School of Medicine NIH-NIAMS STREAM, R01AR064066, Johns Hopkins Bloomberg School of Public Health PCORI Prevent Clot, PCS-1511-32745, University of Maryland School of Medicine i METRC. Aspirin or low-molecular-weight heparin for thromboprophylaxis after fracture. N Engl J Med 2023;388:203-13. ii Bosse, M.J., MacKenzie, E.J., Pollak, A.N., Stinner, D.J. (Eds). 2017. The Major Extremity Trauma Research Consortium. [Special Issue]. J Orthop Trauma. 31(4). iii METRC. 2021. Effect of Intrawound Vancomycin Powder in Operatively Treated High- risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surgery. 156(5):e207259- e207259. iv Schmidt AH, Bosse MJ, Obremskey WT, et al. 2018. Continuous near-infrared spectroscopy demonstrates limitations in monitoring the development of acute compartment syndrome in patients with leg injuries. J Bone Joint Surg Am. 100(19):1645-1652. v Schmidt AH, Di J, Zipunnikov V, et al. 2020. Perfusion pressure lacks diagnostic specificity for the diagnosis of acute compartment syndrome. J Orthop Trauma. 34(6):287-293. vi METRC. 2021. Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: comparison of limb salvage and transtibial amputation (OUTLET). J Bone Joint Surg Am. 103(17):1588-1597. SOURCE American Academy of Orthopaedic Surgeons