Journal ArticleDOI
Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: A multicenter, randomized, controlled trial (VANCO study)
Robert V OʼToole,Manjari Joshi,Anthony R. Carlini,Clinton K. Murray,Lauren E. Allen,Daniel O. Scharfstein,Joshua L. Gary,Michael J. Bosse,Renan C. Castillo,Metrc +9 more
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TLDR
This study should provide important information regarding the use of local vancomycin powder during the definitive treatment of lower extremity fractures and has the potential to significantly reduce the incidence of infection after orthopaedic trauma.Abstract:
A number of clinical studies in the spine literature suggest that the use of local vancomycin powder may substantially reduce surgical site infections (SSIs). These studies are primarily retrospective and observational and few focus on orthopaedic trauma patients. This study is a phase III, prospective, randomized, clinical trial to assess the efficacy of locally administered vancomycin powder in the prevention of SSI after fracture surgery. The primary goal of the VANCO Study is to compare the proportion of deep SSI 6 months after fracture fixation surgery. A secondary objective is to compare species and antibacterial susceptibilities among study patients who develop SSI. An additional objective is to build and validate a risk prediction model for the development of SSI. The study population consists of patients aged 18-80 years with tibial plateau or pilon (tibial plafond) fractures, at higher risk of infection, and definitively treated with plate and screw fixation. Participants are block randomized (within center) in a 1:1 ratio to either treatment group (local vancomycin powder up to a maximum dose of 1000 mg, placed immediately before wound closure) or control group (standard of care) for each study injury location, and return to the clinic for evaluations at 2 weeks, 3 months, and 6 months after fixation. The targeted sample size for the study is 500 fractures per study arm. This study should provide important information regarding the use of local vancomycin powder during the definitive treatment of lower extremity fractures and has the potential to significantly reduce the incidence of infection after orthopaedic trauma.read more
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Journal ArticleDOI
The effect of local antibiotic prophylaxis when treating open limb fractures: A systematic review and meta-analysis.
Mario Morgenstern,A Vallejo,Martin A. McNally,Thomas Fintan Moriarty,Jamie Ferguson,Stefaan Nijs,Willem-Jan Metsemakers +6 more
TL;DR: In this article, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and is considered to be the best in the world for open fracture management, including debridement and irrigation, soft-tissue coverage, and osseous stabilization.
Journal ArticleDOI
Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection.
Willem-Jan Metsemakers,Austin T. Fragomen,T. Fintan Moriarty,Mario Morgenstern,Kenneth A. Egol,Charalampos G. Zalavras,William T. Obremskey,Michael J. Raschke,Martin A. McNally +8 more
TL;DR: Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients and the use of locally delivered antimicrobials to address the specific problems of FRI is of critical importance.
Journal ArticleDOI
Evolution in Management of Tibial Pilon Fractures
TL;DR: This review will discuss the recent developments in the treatment of tibial pilon fractures, and challenges the 7-cm myth regarding the distance needed between skin incisions.
Journal ArticleDOI
High-energy tibial pilon fractures: an instructional review.
TL;DR: It has been shown that the quality of fracture reduction may significantly correlate with the long-term functional outcomes, and the orthopaedic community has come a long way with regard to safe management of high-energy tibial pilon fractures.
Journal ArticleDOI
Systematic Review and Meta-Analysis of Intrawound Vancomycin in Total Hip and Total Knee Arthroplasty: A Call for a Prospective Randomized Trial.
Nathanael Heckmann,Cory K Mayfield,Chris Culvern,Daniel A. Oakes,Jay R. Lieberman,Craig J. Della Valle +5 more
TL;DR: The results from this analysis are limited by the low quality of evidence and inherent potential for bias, highlighting the need for randomized controlled trials before broad adoption of this practice can be recommended given the potential implications of widespread use of vancomycin in hip and knee arthroplasty.
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Journal ArticleDOI
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