Plastic Surgery | Open Access Articles | Digital Commons Network™

Revisiting The Faith Trial: A Secondary Analysis Yielding Novel Insights With The Win Ratio, Sofia Bzovsky, Nathan N. O'Hara, Gerard P. Slobogean, Sheila Sprague, Daniel E. Axelrod, Graeme Hoit, Kiara Pannozzo, Mohit Bhandari, Marc Swiontkowski, Emil Schemitsch, Rudolf W. Poolman, The Faith Investigators

Orthopaedic Surgery Faculty Publications

Background: Many orthopaedic trials use any unplanned reoperation as the primary outcome, but this overlooks how patients experience those outcomes. Using a high-quality hip fracture trial, we demonstrate how the relative importance of multiple patient-important outcomes can be effectively incorporated into data analysis, providing a more comprehensive understanding of treatment impact. Methods: This secondary analysis of the Fixation using Alternative Implants for the Treatment of Hip Fracture (FAITH) trial included 1,079 patients aged 50 years or older with a low-energy femoral neck fracture who were randomly assigned to treatment with a sliding hip screw or cancellous screws. The original trial …

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Infection And Nonunion Rates In Open Fractures, Roman M. Natoli, Lucas S. Marchand, Sofia Bzovsky, Jennifer E. Hagen, Mark J. Gage, Christina A. Stennett, Nathan N. O’Hara, Kyle J. Jeray, Brad Petrisor, Sheila Sprague, Gerard P. Slobogean, Jeffrey Wells, Mohit Bhandari, Anthony D. Harris, C. Daniel Mullins, Lehana Thabane, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Lyndsay M. O’Hara, Robert Zura, Christopher Lee, Joseph Patterson, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang, Monica Taljaard, The Flow Investigators, The Prep-It Investigators

Orthopaedic Surgery Faculty Publications

Background: Infection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes. Methods: A descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed …

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Fascia Iliaca Compartment Block And Pericapsular Nerve Group Block Effect On Opioid Consumption In Hip Fracture Patients, David A. Brueggeman, Garrhett G. Via, Prachi Lele, Andrew W. Froehle, Michael J. Prayson, Scott J. Hadaway

Orthopaedic Surgery Faculty Publications

Background Effective pain control and reduced opioid consumption improve hip fracture outcomes. Fascia iliaca compartment blocks (FICB) effectively and safely manage acute hip fracture pain while reducing opioid consumption. Alternatively, pericapsular nerve group (PENG) blocks may provide similar analgesia while better-preserving motor function by targeting the highly innervated anterior hip capsule and sensory branches of the femoral, obturator, and accessory obturator nerves. Evidence for PENG's effectiveness is limited. The present retrospective study compared pain and MME in hip fracture patients receiving FICB (n = 1596) or PENG (n = 254), vs. a no-block (NB; n = 287) reference group. Methods …

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First Profunda Artery Perforator Flap For Breast Reconstruction Performed At A Va Hospital, Kaitlynne Pak, Amanda Fang, Garrison Leach, Riley Dean, Sarah Crowley

Medical Student Research Symposium Abstracts and Posters

The profunda artery perforator (PAP) flap for breast reconstruction originated by Dr. Robert J. Allen in 2010 after multiple failed attempts at using muscle-sparing transverse rectus abdominal muscle (MS-TRAM) flap and implants. This flap method was initially approached due to the patient’s request for an autologous tissue graft that did not sacrifice muscle. The PAP flap has grown significantly in popularity and usage in breast reconstruction and makes up to about 16% of autologous breast reconstruction, coming second to DIEP flaps (76%). This well-tolerated, muscle-sparing approach is ideal for patients without sufficient abdominal fat (low BMI or previous abdominal liposuction) …

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Reconstructionof Congenital Arhinia With Stereolithography, Kelly Spiller, Kaitlynne Pak, Lucas M. Harrison, Spencer Anderson, Steven Schmidt, Salim Mancho

Medical Student Research Symposium Abstracts and Posters

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and nasopharyngeal airway. In this study, we report our novel multi-staged reconstructive approach of congenital arhinia in addition to literature review. Reconstruction was achieved via several spaced operations. A nasal methyl methacrylate prosthesis was first created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 osteotomy with cannulization was then utilized for midface advancement and nasopharyngeal airway formation. External nasal framework was constructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. The patient was overall pleased …

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Managing Work Flow In High Enrolling Trials: The Development And Implementation Of A Sampling Strategy In The Prepare Trial, David Pogorzelski, Uyen Nguyen, Paula Mckay, Lehana Thabane, Megan Camara, Lolita Ramsey, Rachel Seymour, J. Brett Goodman, Sheketha Mcgee, Joanne Fraifogl, Andrea Hudgins, Stephanie L. Tanner, Mohit Bhandari, Gerard P. Slobogean, Sheila Sprague, Jeffrey Wells, Prep-It Investigators Executive Committee

Orthopaedic Surgery Faculty Publications

Pragmatic trials in comparative effectiveness research assess the effects of different treatment, therapeutic, or healthcare options in clinical practice. They are characterized by broad eligibility criteria and large sample sizes, which can lead to an unmanageable number of participants, increasing the risk of bias and affecting the integrity of the trial. We describe the development of a sampling strategy tool and its use in the PREPARE trial to circumvent the challenge of unmanageable work flow. Given the broad eligibility criteria and high fracture volume at participating clinical sites in the PREPARE trial, a pragmatic sampling strategy was needed. Using data …

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Risk Factors Associated With Infection In Open Fractures Of The Upper And Lower Extremities, Paul Tornetta, Gregory J. Della Rocca, Saam Morshed, Clifford Jones, Diane Heels-Ansdell, Sheila Sprague, Brad Petrisor, Kyle J. Jeray, Gina Del Fabbro, Sofia Bzovsky, Mohit Bhandari, Gordon H. Guyatt, Stephen D. Walter, Emil H. Schemitsch, Jeffrey Anglen, Michael Bosse, Susan Liew, Parag Sancheti, Paula Mckay, Kim Madden, Kerry Tai, Lisa Buckingham, Aravin Duraikannan, Stephanie L. Tanner, Rebecca G. Snider, Douglas Altman, Rajiv Gandhi, Markus Bischoff, Bill Ristevski, Krishan Rajaratnam, Dale Williams, Flow Investigators

Orthopaedic Surgery Faculty Publications

Introduction: Open fractures are associated with a high risk of infection. The prevention of infection is the single most important goal, influencing perioperative care of patients with open fractures. Using data from 2,500 participants with open fracture wounds enrolled in the Fluid Lavage of Open Wounds trial, we conducted a multivariable analysis to determine the factors that are associated with infections 12 months postfracture. Methods: Eighteen predictor variables were identified for infection a priori from baseline data, fracture characteristics, and surgical data from the Fluid Lavage of Open Wounds trial. Twelve predictor variables were identified for deep infection, which included …

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Inadvertent Radial Head Inversion During Closed Reduction Of A Pediatric Radial Neck Fracture, Zachary J. Sirois, Sarah Kreul, Craig F. Shank

Orthopaedic Surgery Faculty Publications

Management of displaced pediatric radial neck fractures can be fraught with challenges. This unique case presents an 11-year-old female with a Salter-Harris type II radial neck fracture and how her radial head overturned 180° with the articular surface facing the radial shaft rather than the capitellum during closed manipulation under anesthesia. The malreduction subsequently required open reduction and highlights the importance of a careful stepwise approach to managing markedly displaced radial neck fractures. After closed reduction, meticulous assessment of intraoperative imaging when determining proper alignment is of the utmost importance as a result of the transverse nature of Salter-Harris type …

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Orthopaedic Surgery Faculty Publications

Orthopaedic Surgery Faculty Publications

Fascia Iliaca Compartment Block And Pericapsular Nerve Group Block Effect On Opioid Consumption In Hip Fracture Patients, David A. Brueggeman, Garrhett G. Via, Prachi Lele, Andrew W. Froehle, Michael J. Prayson, Scott J. Hadaway

Orthopaedic Surgery Faculty Publications

First Profunda Artery Perforator Flap For Breast Reconstruction Performed At A Va Hospital, Kaitlynne Pak, Amanda Fang, Garrison Leach, Riley Dean, Sarah Crowley

Medical Student Research Symposium Abstracts and Posters

Reconstructionof Congenital Arhinia With Stereolithography, Kelly Spiller, Kaitlynne Pak, Lucas M. Harrison, Spencer Anderson, Steven Schmidt, Salim Mancho

Medical Student Research Symposium Abstracts and Posters

Orthopaedic Surgery Faculty Publications

Orthopaedic Surgery Faculty Publications

Inadvertent Radial Head Inversion During Closed Reduction Of A Pediatric Radial Neck Fracture, Zachary J. Sirois, Sarah Kreul, Craig F. Shank

Orthopaedic Surgery Faculty Publications