Foot fractures and complex trauma of the foot: a case series.

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Abstract

[Indexed for MEDLINE] 15. J Bone Joint Surg Am. 2025 Jun 18;107(Suppl 1):51-59. doi: 10.2106/JBJS.24.01223. Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close: A Propensity Score-Matched Analysis. Jang Y(1), Natoli RM(1), Della Rocca GJ(2), Zura RD(3), Phelps KD(4), Potter GD(5), Scolaro JA(6), Gage MJ(7), Saiz AM Jr(8), O'Hara NN(9), Stennett CA(9), Sprague S(10)(11), Slobogean GP(9); the PREP-IT Investigators. Collaborators: Slobogean GP, Sprague S, Wells J, Bhandari M, Harris AD, Mullins CD, Thabane L, Wood A, Della Rocca GJ, Hebden J, O'Hara LM, Zura R, Lee C, Patterson J, Gardner MJ, Blasman J, Davies J, Liang S, Taljaard M, Devereaux PJ, Guyatt GH, Marvel D, Palmer J, Friedrich J, Grissom F, D'Alleyrand JC, Rivera J, Talbot M, Joshi MG, Mossuto F, Medeiros M, Polk G, Kettering E, Mahal N, Pogorzelski D, Dodds S, Leonard J, Li S, Rojas A, Del Fabbro G, Szasz OP, Heels-Ansdell D, Bzovsky S, McKay P, Minea A, Murphy K, O'Toole RV, O'Hara NN, Schrank G, Eglseder A, Johnson A, Langhammer C, Nascone J, Pensy R, Pollak A, Sciadini M, Hempen E, Degani Y, Howe A, Camara M, Phipps H, Rudnicki J, Holler C, Aumann K, Spelta J, Nieves J, Smetzer B, Dunning J, Krudener K, Lock E, Marineau L, Petrisor BA, Johal H, Ristevski B, Williams D, Denkers M, Rajaratnam K, Al-Asiri J, Gallant J, Pusztai K, MacRae S, Renaud S, Gjorgjievski M, Jeray KJ, Adams JD, Beckish ML, Bray CC, Brown TR, Cross AW, Dew T, Faucher GK, Gurich RW Jr, Lazarus DE, Millon SJ, Moody MC, Palmer MJ, Porter SE, Schaller TM, Sridhar MS, Sanders JL, Rudisill LE Jr, Garitty MJ, Poole AS, Sims ML, Walker CM, Carlisle R, Hofer EA, Huggins B, Hunter M, Marshall W, Ray SB, Smith C, Altman KM, Pichiotino E, Quirion JC, Loeffler MF, Pichiotino ER, Cole AA, Maltz EJ, Parker W, Ramsey TB, Burnikel A, Colello M, Stewart R, Wise J, Anderson M, Eskew J, Judkins B, Miller JM, Tanner SL, Snider RG, Townsend CE, Pham KH, Martin A, Robertson E, Bray E, Sykes JW, Yoder K, Conner K, Abbott H, Natoli RM, McKinley TO, Virkus WW, Sorkin AT, Szatkowski JP, Mullis BH, Jang Y, Lopas LA, Hill LC, Diaz MM, Garst KM, Denari EW, Osborn P, Fowler J, Pierrie S, Morshed S, Miclau T, Marmor M, Matityahu A, McClellan RT, Shearer D, Toogood P, Ding A, Murali J, El Naga A, Tangtiphaiboontana J, Belaye T, Berhaneselase E, Pokhvashchev D, Obremskey WT, Jahangir AA, Sethi M, Boyce R, Stinner DJ, Mitchell P, Trochez K, Rodriguez E, Pritchett C, Hogan N, Moreno AF, Hagen JE, Patrick M, Vlasak R, Krupko T, Talerico M, Horodyski M, Pazik M, Lossada-Soto E, Gary JL, Warner SJ, Munz JW, Choo AM, Achor TS, Chip Routt ML, Kutzler M, Boutte S, Warth RJ, Prayson M, Venkatarayappa I, Horne B, Jerele J, Clark L, Boulton C, Lowe J, Ruth JT, Askam B, Seach A, Cruz A, Featherston B, Carlson R, Romero I, Zarif I, Dehghan N, McKee M, Jones CB, Sietsema DL, Williams A, Dykes T, Guerra-Farfan E, Tomas-Hernandez J, Teixidor-Serra J, Molero-Garcia V, Selga-Marsa J, Porcel-Vazquez JA, Andres-Peiro JV, Esteban-Feliu I, Vidal-Tarrason N, Serracanta J, Nuñez-Camarena J, Villar-Casares MDM, Mestre-Torres J, Lalueza-Broto P, Moreira-Borim F, Garcia-Sanchez Y, Marcano-Fernández F, Martínez-Carreres L, Martí-Garín D, Serrano-Sanz J, Sánchez-Fernández J, Sanz-Molero M, Carballo A, Pelfort X, Acerboni-Flores F, Alavedra-Massana A, Anglada-Torres N, Berenguer A, Cámara-Cabrera J, Caparros-García A, Fillat-Gomà F, Fuentes-López R, Garcia-Rodriguez R, Gimeno-Calavia N, Martínez-Álvarez M, Martínez-Grau P, Pellejero-García R, Ràfols-Perramon O, Peñalver JM, Domènech MS, Soler-Cano A, Velasco-Barrera A, Yela-Verdú C, Bueno-Ruiz M, Sánchez-Palomino E, Andriola V, Molina-Corbacho M, Maldonado-Sotoca Y, Gasset-Teixidor A, Blasco-Moreu J, Fernández-Poch N, Rodoreda-Puigdemasa J, Verdaguer-Figuerola A, Cueva-Sevieri HE, Garcia-Gimenez S, Viskontas DG, Apostle KL, Boyer DS, Moola FO, Perey BH, Stone TB, Lemke HM, Spicer E, Payne K, Hymes RA, Schwartzbach CC, Schulman JE, Malekzadeh AS, Holzman MA, Gaski GE, Ramsey L, Pilson H, Carroll EA, Halvorson JJ, Babcock S, Goodman JB, Holden MB, Williams W, Hill T, Brotherton A, Syme J, Romeo NM, Vallier HA, Vergon A, Levine A, Hirschfeld A, Higgins TF, Haller JM, Rothberg DL, Marchand LS, Olsen ZM, McGowan AV, Hill S, Dauk MK, Bergin PF, Russell GV, Graves ML, Morellato J, McGee SL, Bhanat EL, Yener U, Khanna R, Nehete P, Powe SE, Potter D, VanDemark R 3rd, Seabold K, Staudenmier N, Gitajn IL, Chang G, Wolinsky P, Mullin DS, Chockbengboun TA, Anderson JM, Malskis B, Fisher L, Phelps K, Bosse M, Karunakar M, Kempton L, Sims S, Hsu J, Seymour R, Churchill C, Mayfield A, Sweeney J, Jaeblon T, Beer R, Demyanovich HK, Bauer B, Meredith S, Talwar S, Domes CM, Kuhn G, Gage MJ, Reilly RM, Paniagua A, Dupree J, Weaver MJ, von Keudell AG, Sagona AE, Brameier D, Suneja N, Mehta S, Donegan D, Horan A, To L, Heng M, Harris MB, Lhowe DW, Esposito JG, Alnasser A, McTague M, Shannon SF, Scott AN, Clinch B, Weber B, Beltran MJ, Archdeacon MT, Sagi HC, Wyrick JD, Le TT, Laughlin RT, Thomson CG, Hasselfeld K, Lin CA, Vrahas MS, Moon CN, Little MT, Marecek GS, Dubuclet DM, Garlich JM, Scolaro JA, Learned JR, Lim PK, Demas S, Amirhekmat A, Dela Cruz YM, Abdallah H. Author information: (1)Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana. (2)Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri. (3)LSUHSC Orthopaedics New Orleans, New Orleans, Louisiana. (4)Division of Orthopaedic Trauma, Atrium Health, Charlotte, North Carolina. (5)Division of Orthopedic Surgery, Northwest Texas Healthcare, Amarillo, Texas. (6)Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California. (7)Division of Orthopaedic Traumatology, Department of Orthopaedics, R Adam's Crowley Shock Trauma Center, University of Maryland, Baltimore, Maryland. (8)UC Davis Department of Orthopaedic Surgery, Sacramento, California. (9)Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, R Adams Cowely Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland. (10)Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. (11)Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. BACKGROUND: Initial surgical management of Gustilo-Anderson type-I to IIIA open fractures varies from surgical fixation of the fracture with immediate closure of the traumatic wound to various combinations of staged fracture and wound management. The decision to choose staged management has historically been based on wound contamination and the severity of the open fracture. The purpose of this study was to compare the rates of surgical site infection (SSI), wound complication, nonunion, and 1-year reoperation between patients with type-I to IIIA open fractures who underwent fix-and-close treatment and those who underwent planned, staged treatment. METHODS: This is a secondary analysis of participants who were enrolled in the Aqueous-PREP and PREPARE-Open studies, excluding those with type-IIIB and IIIC open fractures. Participants were divided into fix-and-close or planned, staged groups and were matched using propensity scores that were computed with multiple variables, including patient and injury characteristics. Associations between treatment type and outcomes were analyzed. RESULTS: A total of 3,170 participants (staged, 872: 70% White, 20% Black, and 10% other or unknown race; fix-and-close, 2,298: 62% White, 21% Black, and 17% other) with Gustilo-Anderson type-I to IIIA open fractures were identified. Eight hundred and thirty-six participants who underwent planned, staged treatment were propensity score-matched to 836 participants who underwent fix-and-close treatment. Staged treatment was significantly associated with increased odds of deep SSI within 90 days (odds ratio [OR], 2.0 [95% confidence interval (CI), 1.15 to 3.47]; p = 0.01) and reoperation specifically for infection within 1 year (OR, 1.47 [95% CI, 1.06 to 2.04]; p = 0.02) but was not associated with increased odds of wound dehiscence (OR, 0.85 [95% CI, 0.49 to 1.49]; p = 0.57), wound necrosis or failure of the wound to heal (OR, 1.37 [95% CI, 0.83 to 2.25]; p = 0.21), reoperation requiring any free or local flap coverage (OR, 0.96 [95% CI, 0.55 to 1.68]; p = 0.89), or reoperation for delayed union or nonunion (OR, 1.30 [95% CI, 0.92 to 1.83]; p = 0.14). 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. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2025 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.24.01223