There is increasing evidence to support the use of topical antibiotics to prevent surgical site infections. Although previous research suggests a minimal nephrotoxic risk with a single dose of vancomycin powder, fracture patients often require multiple procedures and receive additional doses of topical antibiotics. We aimed to determine if cumulative doses of intrawound vancomycin or tobramycin powder for infection prophylaxis increased the risk of drug-induced acute kidney injury (AKI) among fracture patients. This cohort study was a secondary analysis of single-centre Program of Randomized Trials to Evaluate Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma (PREP-IT) trial data. We included patients with a surgically treated appendicular fracture. The primary outcome was drug-induced AKI. The odds of AKI per gram of vancomycin or tobramycin powder were calculated using Bayesian regression models, which adjusted for measured confounders and accounted for the interactive effects of vancomycin and tobramycin.Aims
Methods
To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures. Patients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the Physical Component Summary (PCS) of the 12-Item Short-Form Health Survey (SF-12) at 12 months post-injury.Aims
Methods
We performed a systematic review of the literature
to evaluate the use and interpretation of generic and disease-specific
functional outcome instruments in the reporting of outcome after
the surgical treatment of disruptions of the pelvic ring. A total
of 28 papers met our inclusion criteria, with eight reporting only
generic outcome instruments, 13 reporting only pelvis-specific outcome
instruments, and six reporting both. The Short-Form 36 (SF-36) was
by far the most commonly used generic outcome instrument, used in
12 papers, with widely variable reporting of scores. The pelvis-specific
outcome instruments were used in 19 studies; the Majeed score in
ten, Iowa pelvic score in six, Hannover pelvic score in two and
the Orlando pelvic score in one. Four sets of authors, all testing construct
validity based on correlation with the SF-36, performed psychometric
testing of three pelvis-specific instruments (Majeed, IPS and Orlando
scores). No testing of responsiveness, content validity, criterion
validity, internal consistency or reproducibility was performed. The existing literature in this area is inadequate to inform
surgeons or patients in a meaningful way about the functional outcomes
of these fractures after fixation.
