A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

Background: The management of open fractures requires wound irrigation and débridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure.

Methods: In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline).

Are recent graduates of orthopaedic training programs performing less fracture care? American Board of Orthopedic Surgeons part II: a quality improvement initiative.

Objectives: The purpose of this study was to evaluate whether there has been a change in the amount of fracture care performed by recent graduates of orthopaedic residency programs over time.

Design: Retrospective review.

Setting: American Board of Orthopaedic Surgery (ABOS) Part II database.

Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures.

Background: Open fractures are an important source of morbidity and are associated with delayed union, nonunion, and infection. Preventing infection through meticulous irrigation and debridement is an important goal in management, and different lavage fluids and irrigation techniques (e.g.

Enhanced fracture and soft-tissue healing by means of anabolic dietary supplementation.

Background: Malnutrition is common in hospitalized injured patients. It contributes to delayed fracture-healing and increased morbidity. However, relatively little attention has been directed toward nutritional strategies for augmenting musculoskeletal recovery after a fracture.

The clinical use of bone stimulators.

Delay or failure of healing in long bone fracture is a common clinical problem confronting the orthopaedic surgeon, and can have significant impact on the quality of life for patients who have it. One treatment option for this problem is the use of electrical or ultrasonic bone stimulation. Electrical signals can be delivered with an implantable direct current stimulator, or noninvasively using inductive or capacitive coupling to induce currents in the tissues.

Treatment of osteomyelitis with local antibiotics delivered via bioabsorbable polymer.

The purpose of the current study was to show the efficacy and safety of an absorbable polymer (polycaprolactone) as an antibiotic delivery vehicle for treatment of osteomyelitis. An intramedullary osteomyelitis was induced in the femur of adult rabbits by Staphylococcus aureus inoculation after use of a sclerosing agent, and then treatment was done with intramedullary irrigation and implantation of a rod made of polycaprolactone, polycaprolactone plus 6% tobramycin, or polymethylmethacrylate plus 6% tobramycin. A control group received irrigation only.

The use of forced flexion/extension views in the obtunded trauma patient.

Objective: To determine whether forced flexion/extension (F/E) films for "clearing" the cervical spine in unconscious or semiconscious patients are useful or actually dangerous.

Design And Patients: Of 810 patients admitted for blunt trauma over a 5-year period, 479 patients whose films and charts were available received passive F/E film views of the cervical spine. Of these, 447 were reviewed retrospectively in masked fashion for any exacerbation of neurological changes subsequent to the procedure and with respect to the final neurological status at discharge.

Flexion and extension views are not cost-effective in a cervical spine clearance protocol for obtunded trauma patients.

Background: Between 1994 and 1999, 837 flexion-extension cervical spine films (F/E) were ordered as part of a protocol to evaluate cervical stability in blunt trauma victims, particularly obtunded patients with otherwise normal films. After 5 years' experience with this protocol, a review of its efficiency and cost-effectiveness was performed.

Method: The radiology reports and charts were reviewed for positive or suggestive F/E series.