Perceptions of barriers and facilitators to opioid reduction after total joint arthroplasty among orthopedic surgeons practicing in Canada, Japan, and the Netherlands: A qualitative description study.

Opioid analgesics are commonly prescribed after total knee and hip arthroplasty to manage pain. Rates of opioid prescribing after arthroplasty differ by country, suggesting differences in policies or surgeons' practices. We adopted a qualitative description design to explore and compare Canadian, Dutch, and Japanese orthopaedic surgeons' perceptions of facilitators and barriers to opioid reduction after total joint arthroplasty.

Efficacy of biomarkers in the endochondral phase of fracture repair and healing in long bones: A clinical observational studys.

Background: Clinical determination of bone fracture healing remains qualitative, typically determined through the combination of plain film radiographs, clinical assessment, and patient-reported pain. Importantly, standard radiographs can only detect bone formation in the fracture site after sufficient tissue mineralization has occurred, restricting utility to the later stages of bone repair. A more rigorous method for determining fracture healing progression could significantly improve patient care.

Orthopaedic surgeons' perspectives on peripheral nerve blocks for surgical fixation of hip fractures in older adults.

Objectives: This study aimed to identify factors influencing orthopaedic surgeons' decision to request peripheral nerve blocks (PNBs) for older adults undergoing hip fracture surgery and to assess the need for further research.

Design: A cross-sectional survey.

Setting: Academic and private practice.

When would orthopaedic surgeons perform arthroplasty for a femoral neck fracture in an older adult?

Purpose: Minimally displaced femoral neck fractures (FNFs) in older adults have traditionally been managed with internal fixation (IF). However, emerging evidence suggests arthroplasty may provide better outcomes. We sought to determine surgeons' current practice patterns and determine which patient and fracture characteristics lead them to prefer arthroplasty.

Prevalence and Acceptability of Dedicated Social Work Support in the Fracture Clinic: A Survey of Orthopaedic Trauma Surgeons.

Aims And Objectives: This study aimed to determine the prevalence of social work services in outpatient fracture clinics, and the potential benefits and barriers to integrating these services as perceived by orthopaedic trauma surgeons.

Methodological Design And Justification: Cross-sectional survey of orthopaedic trauma surgeons.

Ethical Issues And Approval: Approved by the Hamilton Integrated Research Ethics Board, #16227 RESEARCH METHODS, INSTRUMENTS AND/OR INTERVENTIONS: A brief, anonymous, self-administered online survey.

The Design of a Patient-Centered Hierarchal Composite Outcome for a Multi-Center Randomized Controlled Trial in Metastatic Bone Disease.

The proximal femur represents the most frequent site in the appendicular skeleton for metastatic bone disease (MBD) to occur, with a high risk for pathologic fracture. While surgical stabilization is typically used to manage fractures, reconstruction approaches are gaining popularity due to improved survival. Previous studies have focused on clinical outcomes, but patient-centered outcomes remain underexplored.

Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close: A Propensity Score-Matched Analysis.

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.

Impact of Living in a Food Desert on Complications After Fracture Surgery.

Background: Food deserts-communities with limited access to healthy food-have been linked with poor surgical outcomes; however, their impact on orthopaedic trauma outcomes remains unknown. The aims of this study were to determine the prevalence of food desert residency among orthopaedic trauma patients and to investigate the impact of food desert residency on the rate of unplanned reoperation with use of a large, high-quality, prospectively collected dataset with adjudicated outcomes. We hypothesized that orthopaedic trauma patients would reside in food deserts at a higher rate than the general U.

Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures.

Background: External fixation is often used in the management of open lower-extremity fractures. The objectives of this study were to identify hospital characteristics that are associated with greater use of temporary external fixation and to determine if external fixation reduces the odds of surgical site infection (SSI) and unplanned reoperation among patients with open lower-extremity fractures.

Methods: This is a secondary analysis of the Aqueous-PREP and PREPARE-Open trials involving open lower-extremity fractures.

Deep Infections After Open and Closed Fractures.

Background: The purpose of this study was to describe the culture and speciation results of patients with surgical site infection (SSI) from the PREPARE and Aqueous-PREP studies from the PREP-IT Investigators.

Methods: Patients with suspected SSI underwent collection of deep or organ tissue samples for culture. The culture positivity rate was estimated as a percentage along with the exact binomial 95% confidence interval (CI).

Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures.

Background: A preoperative chlorhexidine gluconate (CHG) bath is used to reduce the risk of surgical site infection (SSI) in elective surgery, but its efficacy in the trauma setting is unknown. We compared the incidence of SSI between patients who did versus did not receive a CHG bath before operative fixation of extremity and/or pelvic fractures.

Methods: We conducted a secondary analysis of the PREP-IT cluster-randomized crossover trials that enrolled patients undergoing operative treatment for open or closed extremity or pelvic fractures.

Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection.

Background: We evaluated antimicrobial resistance (AMR) patterns following local antibiotic use in a large cohort of patients with fractures from the PREP-IT (A Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) study. We hypothesized that, among patients with extremity fractures who developed fracture-related infection (FRI), there would be no difference in AMR rates between those who had or had not received local antibiotic therapy with surgical fixation.

Methods: This was a secondary analysis of all patients in the PREP-IT trial who developed FRI.

Outcomes Associated with Choice of Prophylactic Antibiotics in Open Fractures.

Background: The ideal antibiotic prophylaxis for open fractures is unknown. We evaluated outcomes following different antibiotic prophylaxis regimens for open fractures.

Methods: This is a secondary analysis of data from PREP-IT.

Performance of the OTA-OFC3 Classification System for Open Fractures.

Background: The purpose of this study was to compare the simplified modification of the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC3) with the original OTA-OFC and Gustilo-Anderson classification systems in predicting surgical site infection and unplanned reoperation.

Methods: This was a retrospective cohort study conducted using the PREP-IT (A Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) trial data of patients with open fractures. The OTA-OFC and Gustilo-Anderson classifications for each included fracture were determined by the treating surgeon at the initial irrigation and debridement.

Alcohol-Based Versus Aqueous Skin Antisepsis Before Surgical Fixation of Open Fractures: A Combined Analysis of 2 Cluster-Randomized Crossover Trials.

Background: Skin antisepsis remains a vital component in prophylaxis against surgical site infection (SSI); however, for open fractures, it is unclear whether alcohol-based or aqueous solutions should be preferred. The purpose of this study was to compare the use of alcohol-based and aqueous skin antisepsis solutions, using data from the 2 PREP-IT trials, with respect to the risks of SSI and unplanned reoperation following surgery for an open fracture.

Methods: Individual patient data from the 2 cluster-randomized, crossover clinical trials were combined to create a single data set of patients undergoing surgery for an open fracture.

Patient Perceptions Towards Reduction or Avoidance of Opioids After Knee and Hip Arthroplasty: A Cross-Sectional Survey.

Background and objective Opioid analgesics are routinely prescribed to manage pain after total joint arthroplasty (TJA) but are associated with several adverse effects. There is a scarcity of literature exploring patients' receptivity, attitudes, and perceptions towards opioid-sparing postoperative protocols. In light of this, we conducted this study to address those gaps in the literature.

How does internal fixation compared with arthroplasty affect quality of life for patients who have suffered femoral neck fractures?

Objectives: To evaluate functional outcomes amongst femoral neck fracture trial participants who did not undergo reoperation.

Design: Secondary analysis of 2 randomized controlled trials.

Setting: Ninety hospitals in 5 continents.

Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis.

Background: Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies.

Objective: This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury.

Methods: We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023.

The ROADS project: Road observational assessment of driving distractions.

Background: Globally, motor-vehicle collisions cause 1.35 million deaths and more than 78 million injuries every year, with distracted driving contributing to many of these tragedies. Our main objective was to covertly determine the proportion of distracted drivers in live traffic.

Does Stem Design Affect the Incidence of Periprosthetic Femoral Fractures in Arthroplasty for Femoral Neck Fractures? A Secondary Analysis of the HEALTH Trial.

Background: The aim of this study was to evaluate how stem design influences the risk of periprosthetic femoral fractures (PFFs) after hemiarthroplasty (HA) and total hip arthroplasty for femoral neck fractures.

Methods: We performed a secondary analysis of the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty trial, a multicenter, prospective, randomized control trial that assessed total hip arthroplasty versus hemiarthroplasty for low-energy femoral neck fractures. Between 1,374 patients (414 men, 960 women) that were assessed, 72 sustained PFFs (5.

Patient perspectives on the desirability of social worker support in outpatient orthopaedic trauma clinics.

Objectives: This study examined the benefits of a dedicated social worker in the fracture clinic setting as perceived by patients and caregivers.

Methods: This cross-sectional survey engaged patients aged 18 and older presenting to the fracture clinic associated with a level 1 trauma center. Surveys were available in English and Arabic and included 11 questions designed to measure level of agreement with various aspects of social worker presence in the outpatient fracture clinic.

Reasons for declining to participate in a trial of online cognitive behavioural therapy following orthopaedic trauma: A mixed methods study.

The timely enrollment of study participants is critical to the success of clinical trials. Understanding factors that contribute to patients' decision to participate in trials involving online cognitive behavioural therapy for pain management should prove helpful to optimize the design of study protocols. Fracture patients from an orthopaedic clinic who declined to participate in the Cognitive behavioural therapy to Optimize Post-operative rEcovery (COPE) trial were asked to complete a Research Participation Questionnaire that asked them about their previous experiences with clinical research and mental health therapy and their reasons for declining to participate in the COPE trial.

Predictors of Response to Medical Cannabis for Chronic Pain: A Retrospective Review of Real-Time Observational Data.

Objective: People living with chronic pain increasingly use medical cannabis for symptom relief. We conducted a retrospective cohort study examining cannabis for chronic pain relief using anonymous archival data obtained from the medicinal cannabis tracking app, Strainprint®.

Method: We acquired cannabis utilization data from 741 adults with chronic pain and used multilevel modeling to examine the association of age, sex, type of pain (muscle, joint or nerve pain), cannabis formulation (high CBD, balanced CBD:THC, or high THC), route of administration (inhaled or ingested), cannabis use before vs.