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Competing Interests: Potential Conflicts of Interest and Funding Sources: This manuscript did not receive any funding. Dr. Hsu reports consultancy for Globus Medical and personal fees from Smith & Nephew speakers’ bureau

Background: Studies evaluating surgical-site infection have had conflicting results with respect to the use of alcohol solutions containing iodine povacrylex or chlorhexidine gluconate as skin antisepsis before surgery to repair a fractured limb (i.e., an extremity fracture)., Methods: In a cluster-randomized, crossover trial at 25 hospitals in the United States and Canada, we randomly assigned hospitals to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (chlorhexidine group) as preoperative antisepsis for surgical procedures to repair extremity fractures. Every 2 months, the hospitals alternated interventions. Separate populations of patients with either open or closed fractures were enrolled and included in the analysis. The primary outcome was surgical-site infection, which included superficial incisional infection within 30 days or deep incisional or organ-space infection within 90 days. The secondary outcome was unplanned reoperation for fracture-healing complications., Results: A total of 6785 patients with a closed fracture and 1700 patients with an open fracture were included in the trial. In the closed-fracture population, surgical-site infection occurred in 77 patients (2.4%) in the iodine group and in 108 patients (3.3%) in the chlorhexidine group (odds ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00; P = 0.049). In the open-fracture population, surgical-site infection occurred in 54 patients (6.5%) in the iodine group and in 60 patients (7.3%) in the chlorhexidine group (odd ratio, 0.86; 95% CI, 0.58 to 1.27; P = 0.45). The frequencies of unplanned reoperation, 1-year outcomes, and serious adverse events were similar in the two groups., Conclusions: Among patients with closed extremity fractures, skin antisepsis with iodine povacrylex in alcohol resulted in fewer surgical-site infections than antisepsis with chlorhexidine gluconate in alcohol. In patients with open fractures, the results were similar in the two groups. (Funded by the Patient-Centered Outcomes Research Institute and the Canadian Institutes of Health Research; PREPARE ClinicalTrials.gov number, NCT03523962.)., (Copyright © 2024 Massachusetts Medical Society.)

This study assessed the effect of preoperative planning using a 3D-printed periarticular fracture model on operative performance. A complex pilon fracture was 3D-printed, and a preoperative plan was developed. Orthopaedic surgery residents (n = 20) were randomized into two groups. Group 1 performed routine preoperative planning, while Group 2 was also practiced using a 3D-printed construct before performing fixation of the 3D-printed model. Resident performance was assessed using a video motion capture system and evaluated by blinded reviewers. Three residents (3D group) completed fixation within the allotted 45 minutes. The 3D group had less hand distance traveled for step 1 (89 m vs. 162 m, p = 0.04). The 3D group had better performance on three of the four components and more acceptable reductions (6 vs. 0, p = 0.009). Average global rating scale was higher in the 3D group (3.0 vs. 1.7, p = 0.0095). Use of 3D-printed models for preoperative planning improved resident performance. (Journal of Surgical Orthopaedic Advances 31(3):187-192, 2022).

Background: Debate exists over the optimal approach for addressing fractures of the proximal humerus. The purpose of this study was to objectively quantify the surface area of the humerus exposed using the deltopectoral (DP) and anterolateral acromial (ALA) approaches and to compare visualized and palpable anatomic landmarks., Methods: Ten arms on five fresh-frozen torsos underwent the DP and ALA approaches. The arms were positioned to simulate a supine patient and held in a fixed position. Visual and/or palpable access to relevant surgical landmarks and the myotendinous junctions were recorded. The myotendinous junctions were used as a rough approximation of consistent proximal exposure of a clinically retracted tuberosity. Landmarks were grouped into quadrants based on the location. Calibrated digital photographs of each approach were analyzed to calculate the surface area and the length of the exposed bone., Results: The DP and ALA approaches exposed 22.9 ± 6.3 cm 2 and 16.3 ± 6.4 cm 2 , respectively ( P = 0.03). The DP and ALA approaches provided equivalent visual and palpable access to all landmarks in the superior and inferior quadrants. The ALA allowed improved visual (80% versus 70%) and palpable (100% versus 70%) access to the myotendinous junction of the infraspinatus in the posterior quadrant. The DP approach allowed better access to anterior quadrant structures, including improved ability to visualize the myotendinous junction of the subscapularis (100% versus zero), the subscapularis insertion (100% versus 80%), and the medial anatomic neck (100% versus 20%). Palpable access to the myotendinous junction of the subscapularis (100% versus 70%) and medial anatomic neck (100% versus 60%) was also improved with the DP., Conclusions: In a cadaver model with fixed arm position, the DP provides increased exposure to the proximal humerus and more reliable access to anterior surgical landmarks, whereas the ALA allows improved access to the most posterior aspect of the shoulder., Competing Interests: Dr. Hamid or an immediate family member serves as a paid consultant to Biomet. Dr. Hsu or an immediate family member serves as a member of a speakers' bureau or has made paid presentations on behalf of Smith & Nephew; serves as a paid consultant to Acumed; and serves as a board member, owner, officer, or committee member of the Limb Lengthening Research Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Harmer, Dr. Crickard, Dr. Phelps, Dr. McKnight, Dr. Sample, and Dr. Andrews.