{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:13:31Z","timestamp":1789002811571,"version":"build-2803163510"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.01223","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T11:00:55Z","timestamp":1750244455000},"page":"51-59","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1394-7378","authenticated-orcid":false,"given":"Yohan","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4182-3244","authenticated-orcid":false,"given":"Roman M.","family":"Natoli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8004-7914","authenticated-orcid":false,"given":"Robert D.","family":"Zura","sequence":"additional","affiliation":[{"name":"LSUHSC Orthopaedics New Orleans, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin D.","family":"Phelps","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Trauma, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6977-6294","authenticated-orcid":false,"given":"G. David","family":"Potter","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Northwest Texas Healthcare, Amarillo, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7926-5017","authenticated-orcid":false,"given":"John A.","family":"Scolaro","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Irvine, Irvine, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7410-7850","authenticated-orcid":false,"given":"Mark J.","family":"Gage","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Traumatology, Department of Orthopaedics, R Adam\u2019s Crowley Shock Trauma Center, University of Maryland, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine M.","family":"Saiz","sequence":"additional","affiliation":[{"name":"UC Davis Department of Orthopaedic Surgery, Sacramento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0537-3474","authenticated-orcid":false,"given":"Nathan N.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, R Adams Cowely Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5282-6785","authenticated-orcid":false,"given":"Christina A.","family":"Stennett","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, R Adams Cowely Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, R Adams Cowely Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PREP-IT Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"issue":"5","key":"bib1-20250619","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1001\/jama.1955.02960220007002","article-title":"Basic principles in management of open fractures","volume":"159","author":"Hampton","year":"1955","journal-title":"J Am Med Assoc."},{"issue":"6043","key":"bib2-20250619","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1016\/S0140-6736(00)76338-0","article-title":"\u201cClosed\u201d treatment of war fractures","volume":"233","author":"Trueta","year":"1939","journal-title":"Lancet."},{"issue":"4","key":"bib3-20250619","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/milmed\/141.4.255","article-title":"Reflections on the past and present treatment of war wounds and fractures","volume":"141","author":"Trueta","year":"1976","journal-title":"Mil Med."},{"issue":"11","key":"bib4-20250619","doi-asserted-by":"crossref","first-page":"3814","DOI":"10.1016\/j.injury.2022.08.045","article-title":"Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients","volume":"53","author":"Dubina","year":"2022","journal-title":"Injury."},{"issue":"6","key":"bib5-20250619","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/BOT.0000000000002802","article-title":"Early versus delayed definitive fixation relative to fasciotomy closure in high-energy tibial plateau fractures with compartment syndrome","volume":"38","author":"Flagstad","year":"2024","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib6-20250619","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00005373-198301000-00005","article-title":"Treatment of open fractures: a prospective study","volume":"23","author":"Benson","year":"1983","journal-title":"J Trauma."},{"issue":"6","key":"bib7-20250619","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1097\/00005373-199906000-00012","article-title":"Aggressive treatment of 119 open fracture wounds","volume":"46","author":"DeLong","year":"1999","journal-title":"J Trauma."},{"issue":"5","key":"bib8-20250619","doi-asserted-by":"crossref","first-page":"380","DOI":"10.2106\/JBJS.L.00545","article-title":"Delayed wound closure increases deep-infection rate associated with lower-grade open fractures: a propensity-matched cohort study","volume":"96","author":"Jenkinson","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib9-20250619","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/BOT.0000000000000751","article-title":"Primary wound closure after open fracture: A prospective cohort study examining nonunion and deep infection","volume":"31","author":"Scharfenberger","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib10-20250619","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1056\/NEJMoa2307679","article-title":"Skin Antisepsis before surgical fixation of extremity fractures","volume":"390","author":"Sprague","year":"2024","journal-title":"N Engl J Med."},{"issue":"10360","key":"bib11-20250619","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/S0140-6736(22)01652-X","article-title":"Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial","volume":"400","year":"2022","journal-title":"Lancet."},{"issue":"8","key":"bib12-20250619","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/BOT.0b013e3181c7cb6b","article-title":"A new classification scheme for open fractures","volume":"24","year":"2010","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib13-20250619","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium-2018","volume":"32","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma."},{"issue":"25","key":"bib14-20250619","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med."},{"issue":"1","key":"bib16-20250619","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1302\/0301-620X.72B1.2298770","article-title":"Primary or delayed closure for open tibial fractures","volume":"72","author":"Russell","year":"1990","journal-title":"J Bone Joint Surg Br."},{"issue":"3","key":"bib17-20250619","doi-asserted-by":"crossref","first-page":"E82","DOI":"10.1503\/cjs.011413","article-title":"Attempting primary closure for all open fractures: the effectiveness of an institutional protocol","volume":"57","author":"Moola","year":"2014","journal-title":"Can J Surg."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01223","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:00Z","timestamp":1787752260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01223"}},"subtitle":["A Propensity Score-Matched Analysis"],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":16,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.01223","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}