Exploring Key Questions in Fracture Management and Infection: Secondary Analyses from the PREP-IT Trial

Several new papers representing a collaborative, multicenter effort to provide investigative insights into critical aspects of fracture management are now available in a special collection published by JBJS: Secondary Analyses from the PREP-IT Trial.  

Drawing on the large prospectively collected datasets of 2 previously published randomized trials—the Aqueous PREP and PREPARE trials^1,2—the new studies delve further into the investigation of infection prevention and management and other strategies in orthopaedic trauma care. Aqueous PREP and PREPARE were part of the PREP-IT (A Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) program and examined whether an iodine or chlorhexidine aseptic skin solution reduces surgical site infections and unplanned reoperations in patients with fractures.  

“The supplement is organized to take the reader through many of the daily clinical decision points with which providers are faced,” write Jennifer E. Hagen, MD, Mark J. Gage, MD, and the PREP-IT Investigators in an introductory editorial. “Do hospital-based infection prevention strategies, such as nasal decolonization, impact infection? What impact does the type and duration of prophylactic antibiotics have on infection rates? Does the use of temporizing external fixators impact infection? Does the preparation solution have an impact on nonunion rates? And, should the patient become infected, what organisms would we see, how soon would they develop, and what is the current practice of medical treatment for these infections?”  

These questions and other topics are explored.  

Articles in the supplement are freely available at JBJS.org for a limited time. Included are the following articles:  

• A Portfolio of Secondary Analyses from the PREP-IT Trial (introductory editorial) 
• Alcohol-Based Versus Aqueous Skin Antisepsis Before Surgical Fixation of Open Fractures. A Combined Analysis of 2 Cluster-Randomized Crossover Trials 
• Performance of the OTA-OFC3 Classification System for Open Fractures 
• Outcomes Associated with Choice of Prophylactic Antibiotics in Open Fractures 
• Local Antibiotics and the Risk of Antimicrobial Resistance in Extremity Fractures Complicated by Fracture-Related Infection 
• Chlorhexidine Gluconate Bathing Has Limited Ability to Prevent Surgical Site Infection Following Operative Fixation of Extremity and Pelvic Fractures 
• Differences in Practice Patterns in the Use of Temporary External Fixation for the Management of Open Lower-Extremity Fractures 
• Higher Reoperation Rates in Planned, Staged Treatment of Open Fractures Compared with Fix-and-Close. A Propensity Score-Matched Analysis 
• Impact of Living in a Food Desert on Complications After Fracture Surgery  
• Good Outcomes Require Good Nutrition, and Good Nutrition Rests Upon Sound Policy (commentary) 
• Deep Infections After Open and Closed Fractures 

To access the collection, go to JBJS.org: Secondary Analyses from the PREP-IT Trial 

In addition, in the June 18 issue of JBJS, you can find 2 additional articles pertaining to the PREP-IT studies: 

Skin Antisepsis in the Surgical Treatment of Extremity Fractures. Should We Reject the Null Hypothesis? This “What’s Important” article is published alongside a related commentary, Skin Antisepsis: When New Evidence Emerges, Reevaluate Your Practice. 

References: 

1. PREP-IT Investigators. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial. Lancet. 2022 Oct 15;400(10360):1334-44.
2. Sprague S, Slobogean G, Wells JL, O’Hara NN, Thabane L, Mullins CD, Harris AD, Wood A, Viskontas D, Apostle KL, O’Toole RV, Joshi M, Johal H, Al-Asiri J, Hymes RA, Gaski GE, Pilson HT, Carroll EA, Babcock S, Halvorson JJ, Romeo NM, Matson CA, Higgins TF, Marchand LS, Bergin PF, Morellato J, Van Demark RE 3rd, Potter GD, Gitajn IL, Chang G, Phelps KD, Kempton LB, Karunakar M, Jaeblon T, Demyanovich HK, Domes CM, Kuhn GR, Reilly RM, Gage MJ, Weaver MJ, von Keudell AG, Heng M, McTague MF, Alnasser A, Mehta S, Donegan DJ, Natoli RM, Szatkowski J, Scott AN, Shannon SF, Jeray KJ, Tanner SL, Marmor MT, Matityahu A, Fowler JT, Pierrie SN, Beltran MJ, Thomson CG, Lin CA, Moon CN, Scolaro JA, Amirhekmat A, Leonard J, Pogorzelski D, Bzovsky S, Heels-Ansdell D, Szasz OP, Gallant JL, Della Rocca GJ, Zura RD, Hebden JN, Patterson JT, Lee C, O’Hara LM, Marvel D, Palmer JE, Friedrich J, D’Alleyrand JG, Rivera JC, Mossuto F, Schrank GM, Guyatt G, Devereaux PJ, Bhandari M; PREP-IT Investigators; The PREP-IT Investigators. Skin Antisepsis before Surgical Fixation of Extremity Fractures. N Engl J Med. 2024 Feb 1;390(5):409-20.