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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses a prospective randomized trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00829621\u0026amp;atom=%2Fspmdc%2F14%2F41%2F9.2.atom\u0022\u003ENCT00829621\u003C\/a\u003E] that compared negative-pressure wound therapy (and standard gauze dressings over primarily closed surgical incisions in outcomes of hip, pelvis, and acetabular fracture surgery.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInfections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBrett D. Crist, MD, University of Missouri, Columbia, Missouri, USA, discussed a prospective randomized trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00829621\u0026amp;atom=%2Fspmdc%2F14%2F41%2F9.2.atom\u0022\u003ENCT00829621\u003C\/a\u003E] that compared negative-pressure wound therapy (NPWT) and standard gauze dressings over primarily closed surgical incisions in outcomes of hip, pelvis, and acetabular fracture surgery.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOrthopaedic surgical site infections exact huge treatment costs, can double the rehospitalization rate, and extend hospital stays [Whitehouse JD et al. \u003Cem\u003EInfect Control Hosp Epidemiol.\u003C\/em\u003E 2002]. Debridement is not effective in about 30% of cases of infected fractures after open reduction and internal fixation [Rightmire E et al. \u003Cem\u003EClin Orthop Relat Res.\u003C\/em\u003E 2008]. Letournel found that infection following acetabular fracture surgery occurs in \u2264 5% of cases for the most common approaches; obese individuals are at heightened risk [Porter SE et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ENPWT, which reportedly decreases wound-related complication in high-risk [Stannard JP et al. \u003Cem\u003EJ Trauma.\u003C\/em\u003E 2006] and acetabular fractures [Reddix RN Jr et al. \u003Cem\u003EJ Surg Orthop Adv.\u003C\/em\u003E 2010], applies a vacuum through a specialized dressing to the wound to accelerate healing.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe aim of the present study was a prospective comparison of NPWT and standard gauze dressings over primarily closed surgical incisions\u2014a popular surgical option for hip, pelvis, and acetabular fractures. The techniques were compared in terms of postoperative surgical wound drainage, infections, and cost-effective hospitalization. A multitude of secondary characteristics were compared.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EReflecting the anatomic similarity of the affected bones and the similar surgical approach typically used, patients with fractures of the hip, pelvis, and acetabulum were grouped. The 115 patients were randomized to receive NPWT for at least 2 days (n = 55) or standard gauze (n = 60). They were followed up for 12 months; 49 NPWT-treated patients and 41 standard gauze-treated patients completed the follow-up, meaning that the study was underpowered. The types of injuries treated in each group are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15133\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15133\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15133\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EFracture Types\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EAt 12 months postoperatively, deep infection had occurred in 5 of 49 NPWT-treated patients (10.2%) and 2 of 41 gauze-treated patients (4.9%; \u003Cem\u003EP\u003C\/em\u003E = .44); while the difference was not significant, NPWT-treated patients were 2.3 times more likely to develop a deep infection. All deep infections occurred in patients with acetabular fractures involving the posterior wall or column requiring a Kocher-Langenbeck surgical exposure; of these 7 patients, 6 had medical comorbidities.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EDeep infections were not associated with body mass index (\u003Cem\u003EP\u003C\/em\u003E = .54), contrary to a study of morbidly obese patients [Porter SE et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2008] but consistent with a study of obese patients treated with NPWT [Reddix RN Jr et al. \u003Cem\u003EAm J Orthop (Belle Mead NJ).\u003C\/em\u003E 2009]. Those patients that ended up with infections spent significantly more time in the intensive care unit (\u003Cem\u003EP\u003C\/em\u003E = .015) and had significantly prolonged hospitalization (\u003Cem\u003EP\u003C\/em\u003E \u2264 .001). A cost comparison proved impossible.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAcknowledging the limitations of sample size and grouping of patients with different fractures, Dr Crist concluded that NPWT may not reduce the risk of infection, especially in patients with acetabular fractures involving the posterior wall or column who have other comorbidities.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/41\/9.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzol21\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzol21\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}