Learn on Demand
Contemporary Treatment of Open Fractures
Presenter: Regis Renard, MD
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Knowledge Gap: 
The purpose of this activity is to educate healthcare providers with the most up-to-date information on Contemporary Treatment of Open Fractures.

Target Audience
The target audience includes all healthcare professionals such as physicians, nurses, pharmacists and allied health professionals who would like to learn about Contemporary Treatment of Open Fractures and how it pertains to their respective profession.

 
Release and Expiration Dates
2/17/2017 - 2/17/2020

Objectives

  1. Define the historic context of open fractures.
  2. Explain the current studies reflecting the role of prehospital care, emergency department care, and surgical treatment for open fractures.
  3. Apply the possible future directions for the treatment of open fractures.

Biographical Info

Dr. Renard is a board certified, orthopaedic traumatologist. He specializes in the care of peri-articular, pelvic and acetabular fractures; treatment of post-traumatic complications including nonunions, malunions and osteomyelitis; limb salvage; deformity correction; joint preservation and post-traumatic adult reconstruction of the hip, knee and ankle.

Dr. Renard graduated from the Johns Hopkins University with a Bachelor of Science in Biomedical Engineering specializing in Material Science as well as a minor in Applied Mathematics. He received a Master of Science in Biomedical Engineering from Rutgers, The State University of New Jersey. He graduated from The University of Medicine and Dentistry of New Jersey-The New Jersey Medical School, where he also completed his Orthopaedic Surgery training. He completed his Orthopaedic Traumatology fellowship at the University of Southern California where he also served on staff at the LAC-USC Medical Center in Los Angeles, California. Prior to joining UAMS, he was an orthopaedic trauma surgeon at Brookhaven Memorial Hospital Medical Center and Long Island Orthopaedic and Spine Specialists.

He has received several honors and awards throughout his medical career including the Gold Humanism Award and Chief Resident teaching award. He has authored several publications and textbook chapters relating to clinical and basic science aspects of orthopaedic injuries. Dr. Renard is a member of the American Association of Orthopaedic Surgeons, American College of Surgeons, Orthopaedic Trauma Association and AO trauma group. He is active teaching and lecturing locally and nationally for the Orthopaedic Trauma Association and AO-North America. His research interests include evaluation of fracture fixation constructs; pharmacologic means to improve fracture healing and evaluation of cartilage injuries associated with peri-articular fractures.



Dr. Renard’s financial relationships:
  1. Consulting Fee-Depuy-Synthes, Inc.
  2. Consulting Fee-Acumed, Inc.
  3. Consulting Fee-Medtronic, Inc. 

 

References

  1. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315(8):801-810
  2. FRIEDRICH, P. L.: Die aseptische Versorgungfrischer Wunden.
  3. Arch. Klin. Chir., 57: 288–310, 1898
  4. http://wellcomeimages.org/indexplus/obf_images/e6/15/abf228125d11666860b0b5af7ab3.jpgGallery: http://wellcomeimages.org/indexplus/image/L0002075.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=35861283
  5. DeBakey ME. Military surgery in World War II. A backward glance and a forward look. N Engl J Med. 1947;236:341-50
  6. Tong MJ. Septic complications of war wounds. JAMA. 1972 Feb 21;219(8):1044-7.
  7. Patzakis MJ, Harvey JP, Ivler D. The role of antibiotics in the management of open fractures. J Bone Joint Surg Am. 1974; 56(3):532-541.
  8. Gustilo RB, Mendoza RM, Williams DN. J Trauma. 1984 Aug;24(8):742-6.
  9. Jackson DS. Sepsis in soft tissue limbs wounds in soldiers injured during the Falklands Campaign 1982. J R Army Med Corps. 1984 Jun;130(2):97-9.
  10. Saveli C, Belknap R, Morgan S, Price C. The Role of Prophylactic Antibiotics in Open Fractures in an Era of Community-acquired Methicillin-resistant Staphylococcus aureus. ORTHOPEDICS. 2011; 34: 611-616
  11. Lack WD et al. Type III Open Tibia Fractures: Immediate Antibiotic Prophylaxis Minimizes Infection. J Orthop Trauma. 2015 Jan 29(1):1-6.
  12. Ostermann PA et al. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. JBJS-Br. 1995 77:93-97.
  13. Henry SL et al. The Prophylactic use of antibiotic impregnated beads in open fractures. J Trauma. 1990 30:1231-1238.
  14. Kragh JF Jr et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma.
  15. J Trauma. 2008 Feb;64(2 Suppl):S38-49; discussion S49-50.
  16. Beekley AC  et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008 Feb;64(2 Suppl):S28-37; discussion S37.
  17. Ode et al. Emergency tourniquets for civilians: Can military lessons in extremity hemorrhage be translated? J Trauma Acute Care Surg. 2015 Oct;79(4):586-91.
  18. Hospenthal et al. Executive Summary: Guidelines for the Prevention of Infections Associated with Combat-Related Injuries: 2011 Update. J Trauma. 2011 August;71(Supp 2):S202-S209.
  19. Murray CK et al. Efficacy of point-of-injury combat antimicrobials. J Trauma. 2011 Aug;71(2 Suppl 2):S307-13.
  20. Thomas SH et al. Helicopter emergency medical services crew administration of antibiotics for open fractures. Air Med J. 2013 Mar-Apr;32(2):74-9.
  21. Smit L and Boyle MJ. Does wound irrigation in the prehospital environment affect infection rates? – A Review of the Literature. Australasian Journal of Paramedicine: 2015;12(4)
  22. Bhandari M et al. Identifying potential opportunities to improve open fracture care: Prognostic Factors for predicting re-operations after operative management of open fractures. Podium Presentation at “Extremity War Injuries XII: Homeland Defense as a Translation of War Lessons Learned. “ Washington DC, 2017
  23. Khatod et al. Outcomes in open tibia fractures: relationship between delay in treatment and infection. J Trauma. 2003 55(5):949-954.
  24. Tripuraneni et al. The effect of time delay to surgical debridement of open tibia shaft fractures on infection rate. Orthopedics. 2008 31(12):1-5.
  25. Pollack AN et al. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. JBJS-Am. 2010 92 (1):7-15.
  26. Singh J et al. The relationship between time to surgical debridement and incidence of infection in grade III open fractures. Stategies Trauma Limb Reconstr. 2012 7 (1):33-37.
  27. Srour M et al. Prospective Evaluation of Treatment of Open Fractures: Effect of time to irrigation and debridement. JAMA Surg. 2015 150(4):332-336.
  28. FLOW Investigators. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Engl J Med 2015;373:2629-41.
  29. Noel SP et al. Chitosan films: a potential local drug delivery system for antibiotics. Clin Orthop Relat Res 2010(6):370-375.
  30. Penn-Barwell JG et al. Local Antibiotic Delivery by a Bioabsorbable Gel is Superior to PMMA Bead Depot in Reducing Infection in an Open Fracture Model. J Orthop Trauma 2014 (6):370-375.
  31. Stinner DJ et al. Local antibiotic delivery using tailorable chitosan sponges: the future of infection control? J Orthop Trauma 2010 24(9):592-597.

 

 

Speaker Disclosures:
The planners, speakers, moderators, peer reviewers and /or panelists of this CE activity have no relevant financial relationships with commercial interests to disclose.

Planners: 
Kim Miller
Sarah Rhoads 
Susan Smith Dodson
Mark Jansen

Speaker:
Regis Renard, MD        

Peer Reviewers: 
Kim Miller, MCHES


Instructions to obtain credit:

1.       Launch the activity 
2.       Complete the pre-test 
3.       View the entire activity online 
4.       Complete the post-test 
           (must pass the post-test with a score of 80% to receive credit)
           You may retake the post-test if you do not receive a passing score.
5.       Complete Evaluation 
Print certificate or transcript (Available in the “My Profile” tab).

 

ANCC Accreditation Statement:
The Office of Continuing Education, University of Arkansas for Medical Sciences is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

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Phone: 501-661-7962 Fax: 501-661-7968

 

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The University of Arkansas for Medical Sciences (UAMS) Office of Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

UAMS Office of Continuing Education 
4301 West Markham Street #525 
Little Rock, AR 72205 
Phone: 501-661-7962 Fax: 501-661-7968

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The University of Arkansas for Medical Sciences (UAMS) Office of Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

Designation Statement 
The University of Arkansas for Medical Science Office of Continuing Education designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Disclosure Policy statement
It is the policy of the University of Arkansas for Medical Sciences (UAMS) College of Medicine to ensure balance, independence, objectivity, and scientific rigor in all directly or jointly provided educational activities. All individuals who are in a position to control the content of the educational activity (course/activity directors, planning committee members, staff, teachers, or authors of CE) must disclose all relevant financial relationships they have with any commercial interest(s) as well as the nature of the relationship. Financial relationships of the individual’s spouse or partner must also be disclosed, if the nature of the relationship could influence the objectivity of the individual in a position to control the content of the CE. The ACCME describes relevant financial relationships as those in any amount occurring within the past 12 months that create a conflict of interest. Individuals who refuse to disclose will be disqualified from participation in the development, management, presentation, or evaluation of the CE activity.

 

 

Type:  Internet Activity (Enduring Material)
53 Registered Users
Credits
1 Hours> Non-Accredited

1 Credits> Accreditation Council for Continuing Medical Education> AMA PRA Category 1 Credit

1 Contact Hours> American Nurses Credentialing Center> ANCC

1 CECH, 1 CECH> National Commission for Health Education Credentialing, Inc. > CHES