January 28, 2026

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Key takeaways:

• Top papers from the Orthopaedic Trauma Association Annual Meeting were discussed at Orthopedics Today Hawaii.
• The papers highlighted topics of infection, rehabilitation, mental health and surgical approach.

WAIKOLOA, Hawaii — At Orthopedics Today Hawaii, **Clifford B. Jones, MD, FAAOS, FAOA, FACS, **discussed the best papers presented at the Orthopaedic Trauma Association Annual Meeting.

The first paper, which received the award for best research components, included 106 patients with fracture-related infections who underwent indocyanine green-based dynamic contrast-enhanced fluorescence imaging to predict reinfection. Jones said researchers found an infection recurrence of 29%, with a revision rate of 4% in small low perfusion areas vs. 27% in large low perfusion areas.

At Orthopedics Today Hawaii, Clifford B. Jones, MD, FAAOS, FAOA, FACS, discussed the best papers presented at the Orthopaedic Trauma Association Annual Meeting. Image: Adobe Stock

“This is probably not for your usual community practice type, but looking at tissues in the future,” Jones, professor and chair at Creighton Medical School — Phoenix, chief of orthopedic surgery at Dignity Health — Arizona, and clinical lead, CDT, at CommonSpirit, said.

METRC studies

Clifford B. Jones

Jones also highlighted four papers from the Major Extremity Trauma Research Consortium (METRC). The first included 1,528 patients with tibial plateau or tibial pilon fractures treated with plate and screw fixation who were at high risk for infection. Patients were randomly assigned to receive either 1.2 g of tobramycin powder plus 1 g of vancomycin powder or 1 g of vancomycin powder alone at definitive fracture fixation.

“They found the infection rate was higher in the combined group of vancomycin and tobramycin than just the vancomycin group alone,” Jones said. “The advice is not to use tobramycin in combination with vancomycin in these complex wounds at time of closure.”

Another METRC study compared venous thromboembolic rates among 12,211 patients with orthopedic trauma fractures who were randomly assigned to receive either aspirin or low-molecular-weight heparin. Of the 379 venous thromboembolic events that occurred, results showed 40.9% occurred during the initial hospital stay.

“The patients who had problems with aspirin had most of these in the hospital,” Jones said. “Probably using low-molecular-weight heparin in the hospital is appropriate. You then need to coordinate your outpatient care for [deep vein thrombosis] prophylaxis thereafter.”

The third METRC study, which received the Bovill Award, randomly assigned 435 patients with ankle fracture to either early (2 weeks postoperatively; n = 214) or delayed (6 weeks postoperatively; n = 204) weight-bearing.

“There was no difference concerning reoperation rate or return to work status, which is somewhat interesting,” Jones said.

Finally, the group randomly assigned 242 patients who developed a fracture-related infection after fracture repair or arthrodesis with fixation with implants to receive either oral antibiotics (n = 122) or IV antibiotics (n = 120).

“They said there was no inferiority, but the biggest thing that you’ll have to take a look at is what amount of bone penetration do you have for the antibiotic for this appropriate bacteria,” Jones said. “That’s the biggest thing that wasn’t covered and that’s very important from this.”

Groundbreaking research

Jones said another groundbreaking study came from the PREP-IT investigators where hospitals were randomly assigned to use 0.7% iodine povacrylex in 74% isopropyl alcohol or 2% chlorhexidine gluconate in 70% isopropyl alcohol as preoperative antisepsis for patients with extremity fractures.

Among 6,785 patients with closed fractures, results showed 2.4% of patients in the iodine group and 3.3% of patients in the chlorhexidine group had a surgical site infection. Meanwhile, among patients with open fractures, researchers found 6.5% and 7.3% of patients in the iodine group and chlorohexidine group, respectively, had a surgical-site infection.

“The discerning thing is that closed fractures seem to have a lower rate of infection in the iodine group vs. the chlorhexidine group,” Jones said. “There was no difference in terms of the open fractures.”

Additional works

Other papers highlighted spanned the topics of mental health, surgical approach and rehabilitation methods.

One paper revealed that patients with high-energy traumatic musculoskeletal injuries who were prescribed fluoxetine had a reduced risk for posttraumatic stress disorder compared with those prescribed calcium.

“The question is who is going to be monitoring this because this is also related with increased risk for suicide,” Jones said. “There’s probably someone who needs to coordinate your care for these patients.”

A study from researchers at NYU Langone randomly assigned 185 patients with isolated displaced distal radius fractures requiring surgical fixation to immediate mobilization (no splint; n = 87) or immobilization (splint; n = 98) postoperatively.

“There was no difference in these patients, although they seem to have worse pain scores at 6 months with the splint group and probably had more physical therapy visits,” Jones said.

Another study highlighted by Jones from researchers at the University of Missouri included data collected from 85 patients with acute acetabular fractures involving one or more columns who were managed with total hip arthroplasty within 3 weeks of injury and had 1-year minimum follow-up. Researchers reviewed medical records, radiographs and operative reports for patient demographics, fracture classification, reduction and fixation, implants used, and outcomes.

Results showed patients who had acetabular trauma fixation principles applied had lower revision and reoperation rates compared with those who did not have acetabular trauma fixation principles applied.

The final study highlighted included 102 patients with acute femoral neck fractures randomly assigned to undergo hemiarthroplasty with the anterior approach (n = 50) or the lateral approach (n = 52).

“There were no differences in any problems — revisions or otherwise — in these patients for up to 6 to 12 months postoperatively,” Jones said.

For more information:

Clifford B. Jones, MD, FAAOS, FAOA, FACS, can be contacted at cbjones230@gmail.com.

Published by:

Sources/Disclosures

Source:

Jones CB. Best papers 2025 OTA — OTA chairs choice papers: Papers that change our practice. Presented at: Orthopedics Today Hawaii; Jan. 11-15, 2026; Waikoloa, Hawaii.

References:

• Gitajn L, et al. Paper 55. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• Hagen JE, et al. Paper 26. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• Hoskins W, et al. Paper 41. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• Major Extremity Trauma Research Consortium. JAMA Surg. 2025;doi:10.1001/jamasurg.2025.6439.
• Marchand LS, et al. Paper 13. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• Moll S, et al. Paper 34. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• Obremskey WT, et al. Paper 25. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• O’Toole RV, et al. Paper 23. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.
• PREP-IT Investigators. N Engl J Med. 2024;doi:10.1056/NEJMoa2307679.
• Woolnough T, et al. Paper 21. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 15-18, 2025; Phoenix.

** Disclosures: ** Jones reports receiving support from Smith & Nephew, Tyber Medical LLC and Zimmer Biomet Holdings Inc.

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