Jul 14, 2026 · 39 min · 9 segments
In this episode, Ayesha and Andrew discuss the **July 15, 2026** issue of JBJS, along with an added dose of entertainment and pop culture. Listen at the gym, on your commute, or whenever your case is…
Andrew SchoenfeldHost
Aisha AbdeenHost
And for our headlines, Andrew will present our first paper, clinical outcomes following open tibial fractures in Latin America, a multicenter prospective study by McKechnie, McKechnie rather.
All right, so this is a study that was done in collaboration with 18 trauma centers in eight countries between 2018 and 2022, spearheaded by the Actuar study group and, uh, the team out of UCSF.
The premise-- so you see the title, and I'm like, "Okay, so what is it about clinical outcomes following open tibial fractures, something that is especially well-studied, uh, for decades in Latin America that requires a multicenter prospective study?" And the author's answer to that is, "Surgeons in Latin America often have to rely on studies from higher-resourced regions, which may not be fully applicable to their patient populations.
Recognizing the need to better understand open tibial fracture management in this region, this study sought to compare health-related quality of life and fracture healing based on fixation strategies following open tibial fractures in Latin America." Okay, I mean, that, I can accept that.
I would say that with that as the motivating premise, what this really is, is a prospective observational data collection, a report of prospective observational data collection from multiple centers.
If it was done for the purposes of just standard patient care and then analyzed retrospectively, that really has the same threats to validity that it does if it was collected prospectively.
Maybe you could make the argument, "Well, there'll be fewer patients lost to follow-up, less missing data," and that would all be acceptable were that actually the case, uh, which, surprise ending, it isn't.
Um, it's a challenging population to take care of, of course, and, and it seems like that is no different in the United States than in Latin America.
Of these, 389 had a baseline evaluation, which is already a surprising drop-off since you'd expect the baseline [laughs] evaluation to happen at the time that the...
And then 352 had at least one follow-up, and then 309 had at least one SF-12 and radiographic follow-up.
So again, let's just come back to the premise here, the premise being that surgeons in Latin America have to rely on studies from higher-resourced regions, and it may not be fully applicable, presumably challenges in terms of delay.
You know, they talk about delayed presentation, de- delayed time to surgery, issues with resource, uh, limitations in resources.
And, you know, these are big countries that the, the studies conducted in Mexico had the highest proportion.
About a third of the patients came from Mexico, which in and of itself is a huge country with lots of different areas and, you know, Mexico City as compared to Juarez as compared to someplace in the Yucatan as compared to Oaxaca or somewhere in Baja California.
Like, these are all as drastically different as Boston to Minot, North Dakota.
You know, the premise, again, is like we need data specific to Latin America because there are all these challenges.
So that, that means that the patient cohort should be appropriately challenged.
The median time from injury to the initial surgery was approximately seven hours for Gustilo Anderson type I, II, and IIIA fractures, and less than six hours for type IIIB and C fractures.
And for our headlines, Andrew will present our first paper, clinical outcomes following open tibial fractures in Latin America, a multicenter prospective study by McKechnie, McKechnie rather.
All right, so this is a study that was done in collaboration with 18 trauma centers in eight countries between 2018 and 2022, spearheaded by the Actuar study group and, uh, the team out of UCSF.
The premise-- so you see the title, and I'm like, "Okay, so what is it about clinical outcomes following open tibial fractures, something that is especially well-studied, uh, for decades in Latin America that requires a multicenter prospective study?" And the author's answer to that is, "Surgeons in Latin America often have to rely on studies from higher-resourced regions, which may not be fully applicable to their patient populations.
Recognizing the need to better understand open tibial fracture management in this region, this study sought to compare health-related quality of life and fracture healing based on fixation strategies following open tibial fractures in Latin America." Okay, I mean, that, I can accept that.
I would say that with that as the motivating premise, what this really is, is a prospective observational data collection, a report of prospective observational data collection from multiple centers.
If it was done for the purposes of just standard patient care and then analyzed retrospectively, that really has the same threats to validity that it does if it was collected prospectively.
Maybe you could make the argument, "Well, there'll be fewer patients lost to follow-up, less missing data," and that would all be acceptable were that actually the case, uh, which, surprise ending, it isn't.
Um, it's a challenging population to take care of, of course, and, and it seems like that is no different in the United States than in Latin America.
Of these, 389 had a baseline evaluation, which is already a surprising drop-off since you'd expect the baseline [laughs] evaluation to happen at the time that the...
And then 352 had at least one follow-up, and then 309 had at least one SF-12 and radiographic follow-up.
So again, let's just come back to the premise here, the premise being that surgeons in Latin America have to rely on studies from higher-resourced regions, and it may not be fully applicable, presumably challenges in terms of delay.
You know, they talk about delayed presentation, de- delayed time to surgery, issues with resource, uh, limitations in resources.
And, you know, these are big countries that the, the studies conducted in Mexico had the highest proportion.
About a third of the patients came from Mexico, which in and of itself is a huge country with lots of different areas and, you know, Mexico City as compared to Juarez as compared to someplace in the Yucatan as compared to Oaxaca or somewhere in Baja California.
Like, these are all as drastically different as Boston to Minot, North Dakota.
You know, the premise, again, is like we need data specific to Latin America because there are all these challenges.
So that, that means that the patient cohort should be appropriately challenged.
The median time from injury to the initial surgery was approximately seven hours for Gustilo Anderson type I, II, and IIIA fractures, and less than six hours for type IIIB and C fractures.
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