Brad Michael Askam

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• O'Hara, N., Frey, K., Stein, D., Levy, J., Slobogean, G., Castillo, R., Firoozabadi, R., Karunakar, M., Gary, J., Obremskey, W., Seymour, R., Cuschieri, J., Mullins, C., O'Toole, R., Carlini, A., Fowler, B., Taylor, T., Wegener, S., Weston-Farber, E., , Herndon, S., et al. (2024). Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial. Journal of Bone and Joint Surgery, 106(7). doi:10.2106/JBJS.23.00824
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  Background:Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.Methods:This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales.Results:The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001).Conclusions:Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
• , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , ., , , ., et al. (2023). The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes. Injury, 54(6). doi:10.1016/j.injury.2023.03.001
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  Background: Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. Methods: We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results: 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). Conclusion: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.
• , M. E., O'Toole, R. V., Stein, D. M., O'Hara, N. N., Frey, K. P., Taylor, T. J., Scharfstein, D. O., Carlini, A. R., Sudini, K., Degani, Y., Slobogean, G. P., Haut, E. R., Obremskey, W., Firoozabadi, R., Bosse, M. J., Goldhaber, S. Z., Marvel, D., & Castillo, R. C. (2023). Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis after a Fracture. The New England journal of medicine, 388(3), 203-213.
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  Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared with aspirin are lacking.
• Askam, B. M. (2022). Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial. Lancet (London, England), 400(10360), 1334-1344.
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  Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture.
• Gitajn, I. L., Werth, P., Fernandes, E., Sprague, S., O'Hara, N. N., Bzovsky, S., Marchand, L. S., Patterson, J. T., Lee, C., Slobogean, G. P., & , P. I. (2022). Association of Patient-Level and Hospital-Level Factors With Timely Fracture Care by Race. JAMA network open, 5(11), e2244357.
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  Racial disparities in treatment benchmarks have been documented among older patients with hip fractures. However, these studies were limited to patient-level evaluations.
• O'Hara, N. N., Heels-Ansdell, D., Bzovsky, S., Dodds, S., Thabane, L., Bhandari, M., Guyatt, G., Devereaux, P. J., Slobogean, G. P., Sprague, S., & , P. I. (2022). A pragmatic randomized trial evaluating pre-operative aqueous antiseptic skin solutions in open fractures (Aqueous-PREP): statistical analysis plan. Trials, 23(1), 772.
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  Approximately 1 in 10 patients with a surgically treated open fracture will develop a surgical site infection. The Aqueous-PREP trial will investigate the effect of 10% povidone-iodine versus 4% chlorhexidine in aqueous antiseptic solutions in reducing infections after open fracture surgery. The study protocol was published in April 2020.
• Gitajn, I. L., Werth, P. M., Sprague, S., O'Hara, N., Della Rocca, G., Zura, R., Marmor, M., Domes, C. M., Hill, L. C., Churchill, C., Townsend, C., Van, C., Hogan, N., Girardi, C., Slobogean, G. P., & , P. I. (2021). Association of COVID-19 With Achieving Time-to-Surgery Benchmarks in Patients With Musculoskeletal Trauma. JAMA health forum, 2(10), e213460.
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  In response to the COVID-19 pandemic, many hospital systems were forced to reduce operating room capacity and reallocate resources. The outcomes of these policies on the care of injured patients and the maintenance of emergency services have not been adequately reported.
• Rice, O. M., Phelps, K. D., Seymour, R., Askam, B. M., Kempton, L. B., Chen, A., Dart, S., & Hsu, J. R. (2021). Single-Stage Treatment of Fracture-related Infections. Journal of orthopaedic trauma, 35(Suppl 2), S42-S43.
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  Fracture-related infections (FRIs) remain a significant problem. Many approach FRI cases in a staged fashion, focusing on infection eradication initially and fracture union during subsequent procedures. The literature quotes high success rates with this strategy. However, associated patient morbidity and economic impact are noteworthy. A single-stage FRI treatment, using an antibiotic-coated locked intramedullary nail, also exists. This video details low-cost, antibiotic-coated locked intramedullary nail fabrication in the operating room alongside preliminary results using this technique for acute FRI and septic nonunion treatment.
• Askam, B. M., Khwaja, A., Manoharan, A., & Morin, M. (2020). The Importance of the Screening Anteroposterior Pelvis Radiograph in Trauma Patients: A Level-1 Trauma Center's Experience with Traumatic Hip Dislocations. Western Journal of Orthopaedics.
• Askam, B., & Sims, S. (2019). Supplemental Superior Buttress Plating for the Treatment of Posterosuperior Wall Acetabulum Fractures. Journal of orthopaedic trauma, 33 Suppl 2, S27-S31.
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  Posterosuperior wall acetabulum fractures are a unique and uncommon fracture pattern. Traditional plate fixation may not provide adequate fixation of these fracture fragments. This article presents a surgical technique and the results of a case series using a supplemental 1/3 tubular superior buttress plate to improve fracture reduction and better neutralize shear forces in the treatment of superior posterior wall fractures. Additionally, we compared failure rates of those posterior superior wall acetabular fractures treated with supplemental superior buttress plates to those treated with standard plate fixation and no supplemental superior buttress plates.
• Lenehan, E. A., Payne, W. B., Askam, B. M., Grana, W. A., & Farrow, L. D. (2015). Long-term outcomes of allograft reconstruction of the anterior cruciate ligament. American journal of orthopedics (Belle Mead, N.J.), 44(5), 217-22.
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  Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.
• Askam, B. M., Farrow, L. D., Grana, W. G., & Lenehan, E. A. (2012). Long-Term Outcomes Following Allograft Reconstruction of the Anterior Cruciate Ligament (SS-65). Arthroscopy. doi:10.1016/j.arthro.2012.04.123
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  Generally, good-excellent long-term results following anterior cruciate ligament (ACL) reconstruction exceed 90 percent. Recently some authors have reported higher rates of both reoperation and graft failure following allograft reconstruction of the ACL. We hypothesize that the rates of reoperation and revision surgery following allograft ACL reconstruction are not as high as that reported in the literature. The purpose of this study is to evaluate the long term results of a cohort of patients undergoing allograft ACL reconstruction at a single institution.
• Wild, J. R., Askam, B. M., Margolis, D. S., Geffre, C. P., Krupinski, E. A., & Truchan, L. M. (2012). Biomechanical evaluation of suture-augmented locking plate fixation for proximal third fractures of the olecranon. Journal of orthopaedic trauma, 26(9), 533-8.
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  To describe a method of suture augmentation of locking plate fixation (PF) of proximal olecranon fractures and to evaluate the biomechanical effectiveness of the suture augmentation using a human cadaveric model.
• Askam, B. M., DeSilva, G. L., Farrow, L. D., & Horton, S. D. (2011). Management of Carpometacarpal Dislocations in a College Football Athlete. International Journal of Athletic Therapy and training. doi:10.1123/ijatt.16.5.14

Proceedings Publications

• Askam, B. M., & Morin, M. (2019, October). Defining the Intramedullary Axis of the Distal Tibia Using CT. In Orthopaedic Trauma Association Annual Meeting.
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  PURPOSE: With the intramedullary (IM) nail constrained by the isthmus, proper nail end position in distal tibia fractures is important in the prevention of malalignment. The purpose of this study was to describe the IM axis of the distal tibia using computed tomography (CT). METHODS: An analysis of CTs of uninjured tibias was performed. Coronal images were oriented perpendicular