Audrey Epstein Reny, Leah Gitajn, Ali Salim
Assistant Professor of Orthopaedics, Dartmouth Geisel School of Medicine
Arvind von Keudell, MD
Brigham and Women’s Hospital
Mitchel B. Harris, MD
Massachusetts General Hospital
Improving Outcomes for Patients with Fracture-Related Infections
Infection following fracture is one of the most prevalent and challenging complications in trauma patients. At 30 percent, recurrent infection rates are unacceptably high, resulting in prolonged morbidity, loss of function, and/or loss of limb. Adequate blood flow to bone is critical to deliver oxygen, nutrients, and antibiotics to infected bone. Management of bony infection is therefore based on thorough surgical removal or debridement of all bone with poor blood flow. Currently, however, there are no objective intraoperative real-time methods suitable for assessing bone viability and thoroughness of debridement. In addition, the current techniques are rudimentary and subjective, leading to substantial variation, particularly among less experienced surgeons.
Our goal with the Stepping Strong award is to provide clinicians with an objective measure of thoroughness of debridement that will result in less variation and enhanced treatment of fracture-related infection. This will result in better outcomes for patients with fracture-related infection, which will return patients to work and/or active duty more rapidly. As a next step, we hope to develop an intraoperative technique to optimize surgical debridement for patients with fracture-related infections. This work has high impact potential both within the military and in civilian trauma care.
Leah Gitajn, MD, completed her general surgery internship at Beth Israel Deaconess Medical Center and completed her orthopaedic residency at the Harvard Combined Orthopaedic Residency Program. She then completed a trauma fellowship at R. Adams Cowley Shock Trauma Center. In 2017 she joined Dartmouth-Hitchcock Medical Center where she currently serves as an assistant professor at Dartmouth Geisel School of Medicine. She recently completed a Master’s in Science at The Dartmouth Institute for Health Policy and Clinical Practice to gain additional expertise in research methodology, outcome, measurement, and comparative effectiveness research. Gitajn’s research interests include complex high energy trauma, infection/osteomyelitis and nonunion, as well as patient reported outcomes after traumatic injury.