Welcome to the collaboration involving the Aqueous-PREP and PREPARE trials1,2. This combined effort represents one of the largest prospectively collected datasets to measure many aspects of practice variability within modern fracture management. Independently published, the Aqueous-PREP and PREPARE trials answered the fundamental question of whether an iodine or chlorhexidine aseptic skin solution reduces surgical site infections (SSIs) and/or unplanned reoperations in patients with a fracture.

This supplement combines the 2 trial datasets and asks a number of other questions regarding the modern management of fractures in patients. The supplement is organized to take the reader through many of the daily clinical decision points with which providers are faced, including the following questions: Do hospital-based infection prevention strategies, such as nasal decolonization, impact infection? What impact does the type and duration of prophylactic antibiotics have on infection rates? Does the use of temporizing external fixators impact infection? Does the preparation solution have an impact on nonunion rates? And, should the patient become infected, what organisms would we see, how soon would they develop, and what is the current practice of medical treatment for these infections? We also explore other topics such as the impact of socioeconomic factors, race, gender, and food deserts on infection development. In addition, we compare a simplified modification of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC3) with the prior OTA-OFC and Gustilo-Anderson classification systems for predicting surgical site infection and unplanned reoperation.

It is our hope that these studies will aid in daily clinical decision-making, spark interest in further lines of research, and, above all, improve fracture care for patients everywhere. The Aqueous-PREP and PREPARE trials were a part of the PREP-IT (A Program of Randomized Trials to Evaluate Preoperative Antiseptic Skin Solutions in Orthopaedic Trauma) program and shared key aspects of study design3. For a detailed summary of each trial and its specific findings, as well as the full supplementary document, please access the full-text link. Copyright © 2025 By the Journal of Bone and Joint Surgery, Incorporated.

https://pubmed.ncbi.nlm.nih.gov/40531109/