- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05157126
Gentamicin Open Tibia Study (GO-Tibia)
A Masked, Randomized Controlled Trial Evaluating Locally-applied Gentamicin Versus Saline in Open Tibia Fractures
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Tibial shaft (shinbone) fractures are the most common major fracture of the lower leg and are frequently associated with a break in the skin known as an open fracture. Because the bone is exposed by the open wound, open tibial fractures are often complicated by infection and failure of bone healing, which can lead to long-lasting disability and in some cases amputation. Intravenous antibiotics administered early after injury are a well-established measure to prevent fracture-related infection (FRI), but their effectiveness is limited by poor blood flow at the fracture site and inability to achieve high local concentrations with systemic administration. Gentamicin applied locally within the open fracture wound is a promising adjunctive measure to reduce the risk of FRI after these injuries, but there are no high-quality clinical trials evaluating its use.
This will be the first randomized trial evaluating locally administered gentamicin to reduce infection in a fracture population. If efficacious, local gentamicin is likely to be a highly cost-effective preventive strategy for FRI and may ultimately be cost saving. Although these findings will originate from a low-income country, results may be generalizable to populations in both high and low-income countries and could therefore significantly reduce the global burden of open fractures.
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: David W Shearer, MD, MPH
- Phone Number: 628-206-8812
- Email: david.shearer@ucsf.edu
Study Contact Backup
- Name: Tigist Belaye, MPA
- Phone Number: 628-206-8812
- Email: tigist.belaye@ucsf.edu
Study Locations
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-
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Dar es Salaam, Tanzania
- Recruiting
- Muhimbili Orthopaedic Institute
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Contact:
- Billy T Haonga, MD
- Phone Number: 255-022-2151298
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Principal Investigator:
- Billy T Haonga, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age>18 years old
Open tibial shaft fracture meeting the following criteria:
- Orthopaed Trauma Association (OTA) Type 42
- Primarily closable wound
- Gustilo-Anderson (GA) Type I, II, or IIIA
Exclusion Criteria:
- Time from injury to presentation > 48 hours
- Time from injury to surgery > 7 days
- Aminoglycoside allergy
- GA IIIB or IIIC open fractures
- Bilateral open tibial fractures
- Severe brain (GCS<12) or spinal cord injury
- Severe vascular injury
- Severe burns (>10% Total Body Surface Area (TBSA) or >5% TBSA with full thickness or circumferential injury)
- Pathologic fracture
- History of active limb infection, ipsilaterally
- Unlikely to complete follow-up
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Gentamicin
The intervention consists of 80mg of liquid gentamicin diluted in 5 mL normal saline (16mg/mL).
The solution is injected by inserting a 22-gauge needle down to bone through an anteromedial approach at the level of the fracture site such that the injected solution fills the wound cavity.
A total of 5mL of study solution will be administered.
|
Liquid gentamicin administered at the open fracture site
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Placebo Comparator: Saline
The control consists of 5 mL normal saline injected immediately after wound closure at the open fracture site.
The solution is injected by inserting a 22-gauge needle down to bone through an anteromedial approach at the level of the fracture site such that the injected solution fills the wound cavity.
A total of 5mL of study solution will be administered.
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Normal saline administered at the open fracture site
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Occurrence of fracture-related infection (FRI)
Time Frame: 12 months
|
Fracture-related infection is a consensus definition of infection after fracture treatment. It is diagnosed by an orthopaedic surgeon based on any of the following four diagnostic criteria: (1) fistula, sinus or wound breakdown; (2) purulent drainage from the wound or presence of pus during surgery; (3) phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; or (4) presence of microorganisms in deep tissue taken during an operative intervention, as seen on histopathological examination. FRI diagnosis is likely to peak between 6 weeks and 6 months after surgery and has a non-normal time-to-event distribution, with incident cases rarely presenting later than 12 months after surgery. All events will be confirmed by an independent adjudication committee comprised of three masked, non-treating orthopaedic trauma surgeons. |
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Occurrence of nonunion
Time Frame: 12 months
|
Binary outcome based on the following criteria:
|
12 months
|
Occurrence of unplanned fracture-related reoperation
Time Frame: 12 months
|
Occurrence of unplanned fracture-related reoperation, a binary variable, for infection, wound healing, or fracture union, excluding removal of implants for prominence/irritation. This may include but is not limited to:
|
12 months
|
Health-related quality-of-life (HRQOL) as measured by EQ-5D-3L (Swahili version)
Time Frame: 12 months
|
The EQ-5D is a survey instrument that assesses multiple domains of quality-of-life, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
|
12 months
|
Fracture healing by modified Radiographic Union Scale for Tibial fractures (mRUST score)
Time Frame: 12 months
|
The mRUST score is based on evaluation plain radiographs of the fracture site.
Each cortex is scored from 1-4 based on the degree of healing and summed resulting in an ordinal scale ranging from 4 to 16, with higher score indicating greater fracture healing.
|
12 months
|
Clinical fracture healing by Function IndeX for Trauma (FIX-IT)
Time Frame: 12 months
|
The FIX-IT score is an ordinal scale from 0-12 that encompasses two domains: ability to weight-bear and pain at fracture site, each scored from 0-6.
Higher score indicates more clinical healing.
|
12 months
|
Occurence of FRI Suggestive Criteria
Time Frame: 12 months
|
Suggestive criteria are signs/symptoms of infection that do not meet criteria for definitive fracture-related infection (FRI).
These include clinical signs (wound redness, fever) and radiographic signs (sequestrum), elevated serum inflammatory markers, and new onset or increased non-purulent wound drainage.
|
12 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adverse events
Time Frame: 12 months
|
All serious and non-serious adverse events will be reported as counts for each treatment group
|
12 months
|
Fold-change in creatinine level
Time Frame: 2 days
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Creatinine is a laboratory value used to assess kidney function.
Creatinine levels will be measured preoperatively and 2-days postoperatively for all study participants.
|
2 days
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: David W Shearer, MD, MPH, University of California, San Francisco
- Principal Investigator: Billy T Haonga, MD, Muhimbili Orthopaedic Institute
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 21-35369
- K23AR079044 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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