Orthopedic Research and Reviews最新文献

{"title":"Perioperative Bleeding Risk and Associated Factors in End-Stage Kidney Disease Patients Undergoing Intertrochanteric Fracture Surgery: Implications for Management.","authors":"Yijun Wang, Hua Gao, Guoqiang Xu, Baojun Wang, Zhenyu Liu, Xiaodong Bai, Ji Ma, Jiatian Wang, Wentao Chen, Gang Wang","doi":"10.2147/ORR.S515632","DOIUrl":"https://doi.org/10.2147/ORR.S515632","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) patients undergoing intertrochanteric fracture surgery face complex coagulation challenges. This study aimed to identify risk factors for coagulation dysfunction in ESRD patients during the perioperative period of intertrochanteric fracture surgery.</p><p><strong>Methods: </strong>This retrospective study included 127 patients who underwent surgical treatment for intertrochanteric femoral fractures between January 2019 and June 2023, of whom 33 had end-stage renal disease (ESRD) and were receiving maintenance dialysis. Propensity score matching was performed at a 1:1 ratio based on age, gender, BMI (body mass index), fracture classification, anesthesia type, and APACHE II score, yielding 33 matched non-ESRD controls. Perioperative data, including coagulation parameters, biochemical indices, and clinical outcomes, were collected. Multivariable regression analysis was conducted to identify risk factors associated with coagulation dysfunction.</p><p><strong>Results: </strong>The dialysis group showed significantly different coagulation profiles compared to controls, particularly in platelet count (71.6 ± 21.3 vs 159.1 ± 35.7×10⁹/L, <i>P</i> = 0.003) and blood loss (609.9 ± 89.2 vs 559.3 ± 55.5 mL, <i>P</i> = 0.007). Regression analysis revealed that blood loss in the dialysis group was primarily influenced by platelet count (<i>P</i> < 0.001) and anticoagulant dose (<i>P</i> < 0.001), while in the control group it was mainly affected by surgery duration (<i>P</i> < 0.001). Although mean surgery duration did not differ significantly between groups, its relationship with blood loss varied markedly between ESRD and non-ESRD patients. The dialysis group experienced more complications, with most bleeding events occurring 5-7 days postoperatively when platelet counts reached their nadir.</p><p><strong>Conclusion: </strong>ESRD patients face increased bleeding risk during intertrochanteric fracture surgery, primarily associated with platelet count and anticoagulant use. The critical period for bleeding complications occurs 5-7 days postoperatively, suggesting the need for careful platelet monitoring and individualized anticoagulation protocols during this timeframe.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"515632"},"PeriodicalIF":2.3,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress Fracture Along with Transient Osteoporosis in a 72-Year-Old Female with Hip Pain: A Case Report.","authors":"Khalil Kargar Shooraki, Arash Aris, Masih Rikhtehgar","doi":"10.2147/ORR.S571126","DOIUrl":"https://doi.org/10.2147/ORR.S571126","url":null,"abstract":"<p><strong>Purpose: </strong>Transient hip osteoporosis (THO) is a rare, self-limiting condition characterized by acute hip pain and bone marrow edema. Although typically benign, THO may coexist with or predispose to femoral neck stress fractures, creating critical diagnostic and therapeutic challenges. We report a case of concurrent THO and femoral neck stress fracture in an elderly patient and discuss implications for management.</p><p><strong>Patients and methods: </strong>A 72-year-old female presented with an eight-month history of persistent right hip pain. Initial radiographs suggested synovial chondromatosis; however, symptoms persisted despite conservative treatment. Repeat radiographs demonstrated subtle sclerotic change and a cortical fracture line at the medial/inferior femoral neck. MRI revealed mild-to-moderate joint effusion and diffuse bone marrow edema involving the femoral head and neck consistent with THO, along with a linear low-signal fracture line consistent with an established femoral neck stress fracture. The patient was initially managed with protected weight-bearing and analgesics.</p><p><strong>Results: </strong>Symptoms persisted after conservative management, and prophylactic fixation with proximal femoral nail antirotation (PFNA) was performed. The patient experienced complete pain resolution by four months. At 18-month follow-up, radiographs demonstrated healing of the stress fracture with full return to weight-bearing.</p><p><strong>Conclusion: </strong>Diffuse marrow edema suggestive of THO does not exclude a clinically meaningful femoral neck stress fracture, particularly in older adults with persistent atraumatic hip pain. Early MRI and close follow-up are essential for detecting occult fractures, guiding weight-bearing recommendations, and preventing progression to displacement.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"571126"},"PeriodicalIF":2.3,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147284704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Outcomes in Patients with Rib Fractures, 2016-2020: A Retrospective Cohort Study from the Nationwide Readmissions Database.","authors":"Jarva Chow, Elizabeth R Hall, Hua She, Sajid Shahul","doi":"10.2147/ORR.S563977","DOIUrl":"https://doi.org/10.2147/ORR.S563977","url":null,"abstract":"<p><strong>Purpose: </strong>Readmissions are associated with worse patient outcomes, higher length of stay, and increased costs. Reducing unnecessary readmissions represents a significant opportunity for improving patient outcomes and healthcare delivery.</p><p><strong>Patients and methods: </strong>This was a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD), part of the United States Healthcare Cost and Utilization Project (HCUP). The NRD was queried to identify all adult (>18 years old) trauma patients with an admission diagnosis of rib fractures. Demographic and hospital data, comorbidities, as well as morbidity and mortality outcomes were collected.</p><p><strong>Results: </strong>The 2016-2020 NRD identified 553,810 patients admitted with a diagnosis of rib fractures, with 65,244 of those patients readmitted within 30 days of discharge. Patients with rib fractures who were readmitted within 30 days were associated with 9-fold higher mortality over six months than if they were not readmitted. Patients with rib fractures were more likely to be readmitted from small or medium-sized hospitals (p<0.001), had underlying depression (OR 1.42, 95% CI [1.34-1.51]), drug abuse (OR 1.23, 95% CI [1.13,1.35]), chronic pulmonary disease (OR 1.49, 95% CI [1.41,1.57]), and obesity (OR1.22, 95% CI [1.13-1.31]). There was an association with higher readmission rates in patients with a single rib fracture compared with multiple rib fractures.</p><p><strong>Conclusion: </strong>Patients readmitted within 30 days of discharge with rib fractures are associated with higher six-month mortality. Rib fractures are a common injury in trauma patients. Reducing unnecessary readmissions in this patient population may improve patient outcomes, satisfaction, and decrease healthcare costs.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"563977"},"PeriodicalIF":2.3,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12912142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Omics Bioinformatic Analyses Linking LOXL4 with Spondylolisthesis.","authors":"Hui Wang, Peng Niu, Xiu Yang, Xin Lin, Jinquan Li, Guangyin Wu, Xiaotang Sun, Jianghu Huang, Feiyue Lin","doi":"10.2147/ORR.S551680","DOIUrl":"10.2147/ORR.S551680","url":null,"abstract":"<p><strong>Purpose: </strong>Spondylolisthesis is a spinal disorder characterized by abnormal vertebral displacement, primarily affecting the lumbar region. Understanding the genetic factors underlying its progression is critical.</p><p><strong>Patients and methods: </strong>This study aimed to identify key genes influencing spondylolisthesis progression. The summary-data-based Mendelian randomization (SMR) analysis was conducted to evaluate gene expression quantitative trait (eQTL) and DNA methylation QTL (mQTL) data that were causally associated with spondylolisthesis. Subsequently, key genes were discerned by Bayesian colocalization analysis. To validate the findings, Quantitative real time polymerase chain reaction (qRT-PCR) experiments were conducted using human osteosarcoma cells (SW-1353). Additionally, enrichment analysis, small molecule compounds prediction and molecular docking were performed to investigate how the key genes might impact spondylolisthesis.</p><p><strong>Results: </strong>SMR analysis identified 841 cis-eQTLs and 3,224 mQTLs potentially linked to spondylolisthesis (P < 0.05). Bayesian colocalization revealed LOXL4 as a key gene, with posterior probabilities (PPH4) exceeding 0.90 for both eQTL (ENSG00000138131) and mQTL (cg09335911). LOXL4 is implicated in pathways like \"protein oxidation\" and \"collagen-containing extracellular matrix\", which are critical for tissue integrity. Molecular docking suggested that LOXL4 binds strongly to estradiol and progesterone, pointing to a potential mechanism of hormonal regulation in spondylolisthesis. However, this remains a hypothesis requiring further experimental validation. Additionally, qRT-PCR experiments in hydrogen peroxide-treated SW1353cells showed that LOXL4 expression changes were consistent with our bioinformatics predictions, although this in vitro model may not fully reflect the gene's role in spondylolisthesis.</p><p><strong>Conclusion: </strong>This findings suggest LOXL4 as a candidate gene involved in spondylolisthesis progression and a potential therapeutic target. Nevertheless, out results are preliminary and further research is needed to confirm LOXL4's role in this condition.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"551680"},"PeriodicalIF":2.3,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Recent Advances in Managing Periprosthetic Joint Infection After Total Knee Arthroplasty: DAIR Technique.","authors":"Hamza Warda, Jameel Suliman, Maria Chakhide, Michel Samaan","doi":"10.2147/ORR.S567611","DOIUrl":"10.2147/ORR.S567611","url":null,"abstract":"<p><p>Periprosthetic joint infection (PJI) is a significant complication that can arise after joint arthroplasty. The Debridement, Antibiotics, and Implant Retention (DAIR) approach is gaining popularity as a treatment to preserve the joint, especially in cases of early or acute infections. This review compiles recent evidence to assess the effectiveness, prognostic factors, and limitations of the DAIR method in managing PJI. Success rates for DAIR vary widely, ranging from 41% to 92%. These rates are significantly influenced by several factors, including the timing of the infection, the microbial profile, patient characteristics, and the surgical techniques used. Success rates for DAIR are generally highest (over 70-90%) when performed within 4-6 weeks of symptom onset, along with the exchange of modular components, particularly for patients who present a lower risk. Staphylococcus aureus infections, when coupled with delayed presentation and comorbidities like advanced age and chronic kidney disease, are associated with higher rates of treatment failure. The use of rifampin, especially when combined with fluoroquinolones, improves patient outcomes. However, the optimal antibiotic regimens have yet to be clearly established. Emerging techniques like DAPRI and novel antiseptic irrigation solutions (eg, Bactisure^®) show promise but need further clinical validation. While DAIR offers significant benefits, its variable success highlights the importance of careful patient selection and the urgent need for high-quality clinical research to establish standardized protocols and enhance long-term outcomes.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"567611"},"PeriodicalIF":2.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13006384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of Mucoid Degeneration in the Cruciate Ligament: Role of Denatured Aggrecan Accumulation and Tissue Dysfunction.","authors":"Akira Inoue","doi":"10.2147/ORR.S562853","DOIUrl":"https://doi.org/10.2147/ORR.S562853","url":null,"abstract":"<p><strong>Purpose: </strong>The frequency of detecting mucoid degeneration of the cruciate ligament (MD-CL) as an abnormal finding on magnetic resonance imaging in daily orthopedic practice is increasing. However, much about its pathogenesis remains unknown. This study investigated the pathophysiology of MD-CL by examining biochemical and physiological aspects in addition to traditional orthopedic approaches.</p><p><strong>Results: </strong>Previous studies have shown that mucoid degeneration of the anterior CL (MD-ACL) and posterior CL (MD-PCL) varies widely in incidence and clinical presentation, but both share similar pathology, marked by histological changes from the accumulation of sulfated glycosaminoglycan. This suggests a common etiology, with anatomical differences between CLs influencing clinical manifestations. Furthermore, MD-CL lesions resolved after debulking surgery, which normalized intraligamentous pressure and circulatory dynamics, suggesting a potential role of altered intraligamentous circulation in MD-CL pathogenesis.</p><p><strong>Conclusion: </strong>MD-CL is a pathological condition caused by an imbalance between the production and efflux of denatured aggrecan, possibly due to impaired matrix turnover or interstitial fluid drainage. In active-age groups, MD-CL is induced by altered intraligamentous circulation and lymphatic drainage dysfunction, combined with denatured aggrecan overproduction linked to inflammation from various proinflammatory factors. Mechanical stress may contribute to local inflammation through mechanotransduction pathways involving neuropeptides. In older adults, age-related dysfunction of nutrient vessels and increased inflammatory cytokines lead to denatured aggrecan accumulation, while age-related impaired lymphatic drainage reduces its clearance. Both age groups may exhibit abnormal deposition of denatured aggrecan within the ligament matrix, impairing CL integrity, altering viscoelasticity, and possibly resulting in osteoarthritis and meniscus damage.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"562853"},"PeriodicalIF":2.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Management of Primary Synovial Chondromatosis of the Ankle: A Case Report and Review of the Literature.","authors":"Antoine Saber, Hafez Saade, Firas Hassan, Hady Ezzeddine, Wendy Ghanem, Ramzi Moucharafieh, Riad R Fakih","doi":"10.2147/ORR.S544850","DOIUrl":"https://doi.org/10.2147/ORR.S544850","url":null,"abstract":"<p><p>Synovial chondromatosis (SC) is a rare, benign condition characterized by the formation of cartilaginous nodules within the synovial membrane of joints. We present a case of primary SC of the ankle in a 49-year-old female who experienced persistent ankle pain and restricted range of motion. She was successfully treated with arthroscopic removal of loose bodies and synovial debridement. A review of the literature since 2010 was conducted to compare outcomes between open and arthroscopic management of ankle SC. The findings suggest that while both approaches are effective and have similar long term outcomes, arthroscopy may offer slight advantage in terms of reduced morbidity, faster rehabilitation, and improved patient satisfaction.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"544850"},"PeriodicalIF":2.3,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13005217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Causal Effects of CCL19, CCL23, and IL17A on Achilles Tendinitis: Insights from Bidirectional Mendelian Randomization and Metabolite-Mediated Pathway Analysis.","authors":"Lu Wei, Wenqiang Wang, Xiang Chen, Shunan Dong, Hongjie Su, Puxiang Zhen, Xinyu Nie, Qikai Hua","doi":"10.2147/ORR.S574286","DOIUrl":"https://doi.org/10.2147/ORR.S574286","url":null,"abstract":"<p><strong>Background: </strong>Achilles tendinitis (AT) is a prevalent musculoskeletal disorder with unclear etiology. This study aimed to investigate the causal relationships between circulating inflammatory cytokines (ICs), metabolites, and AT risk using bidirectional Mendelian randomization (MR), and to identify potential metabolite-mediated pathways.</p><p><strong>Methods: </strong>A bidirectional MR design was implemented, integrating genetic instruments for 91 ICs and 1400 metabolites with GWAS summary statistics from the FinnGen consortium. Causal inferences were drawn using inverse variance weighting (IVW), MR-Egger regression, and weighted median approaches, accompanied by sensitivity and mediated analyses.</p><p><strong>Results: </strong>CCL19, CCL23, and IL17A were identified as protective factors for AT, with CCL23 demonstrating consistent associations across multiple MR methods. 65 metabolite traits were significantly associated with disease risk. Glycochenodeoxycholate glucuronide showed a protective effect (P = 0.002), whereas the alpha-tocopherol to glycerol ratio increased risk (P = 0.011). Mediation analysis indicated six pathways: CCL19 - pantothenate - AT; CCL19 - Picolinate - AT; CCL19 - X-21845- AT; CCL23 - X-12822 - AT; CCL23 - X-18921 - AT; IL17A - cysteinylglycine disulfide - AT.</p><p><strong>Conclusion: </strong>This is the first MR study to systematically assess the causal roles of ICs and metabolites in AT, identifying CCL19, CCL23, and IL17A as protective factors and highlighting multiple metabolite signatures linked to disease risk, offering novel insights for mechanistic research and targeted intervention.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"574286"},"PeriodicalIF":2.3,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extensile Posterolateral Novel Approach Through the Anconeus Muscle for an Atypical Coronal Shear Fracture of the Capitellum with Associated Lateral Epicondyle and Olecranon Fractures: A Case Report.","authors":"Abdulaziz Ahmed Abdulaziz, Osama Mohammed Qasim, Abdullah Hesham Alsawaf, Abdulraheem A Almokhtar, Khalid Jubran Idris, Atif Ahmed Labban, Khalid Ibrahim Najjar","doi":"10.2147/ORR.S549745","DOIUrl":"10.2147/ORR.S549745","url":null,"abstract":"<p><p>A 70-year-old female with a history of hypertension presented with a complex elbow injury following a fall. Imaging revealed fractures of the capitellum, lateral epicondyle, and olecranon. The fractures were managed using an extensile posterolateral approach through the anconeus muscle, achieving anatomical reduction and satisfactory functional outcomes 110° of flexion and full pronation/supination and Mayo Elbow Performance Score (MEPS) indicated an excellent outcome. This approach preserved the extensor origin and facilitated access for fixation, suggesting its potential as an alternative for managing such rare injuries.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"549745"},"PeriodicalIF":2.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Tibial Fractures Part 2: A Narrative Review of Definitive Treatment and Potential Applicability to the Southern African Context.","authors":"Erik Hohmann, Maketo Molepo, Maritz Laubscher, Kevin Tetsworth","doi":"10.2147/ORR.S553515","DOIUrl":"https://doi.org/10.2147/ORR.S553515","url":null,"abstract":"<p><p>The purpose of this study was to conduct a review of contemporary definitive treatment options, potential complications and clinical outcomes for open tibial shaft fractures and while assessing their relevance and applicability within South African context. Treatment options available in high-income countries may not be accessible in low-resource settings, requiring adaptations to the treatment approach based on local conditions. Only one African country has attempted to establish principal guidelines for the treatment of open tibial fractures through a consensus-based approach. These guidelines cover primary assessment, antibiotics, initial stabilization, referral criteria, debridement and irrigation, documentation, wound closure, soft-tissue management, amputation, and definitive internal fixation. Unfortunately, definitive fracture management recommendations for African low-resource countries are not yet available. There is a lack of data regarding the treatment of open tibial fractures in low-resource countries, particularly in regional and rural areas. Existing guidelines address antibiotic prophylaxis and treatment, debridement and lavage, initial surgical fixation, wound closure (both primary and definitive), soft-tissue management (including flap coverage), and bone fragment retention, all adapted to local resource availability. However, guidelines for definitive treatment remain unavailable. Treatment options recommended by high-income countries are largely unsuitable, and Southern African nations should focus on developing guidelines tailored to their available resources.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"553515"},"PeriodicalIF":2.3,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}