OTA international : the open access journal of orthopaedic trauma最新文献

{"title":"How does internal fixation compared with arthroplasty affect quality of life for patients who have suffered femoral neck fractures?","authors":"Zafar Ahmad, Daniel Axelrod, Marianne Comeau-Gauthier, Sofia Bzovsky, Rudolf W Poolman, Frede Frihagen, Mohit Bhandari, Marc Swiontkowski, Sheila Sprague, Emil Schemitsch","doi":"10.1097/OI9.0000000000000404","DOIUrl":"10.1097/OI9.0000000000000404","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate functional outcomes amongst femoral neck fracture trial participants who did not undergo reoperation.</p><p><strong>Design: </strong>Secondary analysis of 2 randomized controlled trials.</p><p><strong>Setting: </strong>Ninety hospitals in 5 continents.</p><p><strong>Participants: </strong>Patients aged 50 years or older with a femoral neck fracture.</p><p><strong>Intervention: </strong>Arthroplasty, including total hip arthroplasty and hemiarthroplasty, or internal fixation, including sliding hip screw or multiple cancellous screws.</p><p><strong>Main outcome measurement: </strong>The Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-item Short Form Health Survey (SF-12) physical component summary (PCS).</p><p><strong>Results: </strong>Data from 716 arthroplasty patients and 549 internal fixation patients were included in our propensity score weighting model. Internal fixation patients had higher WOMAC stiffness scores (leading to poorer function) at 24 months postoperatively compared with total hip arthroplasty patients (adjusted mean difference [AMD] 0.42 points, 99% confidence interval [CI] 0.09-0.75; <i>P</i> < 0.001) and hemiarthroplasty patients (AMD 0.39 points, 99% CI 0.04-0.74; <i>P</i> = 0.004). However, this statistically significant difference did not reach the 7-point threshold for a minimal clinically important difference. No statistically significant differences were found in the other WOMAC scales, nor with the SF-12 PCS. In participants aged 70 years or younger, no difference was found in any of the functional outcomes at 24 months.</p><p><strong>Conclusion: </strong>While stiffness is worse following internal fixation, our results show similar functional outcomes in femoral neck fracture patients undergoing modern methods of internal fixation versus arthroplasty. These results, however, may not be applicable to a younger, more active hip fracture population.</p><p><strong>Level of evidence: </strong>Prognostic Level II.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2","pages":"e404"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183563","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":"Distal femur fractures stabilized using titanium lateral locked plates with nonlocking diaphyseal fixation: a retrospective review.","authors":"Asa Peterson, Benjamin Nwadike, Mikel Headford, Thomas Revak","doi":"10.1097/OI9.0000000000000399","DOIUrl":"10.1097/OI9.0000000000000399","url":null,"abstract":"<p><strong>Objectives: </strong>Multiple treatment modalities exist for treating distal femur fractures. Lateral locked plating has become the method of choice because it prevents loss of reduction due to varus collapse, but has been associated with nonunion rates of up to 30%. Titanium implants may provide a more optimal biomechanical environment for fracture healing. The primary aim of this study is to evaluate nonunion rates and risk factors for nonunion in a series of distal femur fractures stabilized with modern locked titanium implants using all nonlocking diaphyseal fixation. A secondary aim is to evaluate whether diaphyseal fixation with nonlocking screws is associated with fixation complications.</p><p><strong>Methods: </strong>A 6-year retrospective study identified patients undergoing operative fixation of distal femur fractures with lateral locked plating and nonlocking diaphyseal fixation. Patient demographics, fracture and fixation characteristics were recorded. Follow-up data recorded included fracture union, implant failure in the setting of nonunion and secondary procedures. Statistical analyses used include <i>t</i> test, Mann-Whitney <i>U</i>, and logistic regression.</p><p><strong>Results: </strong>Eighty-one fractures met inclusion criteria with 16 fractures resulting in nonunion (19.75%). Comparing union and nonunion cohorts, nonunions were found to be associated with higher body mass index (<i>P</i> = 0.001). Fixation construct data found nonunions had a higher average number of diaphyseal screws (4.25 vs. 3.74, <i>P</i> = 0.038). Subgroup analysis found a nonunion rate of 4.2% (1 out of 24) in fractures with 3 diaphyseal screw fixation versus 26.3% (15 out of 57) with 4 or more diaphyseal screws (<i>P</i> = 0.038). No diaphyseal fixation failures were noted with nonlocking diaphyseal screw fixation.</p><p><strong>Conclusion: </strong>Our study found using a titanium construct produced a nonunion rate of 19.75%, comparable with historic rates. Interestingly, diaphyseal fixation with more than 3 screws led to higher nonunion rates. No catastrophic failures were observed involving the diaphyseal nonlocking screw fixation.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2","pages":"e399"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183461","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":"Regenerate stabilization with a photodynamic bone stabilization system after acute shortening and then lengthening: a case report.","authors":"Elizabeth P Wellings, James A Blair","doi":"10.1097/OI9.0000000000000408","DOIUrl":"10.1097/OI9.0000000000000408","url":null,"abstract":"<p><strong>Case: </strong>A 42-year-old African-American woman sustained a type IIIA open pilon fracture requiring open reduction internal fixation complicated by wound dehiscence. Acute shortening for primary wound closure was performed followed by relengthening in a circular frame. Owing to the patient's intolerance to the circular frame, pre-existing osseous deformity, large body habitus, and soft tissue compromise, conversion to intramedullary stabilization with standard nailing was deemed exceedingly difficult. We describe the use of a photodynamic bone stabilization system allowing for percutaneous entry and implant flexibility for the purpose of early circular frame removal.</p><p><strong>Conclusion: </strong>This case demonstrates successful protection of immature regenerate using a photodynamic bone stabilization system, offering another tool to minimize time spent in a circular frame.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2","pages":"e408"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12114000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175979","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":"Pelvis/acetabulum: management of geriatric injuries.","authors":"Jaime A Leal, Pol M Rommens, Rafael Amadei","doi":"10.1097/OI9.0000000000000394","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000394","url":null,"abstract":"<p><p>Geriatric pelvic and acetabular fractures pose significant challenges due to patient frailty, comorbidities, and the complexity of fracture patterns. This review examines current evidence and evolving strategies for managing these injuries. Treatment approaches range from nonoperative management to surgical interventions, including percutaneous fixation, open reduction and internal fixation (ORIF), and total hip arthroplasty, either as a standalone procedure or combined with ORIF. Decision making is guided by fracture morphology, patient functionality, and physiological reserve to optimize clinical outcomes. Minimally invasive techniques, particularly for fragility fractures of the pelvis, have gained traction because of their ability to provide stable fixation while minimizing surgical morbidity. The importance of early mobilization and a multidisciplinary perioperative approach is highlighted as essential in reducing complications and improving recovery. Despite advancements, controversy remains regarding the optimal treatment of complex acetabular fractures in elderly patients. This review synthesizes the latest evidence and expert perspectives to aid clinicians in selecting the most appropriate management strategies, with the goal of restoring mobility, minimizing complications, and enhancing the quality of life in this vulnerable population.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3 Suppl","pages":"e394"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061536","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":"Trauma systems: a global comparison.","authors":"Theodore Miclau, Zsolt J Balogh, Katherine R Miclau, Brian Bernstein, Kodi Edson Kojima, Taketo Kurozumi, Ross K Leighton, Douglas W Lundy, Guy Putzeys, Inger B Schipper, Wim Vandesande, Marcos de Camargo Leonhardt, Maria Adelaide Miranda Goncalves, Guilherme Pelosini Gaiarsa, Hans-Christoph Pape","doi":"10.1097/OI9.0000000000000376","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000376","url":null,"abstract":"<p><p>Traumatic injuries are a leading cause of global morbidity and mortality, with 40 million people permanently injured and nearly 6 million deaths every year. Approximately 90% of trauma-related deaths occur in low- and middle-income countries, and 50% of trauma-related deaths are believed to be preventable. Although effective trauma systems encompassing prehospital, hospital, and rehabilitative care are critical for improving outcomes, global documentation remains limited. This study provides a comparative analysis of trauma care systems across 8 countries-the United States, Canada, Brazil, Belgium, the Netherlands, Australia, Japan, and South Africa-spanning 5 continents. Each country's analysis includes demographic context, system organization (including prehospital, hospital, and posthospital care), clinical and systemic outcomes, and future directions. Trauma systems across countries vary significantly in the structure and regulation of trauma care, injury patterns, national data collection, and accessibility, reflecting diverse demographics and healthcare infrastructures. National trauma registries are well established in countries like the Netherlands, Japan, and Canada but are in early development stages in Brazil, South Africa, and Belgium. In some countries, such as the Netherlands and Canada, trauma from traffic collisions and falls dominates, whereas others, such as Brazil and South Africa, have higher rates of violence-related injuries like homicides. Accessibility in remote areas remains a challenge in countries with large landmasses such as Canada and Australia, where rural populations often face limited or delayed trauma care. Other countries, such as the United States and South Africa, face different challenges linked to disparities in quality of and access to care between public and private systems. Although centralization of trauma care, standardization of national trauma care systems, and investment in workforce and infrastructure are universal goals for improving outcomes, solutions tailored to each country are required to optimize trauma systems globally.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3 Suppl","pages":"e376"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042938","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":"Proximal humerus fractures: Treatment controversies.","authors":"Utku Kandemir, Guy Putzeys, Michael McKee","doi":"10.1097/OI9.0000000000000382","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000382","url":null,"abstract":"<p><p>The treatment of proximal humerus fractures is challenging, and significant controversy exists even regarding which patients are indicated for surgical treatment. When surgery is indicated, open reduction and internal fixation is the most common type of treatment. Arthroplasty is reserved for unreconstructible fractures. Hemiarthroplasty may not provide good, reliable function but may be the best option in younger or middle-aged patients when fracture fixation is not feasible. While several studies reported no benefit of surgical treatment in elderly patients, more recent literature showed better outcomes with reverse total shoulder arthroplasty.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3 Suppl","pages":"e382"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001712","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":"Current concepts in tibial plateau fracture management: a Spanish Orthopaedic Trauma Association review.","authors":"Francisco Chana-Rodríguez, Jordi Teixidor-Serra, Juan Boluda-Mengod, Jesús Gómez-Vallejo, Ion Carrera-Fernández, Alberto Delgado Martínez, Theodore Miclau","doi":"10.1097/OI9.0000000000000392","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000392","url":null,"abstract":"<p><p>This article summarizes a symposium on topics regarding the current management of tibial plateau fractures presented by the Spanish Orthopaedic Trauma Association as a guest nation society at the Orthopaedic Trauma Association Annual Meeting in October 2023 in Seattle, Washington. These topics include staged treatment strategies, surgical planning, fracture classification, and factors influencing weight bearing. A staged protocol for treating high-energy fractures of the proximal tibia using spanning external fixation with quadrangular configuration is a simple and reproducible way to apply the device and reduce and span these fractures. Multicolumnar fractures can behave differently based on their categorization using the main deformity direction concept, defined as a theoretical vector representing the global displacement or deformity of the columns in a specific direction, and this can help surgeons decide on the definitive treatment. With the classification of columnar involvement and their variants, surgeons can use computed tomography scans to formulate solutions to approach and fix individual fracture patterns. Finally, a finite element analysis may inform the surgeon's decision for immediate weight bearing of a split plateau fracture after fixation with locking screw plates or cannulated screws.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3 Suppl","pages":"e392"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060720","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":"Muscle injury in orthopaedic trauma.","authors":"Justin Haller, Roman Natoli, Augustine Saiz, Joseph Wenke, Dillon O'Neill, Andrew Evans","doi":"10.1097/OI9.0000000000000362","DOIUrl":"10.1097/OI9.0000000000000362","url":null,"abstract":"<p><p>Muscle injury in the setting of orthopaedic trauma is common. Skeletal muscle injury can cause immune dysregulation and impair fracture healing both in patients and in various preclinical models. Muscle injury can also be associated with impaired vascularity and eliminate the muscle paracrine effect, both of which can impair fracture healing. Severe muscle injury can lead to volumetric muscle loss. While there are currently no effective treatments for volumetric muscle loss, minced muscle autograft has been shown to improve fracture healing, but not improve muscle function. Acute compartment syndrome can severely impact functional recovery and limit fracture healing. However, current animal models of compartment syndrome lack appropriate translation to the clinical injury.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2 Suppl","pages":"e362"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766185","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":"The expanding role of additive manufacturing in orthopaedic traumatology.","authors":"Vu Le, Malcolm DeBaun, Samir Mehta, Guha Manogharan, Michael W Hast","doi":"10.1097/OI9.0000000000000388","DOIUrl":"10.1097/OI9.0000000000000388","url":null,"abstract":"<p><p>The 2023 Orthopaedic Trauma Association's Basic Science Focus Forum featured a symposium on additive manufacturing (AM) in orthopaedics. Three experts presented on various aspects of AM: Dr. Malcolm DeBaun discussed custom 3D-printed implants for segmental bone loss, Dr. Samir Mehta explored 3D printing in education and surgical planning, and Dr. Guha Manogharan addressed challenges and opportunities in AM and hybrid manufacturing. The symposium highlighted AM's significant impact across clinical, educational, and industrial applications in orthopaedic trauma.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2 Suppl","pages":"e388"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765817","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":"Artificial intelligence: international perspectives on critical issues.","authors":"Meir T Marmor, Justin Krogue, Job N Doornberg, Michiel Herteleer, Adam J Starr, Hans-Christoph Pape","doi":"10.1097/OI9.0000000000000389","DOIUrl":"10.1097/OI9.0000000000000389","url":null,"abstract":"","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2 Suppl","pages":"e389"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766173","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}