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

{"title":"Pelvis and lower extremity fractures related to 4-wheeled off-road vehicles: trends from the national electronic injury surveillance system database.","authors":"Elizabeth Rivenbark, Charlotte Lenz, Alejandro Esparza, Galen Robert Cummings, Jordan E Johnson","doi":"10.1097/OI9.0000000000000483","DOIUrl":"10.1097/OI9.0000000000000483","url":null,"abstract":"<p><strong>Objective: </strong>This paper characterizes recent trends in pelvis and lower extremity orthopaedic injuries treated in US emergency departments from 2012 to 2021 associated with four-wheeled off-road vehicles (ORVs).</p><p><strong>Methods: </strong>The National Electronic Injury Surveillance System database was queried for ORV-related lower trunk and lower extremity injuries from 2012 to 2021. Injury totals and trends were analyzed descriptively, with a weighted analysis generalizing results to the US population.</p><p><strong>Results: </strong>A total of 1795 cases were analyzed, representing 71,506 lower extremity and pelvis injuries from 2012 to 2021. Adults (age ≥18) accounted for 47,342 injuries (45,036 fractures and 1643 dislocations), whereas pediatric (age <18) patients accounted for 24,164 (21,951 fractures and 1388 dislocations) injuries. Adult fractures most commonly involved the lower leg (14,560, 30.8%), ankle (9416, 19.9%), and pelvis/hip (7566, 16.0%). The commonest pediatric fractures were in the lower leg (7561, 31.2%), ankle (3498, 14.5%), and upper leg (3247, 13.4%). There was a notable increase in fractures after 2018, mainly because of rising ankle, knee, and pelvis fractures. From 2012 to 2021, there were 21,782 hospital admissions.</p><p><strong>Conclusion: </strong>ORV-related injuries are increasing in prevalence and severity as ORV use increases. Rates of lower extremity orthopaedic injuries, particularly ankle, knee, and pelvis fractures, have risen, especially since 2018. These data should inform the trauma community to promote awareness of ORV dangers and safety.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e483"},"PeriodicalIF":0.0,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13193280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019133","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":"Appropriateness of patients transferred with orthopaedic injuries: a retrospective study of a Level III teaching hospital.","authors":"Cameron O'Brien, Trevon Jelinek, Alec Young, Cole Phelps, Amar Patel, Clint Basener, Jeremy Scott","doi":"10.1097/OI9.0000000000000484","DOIUrl":"10.1097/OI9.0000000000000484","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the appropriateness, clinical outcomes, and cost burden of interfacility orthopaedic transfers to a Level III teaching hospital, and to assess adherence to institutional transfer protocols.</p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level III teaching hospital in the Midwest United States.</p><p><strong>Patients/participants: </strong>All patients referred for orthopaedic transfer between March 1, 2023, and May 31, 2024 (N = 267 transfers; 192 accepted, 73 denied).</p><p><strong>Intervention: </strong>Not applicable. This was an observational study.</p><p><strong>Main outcome measurements: </strong>Transfer appropriateness based on consultation timing, surgical intervention, and alignment with institutional protocols; secondary outcomes included transport distances, financial burden, and rate of secondary transfers.</p><p><strong>Results: </strong>Most (77.6%) transfers were accepted by emergency medicine, with orthopaedic consultation requested in 80.9% of cases, but only 21.4% of these consultations occurred before initiation of the transfer. Approximately 50% of transferred patients required surgery, with an average time to surgery of 57.8 hours after their arrival at our Level III facility. The estimated transportation cost ranged from $502,507 to $573,707, with an additional hospital stay cost of $211,697.41. The total cost of transfers and care ranged from $714,204 to $785,404.</p><p><strong>Conclusion: </strong>A substantial proportion of orthopaedic transfers to this Level III hospital were nonurgent, frequently lacked pretransfer orthopaedic consultation, and resulted in significant financial and resource burden. These findings highlight inefficiencies in current interfacility transfer practices and underscore the need for improved triage, communication, and adherence to existing transfer protocols. Further research is warranted to evaluate structured approaches aimed at improving transfer appropriateness and resource utilization.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Comparative Study.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e484"},"PeriodicalIF":0.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147870586","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":"Deriving the OTA/AO fracture classification from routinely collected radiology reports using a large language model.","authors":"Stephanie Hu, Timothy Keeley, Ryan Halvorson, Sean T Campbell, Kelly Ann Lefaivre, Ashley Levack, Douglas W Lundy, Eric Meinberg, Kyle Schweser, Stephen J Shymon, Meir T Marmor","doi":"10.1097/OI9.0000000000000482","DOIUrl":"10.1097/OI9.0000000000000482","url":null,"abstract":"<p><strong>Objectives: </strong>Fracture classification plays a pivotal role in research and quality assurance; despite its wide acceptance, the OTA/AO classification is seldom documented in patients' electronic medical records, which impedes fracture registry creation and effective interdisciplinary communication. In this study, we investigate \"off-the-shelf\" large language models (LLMs) in translating free text in radiology reports into OTA/AO classification labels.</p><p><strong>Methods: </strong>We employed a Health Insurance Portability and Accountability Act-compliant LLM to classify 109 fracture descriptions from randomly selected radiology reports in a deidentified electronic medical record database. Ground-truth classifications were assigned by expert orthopaedic traumatologists based on corresponding radiographs. Multiple prompting strategies were tested, including zero-shot prompting, zero-shot chain-of-thought prompting, and retrieval-augmented generation. We additionally asked the LLM to assign classification labels to \"ideal\" fracture descriptions written according to the 2018 OTA/AO Fracture and Dislocation Classification Compendium. Model performance was assessed using Cohen kappa and accuracy against ground-truth labels.</p><p><strong>Results: </strong>The 3 prompting strategies tested yielded similar classification performance on radiology report fracture descriptions, with almost perfect agreement at the <i>bone</i> and <i>bone and location</i> levels. Performance declined to slight agreement at the subgroup level. The best performance was observed using ideal fracture descriptions with retrieval-augmented generation, in which the agreement between the full LLM-generated and ground-truth labels remained moderate. Classification errors were largely due to imprecise descriptions, hallucinated information, or incorrect application of factually correct information.</p><p><strong>Conclusions: </strong>Our study demonstrates some potential for LLMs to translate free-text fracture descriptions into OTA/AO classifications, allowing for efficient labeling of large datasets of radiology reports. Future work should focus on refining model classification capabilities using more sophisticated prompting methods.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e482"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13134765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824428","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":"Long-term outcomes after intrepid dynamic exoskeletal orthosis treatment coupled with advanced rehabilitation.","authors":"Sarah N Pierrie, Michelle D Lockwood, Tyler J Cagle, John R Fergason, Walter L Childers","doi":"10.1097/OI9.0000000000000477","DOIUrl":"10.1097/OI9.0000000000000477","url":null,"abstract":"<p><strong>Objective: </strong>To measure Intrepid Dynamic Exoskeletal Orthosis (IDEO) use patterns, return to work or return to duty, and amputation rate among patients undergoing limb salvage ≥2 years after discharge.</p><p><strong>Design: </strong>Telephone survey and retrospective medical chart review.</p><p><strong>Setting: </strong>Military tertiary care hospital and rehabilitation center.</p><p><strong>Patients/participants: </strong>A total of 190 active duty or retired service members, military health care beneficiaries, and civilians aged 22 to 64 years old with traumatic lower limb injuries treated with an IDEO were invited to participate in a telephone survey. A total of 145 individuals (76.3% of those contacted) completed the survey.</p><p><strong>Main outcome measurements: </strong>IDEO use patterns, participation in the Return to Run (RTR) rehabilitation program, return to work or active duty, and elective amputation rate.</p><p><strong>Results: </strong>The most common initial diagnosis was lower limb fracture (54.5% of participants). The most common mechanism of injury was from explosive devices (22.8%). After IDEO prescription, 86.9% of respondents participated in the RTR program. Approximately 77.9% of patients returned to work; 67.3% of active duty IDEO users returned to active duty. At final follow-up (mean 90.3 ± 32.9 months, range 24.0-157.0 months), 80 patients (55.2%) still use their IDEO, whereas 14 patients (9.7%) had elected for amputation.</p><p><strong>Conclusions: </strong>Long-term IDEO use combined with the RTR rehabilitation program was associated with positive long-term outcomes as evidenced by a high self-reported activity level, high rate of return to work or duty, and low elective amputation rate among patients with severe lower limb injuries.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e477"},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679197","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":"Skin laceration during closed reduction of distal radius fracture in the elderly: an underappreciated complication.","authors":"Arun Upreti, Harihar Adhikari, Shirish Adhikari","doi":"10.1097/OI9.0000000000000481","DOIUrl":"10.1097/OI9.0000000000000481","url":null,"abstract":"<p><strong>Background: </strong>Distal radius fractures are common osteoporotic injuries in elderly patients. Dermatoporosis, an age-related cutaneous insufficiency often associated with corticosteroid use and malnutrition, is frequently overlooked in these cases despite its clinical relevance during fracture management.</p><p><strong>Materials and methods: </strong>A 72-year-old underweight woman with chronic obstructive pulmonary disease and long-term corticosteroid use presented with an extra-articular Colles-type distal radius fracture after a trivial fall. Closed reduction under hematoma block was attempted. During disimpaction, a 5 × 2-cm dorsal wrist skin laceration occurred without communication with the fracture hematoma, necessitating abandonment of the procedure. Definitive treatment consisted of gentle closed reduction and percutaneous K-wire fixation under brachial plexus block, with primary closure of the skin laceration using horizontal mattress sutures.</p><p><strong>Result: </strong>The wound healed uneventfully; sutures were removed at 3 weeks and K-wires at 6 weeks, followed by early wrist mobilization.</p><p><strong>Conclusion: </strong>Skin tearing during closed reduction of distal radius fractures can occur in elderly patients with fragile skin because of dermatoporosis. Recognition of this condition, adoption of gentle reduction techniques, and meticulous soft-tissue management are essential to reduce wound-related complications and optimize outcomes in this vulnerable population.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e481"},"PeriodicalIF":0.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679326","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":"High-velocity gunshot-related humeral fractures managed with circular external fixation in a resource-limited setting, Samburu County, Kenya: Surgical technique highlights from a case series.","authors":"Daniele Sciuto, Kiran J Agarwal-Harding, Luigi Paolo Spreafico","doi":"10.1097/OI9.0000000000000476","DOIUrl":"10.1097/OI9.0000000000000476","url":null,"abstract":"<p><strong>Introduction: </strong>High-velocity gunshot-related humeral fractures are complex injuries often associated with a high rate of nonunion, infection, and poor functional outcome. In low- and middle-income countries these injuries are further complicated by delayed presentation and implant unavailability. Staged management with spanning external fixation followed by internal fixation with intramedullary nail or plate has been well described in the literature; however, the use of a circular frame as a definitive treatment has been very seldom mentioned.</p><p><strong>Materials and methods: </strong>Six high-velocity gunshot-related humeral fractures cases were treated with a single stack half ring circular external fixator as a definitive surgery performed by a single surgeon. Aspects related to surgical technique, fracture reduction, infection prevention, and restoration of upper limb function using circular frame external fixator are described.</p><p><strong>Results: </strong>Fracture union was achieved with circular fixation alone in 5 of the 6 patients. One patient developed a nonunion and required a second operation with a lateral compression plate combined with iliac crest autograft. The median circular fixator time was 16 weeks, and the median elbow range of motion was from 0° to 130° of flexion. The median shoulder range of motion was from 0° to 170° of overhead extension. The median Quick-DASH score was 4.5. No patients developed pin site infections.</p><p><strong>Conclusion: </strong>Single-stage definitive treatment with a circular external fixator may be a valid option, not only for surgeons working in resource-constrained environments, for high-velocity gunshot fractures of the humerus. Patients' cultural acceptance and maintenance of the external device far exceeded our expectations.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e476"},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13004204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147500928","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":"A biomechanical comparison of antegrade versus retrograde cannulated screw direction in suture-based tension band fixation of transverse patella fractures.","authors":"Shannon M Kaupp, Lincoln K Andre, Wayne Scalisi, Robert W Rutz, Patrick A Massey, Giovanni F Solitro","doi":"10.1097/OI9.0000000000000480","DOIUrl":"10.1097/OI9.0000000000000480","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of this study was to determine if there is a difference in load to fixation failure when comparing antegrade or retrograde screw direction in tension band fixation of transverse patella fractures.</p><p><strong>Methods: </strong>A simulated fracture was created in 16 patellae with an oscillating saw, which was then reduced and fixed using two 4.0-mm headed partially threaded cannulated screws inserted in either an antegrade or retrograde fashion. FiberWire suture was passed through the screws in figure-of-eight fashion and tied. The quadriceps tendon was loaded in tension, and failure was defined by 2 mm of separation between the proximal and distal fragments. Loading was continued until catastrophic failure. Tension forces at 2 mm of fracture gapping and peak loads were recorded.</p><p><strong>Results: </strong>The mean load at 2-mm fracture gapping was 715.8 and 701.9 N for the antegrade and retrograde screw configurations, respectively. Mean peak load was 1070.9 N for the antegrade group and 1166.8 N for the retrograde group. There was no significant difference between load to failure (<i>P</i> = 0.945) or peak load (<i>P</i> = 0.575) between the 2 tested configurations.</p><p><strong>Conclusion: </strong>Our biomechanical study demonstrates no significant difference in load to fixation failure between antegrade or retrograde cannulated screws in a suture-based anterior tension band for transverse patella fractures.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e480"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488712","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 reduction and internal fixation versus distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis.","authors":"Tyler Brady, Sam Shapiro, Kurt Barger, Niloofar Dehghan","doi":"10.1097/OI9.0000000000000475","DOIUrl":"10.1097/OI9.0000000000000475","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review and meta-analysis compares open reduction and internal fixation (ORIF) versus distal femoral replacement (DFR) for periprosthetic distal femur fractures (PDFF), focusing on patient-reported outcomes, perioperative measures, functional results, and complications.</p><p><strong>Data sources: </strong>Following PRISMA guidelines, PubMed, Embase, Scopus, and ScienceDirect were searched from January 2010 through November 2024 using keywords and MeSH strategies.</p><p><strong>Study selection: </strong>Studies were eligible if they compared outcomes of ORIF and DFR for PDFFs and included ≥10 patients. Exclusion criteria included noncomparative studies, primary arthroplasty indications, and nonperiprosthetic fractures.</p><p><strong>Data extraction: </strong>Two independent reviewers extracted data on demographics, interventions, patient-reported outcomes, functional outcomes, and complications. Quality was assessed using the Newcastle-Ottawa Scale. Discrepancies were resolved by a third author.</p><p><strong>Data synthesis: </strong>Random-effects meta-analyses were used to calculate pooled incidence rates and risk ratios with 95% confidence intervals. Heterogeneity was assessed via I² and Cochran Q. Thirteen retrospective cohort studies (n = 881; ORIF: 554, DFR: 327) were included.</p><p><strong>Conclusions: </strong>Knee Society Functional Scores were significantly better for ORIF vs DFR in the 2 studies reporting this metric (53 vs 39, <i>P</i> = 0.012; 52 vs 37, <i>P</i> = 0.027). There was no significant difference in Oxford Knee Scores (MD = -0.11, 95% confidence intervals: [-1.74, 1.52], <i>P</i> = 0.85). Mean time to weight bearing was shorter for DFR vs ORIF (2 vs 78 days, respectively; <i>P</i> = 0.04), although risk ratios for returning to preoperative mobility and achieving unassisted ambulation were statistically insignificant. The rate of reoperation was significantly higher for ORIF versus DFR (12% vs 7%, respectively; <i>P</i> = 0.048). ORIF may offer advantages in patient-reported functional outcomes compared with DFR. Although DFR allows for immediate weight bearing, this advantage may not imply superior long-term mobility.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e475"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488762","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":"Trans-symphyseal fixation for complex anterior pelvic fractures: a novel technique guide and case series.","authors":"Nicholas F Quercetti, Steve DiStefano, Michael Yayac, John Getchell, Mitchell K Ng","doi":"10.1097/OI9.0000000000000479","DOIUrl":"10.1097/OI9.0000000000000479","url":null,"abstract":"<p><strong>Objectives: </strong>To describe a novel percutaneous technique utilizing a curved intramedullary implant for fixation of complex anterior pelvic ring fractures and to report preliminary clinical outcomes from a retrospective case series.</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Setting: </strong>Single academic Level I trauma center.</p><p><strong>Patients/participants: </strong>Nine female patients (mean age 74.8 years, range 53-89 years) with anterior pelvic ring injuries treated with percutaneous trans-symphyseal fixation using a curved intramedullary device between June 2023 and December 2024. All patients were treated by a single orthopaedic trauma surgeon and followed for a minimum of 6 months.</p><p><strong>Intervention: </strong>Percutaneous intramedullary fixation of the superior pubic ramus crossing the pubic symphysis and terminating in the contralateral ramus using a novel flexible, curved implant.</p><p><strong>Main outcome measurements: </strong>Operative time, estimated blood loss, implant complications, fracture union, and discharge disposition.</p><p><strong>Results: </strong>The novel technique was successfully performed in all 9 patients. Average total surgical time was 106.3 minutes, with a mean of 54.8 minutes dedicated to the anterior fixation. Average estimated blood loss was 132.2 mL. All fractures progressed to union with no cases of implant failure or surgical site infection. Assistive measures were required in 3 of 9 cases. Discharge disposition was favorable, with 5 of 9 patients discharged to home or acute rehabilitation. No complications related to the anterior implant were noted.</p><p><strong>Conclusions: </strong>This retrospective review suggests that trans-symphyseal curved intramedullary fixation is a feasible and safe technique for managing anterior pelvic ring fractures, including fragility and high-energy patterns. The method provides stable fixation while minimizing operative time, blood loss, and surgical exposure. Further studies are warranted to compare this technique against established modalities in larger cohorts.</p><p><strong>Level of evidence: </strong>Level IV-Therapeutic study.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e479"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488764","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":"Use of intraoperative vancomycin powder and its effects on the incidence of surgical site infection in orthopaedic trauma: a systematic review with meta-analysis.","authors":"Troy B Puga, McKenna W Box, Alan Lam, Claire Ferguson, Mason Poffenbarger, Cornelis J Potgieter, Kisan Parikh, John T Riehl","doi":"10.1097/OI9.0000000000000474","DOIUrl":"10.1097/OI9.0000000000000474","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infection (SSI) in orthopaedic trauma can have devastating consequences. The use of intraoperative powdered vancomycin is one strategy used in orthopaedic trauma surgery to reduce SSI; however, evidence and guidelines remain unclear. The aim of this systematic review is to evaluate the evidence for the use of powdered vancomycin in orthopaedic trauma surgery for the prevention of SSI.</p><p><strong>Methods: </strong>A search was conducted across PubMed/Medline, Cochrane, and Embase databases to evaluate the use of powdered vancomycin in orthopaedic trauma surgery for the prevention of SSIs. The search used a combination of keywords and MeSH terms. Titles and abstracts were screened for inclusion criteria eligibility. Full texts were screened and included if they met eligibility criteria. A meta-analysis was completed to evaluate the effects of vancomycin in orthopaedic trauma surgery for the prevention of SSIs. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) standards were followed.</p><p><strong>Results: </strong>Seven studies met final inclusion criteria. Four of 7 studies found a statistically significant reduction in either surgical site/fracture-related infection or reduction in gram-positive SSIs. No studies found any effect on the rate of gram-negative infections. Meta-analysis of 7 studies demonstrated a decrease in overall SSI when powdered vancomycin was used (odds ratio = 0.49; 95% confidence interval: 0.33-0.72, <i>P</i> = 0.0003) and a decrease in the incidence of gram-positive SSI (odds ratio = 0.35 [95% confidence interval: 0.14-0.84], <i>P</i> = 0.0185).</p><p><strong>Conclusion: </strong>Powdered vancomycin may be a safe and effective treatment option that reduces the rate of overall SSI and gram-positive SSI in orthopaedic trauma surgery patients. However, these findings are tempered by the included studies heterogeneous populations and vancomycin dosing. Further large-scale trials stratified by fracture type, gram-negative risk, and cost-effectiveness studies, along with investigations into resistance patterns, biofilm prevention strategies, and local delivery systems, are essential for refining and optimizing the use of intraoperative powdered vancomycin in orthopaedic trauma care.</p><p><strong>Level of evidence: </strong>Level III; Therapeutic.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e474"},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463575","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}