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

{"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}

{"title":"Orthopaedic infections: novel treatment strategies and evolving concepts.","authors":"Christopher Lee, I Leah Gitajn, Kyle Schweser, Joseph Wenke, Edward McPherson, Jack Wixted","doi":"10.1097/OI9.0000000000000395","DOIUrl":"10.1097/OI9.0000000000000395","url":null,"abstract":"<p><p>Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall rate of infection following orthopaedic surgery with internal fixation devices has been estimated at 5%, with hospital costs 8 times that of those without fracture-related infections and with significantly poorer outcomes regarding function and pain. Fracture-related infections (FRIs) occur in approximately 20% of all trauma cases, and treatment has evolved very little over the years. While union can be achieved 70%-89% of the time, long-term recurrence rates vary between 9% and 58% and retention of implants is only around 30%-40%. This is underscored by the financial, psychosocial, and physical burden placed on the patients. The difficult management of FRIs is multifactorial; however, a major contributor is biofilm. Alternative treatment strategies to combat biofilm have come in the form of photodynamic therapy and bacteriophage therapy. Use of local antibiotic therapy in the form of powder and dissolvable antibiotic beads has continued to be expanded, with new applications explored. Systemic antibiotic use has continued to be optimized, with new treatment protocols calling for per os (PO) administration as opposed to intravenous. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2 Suppl","pages":"e395"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766189","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":"New paradigms in pain management after skeletal trauma: Orthopaedic Trauma Association's 2023 Basic Science Focus Forum Symposium.","authors":"Jasmine V Hartman Budnik, Thomas F Higgins, Anne-Marie Malfait, Jarret A P Weinrich, Allan I Basbaum, Joseph R Hsu, Saam Morshed, Chelsea S Bahney","doi":"10.1097/OI9.0000000000000352","DOIUrl":"10.1097/OI9.0000000000000352","url":null,"abstract":"<p><p>Traumatic injuries are associated with significant acute pain and subsequent high risk of the development of chronic pain. However, addressing pain after skeletal trauma presents a complex challenge to achieve effective pain relief that minimizes risk of addiction and does not interfere with functional recovery. The Orthopaedic Trauma Association's 2023 Basic Science Focus Forum aimed to bridge the gap between basic science and clinical outcomes with an educational symposium on pain management designed to foster collaboration and provide practical strategies from the frontiers of pain research. Owing to the subjective and multifaceted nature of pain, the development of effective preclinical and clinical pain assessment measures is the first step to making impactful progress in studying pain. Preclinical models prove a valuable tool for studying the molecular mechanisms associated with pain following orthopaedic trauma. These models also allow study of the efficacy of novel pain management techniques, such as testing novel analgesics. Translating novel analgesics and pain management strategies to the clinic requires that we have accurate methods to describe pain to determine whether new approaches are meaningful. It is also necessary to recognize the patient's role and the importance of patient education in the prevention of pain medication misuse, particularly in light of the current national opioid crisis. Overall, collaboration with orthopaedic surgeons in the application of these strategies in a clinical setting is vital for addressing the downfalls of current pain management efforts and providing patients with safe and effective improvements in pain relief after skeletal trauma.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2 Suppl","pages":"e352"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766187","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":"Development of a small animal bone-anchored limb replacement model for infection interventions.","authors":"Bailey V Fearing, Sarah M Romereim, Kerry Danelson, Matthew Smykowski, Marina Barankevich, Ryan Serbin, Nainisha Chintalapudi, Jana Davis, Susan Appt, Heather Burkart, Rachel B Seymour, Joseph R Hsu","doi":"10.1097/OI9.0000000000000366","DOIUrl":"10.1097/OI9.0000000000000366","url":null,"abstract":"<p><strong>Purpose: </strong>Osseointegration-associated infections are a critical barrier to widespread implementation of osseointegrated (OI) prosthetics. To address this challenge, a preclinical animal model must exist of the human model to test potential interventions. In this article, we describe a novel rabbit model of OI implant-related infection that can act as a platform for rapid translation and development of therapeutic approaches to combat these uniquely challenging infections.</p><p><strong>Methods: </strong>A single-stage amputation was performed by exposure, transection, reaming, and tapping of the tibia, followed by placement of a 75-mm Ti-6Al-4V cortical screw implant. Muscle and skin were closed, and a prosthetic was attached to the screw. Hematology, clinical chemistry, and imaging were performed up to 8 weeks. High-resolution microCT and histology were conducted at terminal end points. Intraosseous vancomycin delivery was compared with intravenous delivery. Serum and bone marrow collection was conducted across a period of 5 hours.</p><p><strong>Results: </strong>Rabbits maintained normal ambulation, mobility, diet, and weight throughout the study period. Clinical chemistry results indicate normal ranges over the study course. microCT and histology demonstrate osseointegration between the threads of the implant within the medullary cavity. Pharmacokinetic data determined that intraosseous vancomycin delivery results in significantly lower vancomycin concentrations systemically compared with intravenous delivery and higher peak vancomycin concentration within the tibial canal.</p><p><strong>Conclusion: </strong>This preclinical translational model represents a reproducible small animal model of OI transtibial amputation that successfully recreates the bone-skin-implant interface, material-bone interactions to match human OI, and a similar immune response. Preclinical efficacy of infection interventions will be further explored with establishment of this model.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e366"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607465","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":"Changes in pain and prosthesis wear following transfemoral osseointegration combined with sciatic nerve RPNI.","authors":"Kirby W Bonvillain, Ainsley K Bloomer, G Dillon Graham, Ryan P Serbin, Rachel B Seymour, Joseph R Hsu, Bryan Loeffler","doi":"10.1097/OI9.0000000000000385","DOIUrl":"10.1097/OI9.0000000000000385","url":null,"abstract":"<p><strong>Background: </strong>Osseointegration (OI) has revolutionized prosthetic rehabilitation for amputees. Despite its contributions, postamputation pain remains a significant problem. This study aims to investigate the role of sciatic nerve regenerative peripheral nerve interface (RPNI) in patients undergoing transfemoral OI, focusing on its impact on pain and prosthetic wear.</p><p><strong>Methods: </strong>Patients underwent OI in a staged manner with RPNI being performed at either stage I or II. Outcome measures included preoperative and postoperative numerical rating scale phantom and residual limb pain (RLP) scores, presence of Tinel sign on physical examination, opioid use, and prosthetic wear. Data were collected through interviews using a standardized script to ensure consistency.</p><p><strong>Results: </strong>A total of 12 patients were included. The patients were reported among cohorts without comorbidities (RPNIw/oC, N = 9) and with comorbidities (RPNIwC, N = 3). The average phantom limb pain (PLP) score decreased by 3.66 in the RPNIw/oC group and 3 in the RPNIw/C group. The RLP score saw an average increase of 0.28 in the RPNIw/oC group and a decrease of 3.33 in the RPNIw/C group. The frequency of a positive Tinel sign went from 2/9 to 0/9 in the RPNIw/oC group and remained constant in the RPNIwC group at 1/3. Finally, the RPNIw/oC group saw an increase in prosthetic wear from 4 h/d preoperatively to 8.2 h/d postoperatively, and the RPNIwC group saw an increase from 2.67 h/d to 7 h/d. No patients required nerve-related revision surgery.</p><p><strong>Conclusion: </strong>This small case series demonstrates improvement in phantom limb pain and prosthesis wear after combined transfemoral OI and sciatic nerve RPNI.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e385"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607457","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":"Basic science review of transcutaneous osseointegration: current status, research gaps and needs, and defining future directions.","authors":"Bailey V Fearing, Ida Leah Gitajn, Sarah M Romereim, Jason S Hoellwarth, Joseph C Wenke","doi":"10.1097/OI9.0000000000000367","DOIUrl":"10.1097/OI9.0000000000000367","url":null,"abstract":"<p><p>Basic science research is vital for advancing the emerging field of bone-anchored limb replacement (BALR), or osseointegration (OI). This article discusses clinical challenges for BALR/OI, summarizes current basic science research regarding those challenges, identifies research gaps, and proposes future directions. OI research draws from related fields such as orthopaedic implants and dentistry. There is a need for small animal models to study critical questions related to osseointegration, including OI implant-associated infections. Small animal models are also critical to ensuring safety and efficacy of novel treatments in this vulnerable population. Key issues include infection prevention through implant surface modifications, biofilm-targeting technologies, and antimicrobial advancements. The skin-implant portal, unique to BALR, also poses significant challenges. Research on skin attachment and inflammatory processes is crucial. Noninfectious inflammatory loosening of implants, though infrequent, needs further investigation. This review emphasizes the need for collaborative efforts to develop effective preclinical models and innovative infection prevention strategies. Addressing these challenges is essential for optimizing patient outcomes and advancing this emerging field.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e367"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607454","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":"Consensus statement on prehabilitation and rehabilitation of osseointegration patients.","authors":"Danielle Melton, Lisa Prasso, Angela Abernethy, Jason S Hoellwarth, Tarey Strickland","doi":"10.1097/OI9.0000000000000371","DOIUrl":"10.1097/OI9.0000000000000371","url":null,"abstract":"<p><p>Rehabilitation protocols vary according to the osseointegration (OI) implant system and the institutions implanting bone-anchored limbs (BALs). While there are limited peer-reviewed OI publications quantifying details for optimizing surgical candidacy and rehabilitation protocols to ensure support across the BAL spectrum, the authors recommend a multidisciplinary team approach over the user's lifetime. Breakout sessions at the Global Collaborative Congress on OI (GCCO) were convened around key topics, including rehabilitation. Current best practice, gaps in the literature, and needs for future research were captured. The authors used these findings along with the available peer-reviewed literature and expert opinion to frame the consensus statements presented in this article. The authors present 3 consensus statements describing each phase of care-preoperative, perioperative, and postoperative.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e371"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607460","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":"Consensus statement on the prevention, diagnosis, and management of infection following transcutaneous osseointegration for patients with limb loss: current state-of-the-art and proposed future studies.","authors":"Jason S Hoellwarth, Colin Harrington, S Robert Rozbruch, Benjamin K Potter","doi":"10.1097/OI9.0000000000000369","DOIUrl":"10.1097/OI9.0000000000000369","url":null,"abstract":"<p><p>The diagnosis, risk factors, treatment algorithms, and long-term sequelae of superficial and deep, implant-related infections in transdermal, bone-anchored osseointegration are not well-defined. In contrast to the robust experience diagnosing and managing periprosthetic joint infections in total joint arthroplasty, osseointegration surgery has only recently been adopted at a small number of osseointegration centers in the United States, contributing to the lack of long-term outcomes. Through the pooled experience from these osseointegration centers, we present a consensus statement on the perioperative management, incidence, treatment, and diagnostic workup for infectious complications following transdermal, bone-anchored osseointegration.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e369"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607463","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}