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

{"title":"Fracture nonunions.","authors":"Vu Le, Clifford Jones, Zachary M Working, Georg Duda, Christopher Evans, Andrew Evans","doi":"10.1097/OI9.0000000000000441","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000441","url":null,"abstract":"<p><p>The Fracture Nonunion Symposium presented at the 2024 Orthopaedic Trauma Association Basic Science Focus Forum featured invited speakers who discussed current perspectives on this topic. Clinical approaches, diagnostic advancements, basic science perspectives, and novel treatment strategies were discussed. This symposium was curated to highlight this common and challenging clinical problem faced by orthopaedic and musculoskeletal practitioners from around the globe.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e441"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240582","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":"Physiologic impact of inflammation in the polytrauma patient.","authors":"Chukwuebuka Achebe, Arun Aneja, Melanie Haffner-Lutzner, Gareth Ryan, Prism Schneider, Michel P J Teuben, Hans-Cristoph Pape, Justin Haller","doi":"10.1097/OI9.0000000000000442","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000442","url":null,"abstract":"<p><p>Polytrauma represents one of the most challenging scenarios in modern trauma care, with fracture healing outcomes that defy conventional expectations. Although isolated fractures typically follow predictable healing patterns, the presence of multiple injuries creates complex interactions that can either accelerate or severely impair bone regeneration. Remarkably, patients with traumatic brain injury often demonstrate enhanced fracture healing with rapid callus formation and shorter time to union, whereas those with systemic inflammatory burden from thoracic or multiorgan trauma frequently experience delayed healing and complications. These paradoxical outcomes reflect distinct biological pathways that are only beginning to be understood. Malnutrition, affecting up to one-third of hospitalized orthopaedic patients, further complicates recovery by impairing both soft tissue and bone healing. Emerging research has identified key molecular mediators including complement factors, inflammatory cytokines, and potentially leptin as critical determinants of healing trajectories. However, translating these laboratory findings into clinical practice remains challenging because of the heterogeneous nature of polytrauma populations and the complexity of coordinating multicenter research. The purpose of this review is to synthesize current understanding of nutritional optimization strategies in polytrauma, delineate the molecular mechanisms underlying both accelerated and delayed fracture healing, explore the unique effects of traumatic brain injury on bone regeneration, and describe the development of collaborative research infrastructure necessary to advance the field.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e442"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240580","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 and current management for fracture-related infections.","authors":"Justin Haller, Lucas Marchand, John Scolaro, Peter V Giannoudis, Joseph Wenke, Hans-Cristoph Pape","doi":"10.1097/OI9.0000000000000431","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000431","url":null,"abstract":"<p><p>Fracture-related infections (FRIs) play a significant role in poor clinical outcomes and patient morbidity for patients with orthopaedic trauma. FRI diagnosis has become more standardized, which will strengthen research efforts to identify prognostic factors and improve clinical management. Biofilm research continues to advance our understanding of how FRIs develop and improve FRI prevention. Antibiotic bead pouches are a useful technique to locally administer high antibiotic concentrations for open fractures that are at high risk for FRI. There are a variety of techniques for managing critical sized bone defects in the setting of infection including serial bone grafting, induced membrane, distraction osteogenesis, and vascularized bone transfer. Management of acute and chronic FRI relies on successful debridement of necrotic tissue with infection eradication and bony reconstruction.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e431"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240564","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":"Emerging basic science concepts in geriatric fracture fixation and patient recovery.","authors":"Makoa Mau, Philipp Leucht, Frede Frihagen, Gustavo Duque, Richard Yoon, Emil Schemitsch, Justin Haller","doi":"10.1097/OI9.0000000000000433","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000433","url":null,"abstract":"<p><p>In recent history, human life expectancy has increased significantly, resulting in a high burden of late-life morbidity and geriatric fractures. Changes to the body as a result of aging, such as degeneration of the bone marrow, osteoblast apoptosis, and a decline in hormone production, coupled with sarcopenia, are only a few factors that predispose the elderly to fractures. In addition, these factors further complicate surgical management, as they increase the risk of fixation failure, nonunion, malunion, and wound complications. As a result, the standards of geriatric fracture fixation must account for variables that are rarely included when planning for surgery in the younger population. Operative fixation should provide a stable limb to allow for early mobilization and weight bearing, lowering the risk of medical complications. Therefore, early mobility is of the utmost importance in the setting of most fragility fractures. However, early mobility in some, such as the pelvic fragility fracture, may lead to an increased risk for bleeding and death. Geriatric fractures carry significant morbidity, mortality, and financial risk, which indicates that there should be a continuing review and understanding of the multifactorial process leading toward and treatment strategies employed after geriatric fractures. The purpose of this review is to summarize the biology of aging, the causes, effects, and treatments of sarcopenia, the current fixation strategies of geriatric fractures, and the importance of mobility in the geriatric patient.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e433"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240606","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":"Are orthopaedic trauma surgeons at risk of occupational noise-induced hearing loss?","authors":"Vincent W Lau, Stephanie A Kwan, Jack Graham, Gregory K Deirmengian","doi":"10.1097/OI9.0000000000000422","DOIUrl":"10.1097/OI9.0000000000000422","url":null,"abstract":"<p><strong>Objectives: </strong>Orthopaedic surgeons are at risk of occupational, noise-induced hearing loss due to exposure to instruments in the operating room. The primary objective of this study was to determine whether orthopaedic trauma procedures exceed recommended decibel (dB) limits. The secondary objective was to demonstrate which actions during a case create the highest sound levels.</p><p><strong>Methods: </strong>Intraoperative recordings were taken during orthopaedic trauma surgeries and classified into open reduction internal fixation (ORIF), intramedullary nailing, closed reduction percutaneous pinning, external fixation, soft tissue procedures, or a combination thereof. Recordings were taken of drilling, screw insertion, suctioning, saw use, and mallet striking. Decibel levels were reported as maximum dB level (MDL), LAeq, LCpeak, and time weighted average (TWA). Percentage of allowable daily noise was reported as dose, while the dose predicted for an 8-hour period was reported as projected dose.</p><p><strong>Results: </strong>A total of 89 recordings were collected, comprising 46 baseline and 43 trauma case recordings. All procedures had significantly higher dB levels compared with controls for all variables (<i>P</i> < 0.001). In all cases, the MDL was greater than 85 dB. ORIF had the highest average MDL (108.4 dB) and TWA (70.3 dB). Overall, no procedures exceeded the maximum allowable daily noise dose. However, the soft tissue group had the highest projected dose (18.8%). Suctioning against soft tissue had the highest dose and projected dose.</p><p><strong>Conclusion: </strong>Orthopaedic trauma procedures stayed within noise limits, but average MDL exceeded 85 dB. ORIF and suctioning produced some of the highest sound levels among procedures and recorded steps.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e422"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981600","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":"Residual radiographic fracture displacement in healed tibial plateau fractures: comparison after treatment with suprapatellar nailing versus lateral plating.","authors":"Ivan Bandovic, Adrian Olson, Austin Smith, Ryan Centanni, Usher Khan, Virginia Leadbetter, Alan Afsari, Benjamin Best","doi":"10.1097/OI9.0000000000000418","DOIUrl":"10.1097/OI9.0000000000000418","url":null,"abstract":"<p><strong>Objectives: </strong>Compare maintenance of articular reduction and alignment in bicondylar tibial plateau fractures (OTA/AO 41-C2/C3) treated with suprapatellar intramedullary nailing (IMN) versus dual-plate open reduction and internal fixation (ORIF).</p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Single Level I academic trauma center.</p><p><strong>Patients/participants: </strong>Fifty-eight adults treated between July 2012 and July 2022 (28 IMN, 30 ORIF); groups were matched for age, body mass index, and fracture pattern.</p><p><strong>Intervention: </strong>Semiextended suprapatellar IMN with ≥1 independent lag screw compared with dual-plate ORIF performed through standard open approaches.</p><p><strong>Main outcome measurements: </strong>Joint-line depression, condylar widening, medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA) at union (12 months).</p><p><strong>Results: </strong>Initial displacement was greater in the ORIF cohort (joint-line 8.2 mm vs. 5.6 mm, <i>P</i> = 0.014; widening 7.2 mm vs. 5.8 mm, <i>P</i> = 0.150). At 12 months, healed widening (0.6 mm IMN vs. 1.0 mm ORIF, <i>P</i> = 0.856), healed depression (2.0 mm vs. 1.1 mm, <i>P</i> = 0.991), MPTA (89.9° vs. 89.6°, <i>P</i> = 0.699), and PPTA (11.3° vs. 9.8°, <i>P</i> = 0.078) did not differ. No secondary loss of reduction requiring revision occurred.</p><p><strong>Conclusion: </strong>Suprapatellar IMN maintained healed joint line displacement, condylar widening, MPTA, and PPTA in OTA/AO C1, C2, and certain C3 fractures. The MPTA and PPTA were surgically restored and maintained. This technique may be useful in certain circumstances where ORIF of the tibial plateau fractures places the soft tissue envelope at risk or where an intramedullary implant is otherwise preferred.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e418"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981585","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":"Osseous union after antibiotic cement application with retention of stable orthopaedic hardware in fracture-related infections without union.","authors":"Devone Mansour, Hunter Ross, Tannor Court, Daniel Cavazos, Trey D VanAken, Rahul Vaidya","doi":"10.1097/OI9.0000000000000415","DOIUrl":"10.1097/OI9.0000000000000415","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate treatment outcomes of patients treated with antibiotic impregnated cement applied over implanted orthopaedic hardware, in the setting of fracture-related infection, without osseous union, after open reduction internal fixation.</p><p><strong>Design: </strong>Retrospective observational case series.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patients/participants: </strong>Retrospective review of 15 patients who underwent antibiotic cement application to their retained plate for the treatment of acute fracture-related infections (12) and acutely infected nonunion (3) status after open reduction internal fixation (ORIF).</p><p><strong>Outcomes: </strong>Suppression of infection and radiographic union by final follow-up.</p><p><strong>Results: </strong>Antibiotic plate application successfully led to fracture union in all 15 patients (100%). Three of these patients (20%) required removal of hardware. Of these 3 patients, all 3 achieved fracture union before hardware removal. However, 2 of these patients developed a chronic infection and were placed on long term PO antibiotics for chronic infection suppression, thus making them ineligible for classification as free of infection.</p><p><strong>Conclusions: </strong>The results of this study suggest that application of antibiotic cement to retained plates/screws for ORIF during treatment of both acute fracture infections and acutely infected nonunions is a viable technique to achieve osseous union. Hardware removal may be required in some cases. Use of this technique supports fracture healing and local infection control, while maintaining construct stability long enough to achieve fracture union.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e415"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877179","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":"European orthopaedic trauma registries: perspectives from Belgium, Greece, Germany, the Netherlands, Spain, and the United Kingdom.","authors":"Lynn Hutchings, Guy Putzeys, Christina Arnaoutoglou, Zoe Dailiana, Kees Jan Ponsen, Pieter Joosse, Frank Bloemers, Francisco Chana-Rodriguez, Jesus Gomez-Vallejo, Hector Aguado-Hernández","doi":"10.1097/OI9.0000000000000407","DOIUrl":"10.1097/OI9.0000000000000407","url":null,"abstract":"<p><strong>Objectives: </strong>To provide an overview of the current status and future directions of trauma registries across Europe, with specific examples from a range of countries.</p><p><strong>Methods: </strong>Member countries of the International Orthopaedic Trauma Association were contacted to provide information on the development, current position, and future plans for trauma registries within their countries. Responses were received from 6 countries-Belgium, Greece, Germany, the Netherlands, Spain, and the United Kingdom-providing an overview of practice across Europe.</p><p><strong>Results: </strong>The background, evolution, and current status of trauma registries varies widely across Europe from highly mature systems to those in the early stages of development. Funding process, data management, and governance also differ between countries.</p><p><strong>Conclusions: </strong>The trauma registries of Germany and the United Kingdom are the most mature and have provided the greatest output for research to date. However, the development of registries in other European countries will allow an increase in comparative data which can be used to drive standards for trauma care. Countries with more evolved registries can provide useful insights to those in development to assist in set-up and improve collaboration.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4 Suppl","pages":"e407"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839293","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 registry history and future in South Africa.","authors":"Brian Bernstein, Odette Koch, Thomas Hilton","doi":"10.1097/OI9.0000000000000381","DOIUrl":"10.1097/OI9.0000000000000381","url":null,"abstract":"<p><p>Data is power. In 2017, the South African Orthopaedic Association (SAOA) presidential line identified a political and market-influenced initiative to collect and use data in the health care space. The South African government had funded a \"Health Market Inquiry\" (HMI), which determined that medical professionals were poorly monitored and lacked peer review. Clinicians were not involved in this effort and were not well positioned to represent the interests of patients. The report noted that funders and hospital groups favored patient-reported outcome measurements (PROs) but proposed to collect and interpret the data themselves. Clinical data was, therefore, being collected and interpreted by nonclinicians. It became evident that it was in the interest of the SAOA to control this data securely with orthopaedic peer interpretation of the data. At the time of the HMI report, 2 databases were in use in South Africa: a National Joint Registry had been created in 2012 (limited to arthroplasty) and the REDCap database had been adopted by many academic units and was used mainly for research. Other than these registries, medical data was individually stored and opaque. This report summarizes the efforts of the SAOA to collect meaningful PROs and provide clinically relevant data analysis to inform health care policy and clinical quality improvement.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4 Suppl","pages":"e381"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839294","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 state of orthopaedic trauma-related registries in Latin America: benefits, barriers, and bearings.","authors":"Luis G Padilla-Rojas, Roberto E López-Cervantes, César A Álvarez-Rengifo, Claudia Medina-Monje, Ángela Hernández-Arenas, Jaime Leal, Marcos C Leonhardt, Matheus L Azi, Horacio Tabares-Neyra, Vincenzo Giordano, David Escalante, Jorge Álvarez, Cristian Pintado, Rafael E Amadei-Enghelmayer, Germán Garabano, Lara Zaez","doi":"10.1097/OI9.0000000000000414","DOIUrl":"10.1097/OI9.0000000000000414","url":null,"abstract":"<p><p>Fracture registries offer a valuable means to enhance understanding of musculoskeletal trauma and related care, providing information that may reduce variation in care, optimize efficiency, improve outcomes, and lower costs. Registries enable healthcare authorities to pinpoint areas of concern, such as a rise in fall-related hip fractures among older adults, and to monitor the effectiveness of public health initiatives aimed at preventing fractures, such as fall prevention programs. In addition, registries provide data for research on risk factors, treatment outcomes, and best practices in fracture management, ultimately leading to enhanced treatment protocols and patient care. Registries help identify variations in treatment practices across different hospitals or regions, facilitating the identification of best practices and ensuring all patients receive optimal care. The following article describes the state of registries in Latin America, specifically Argentina, Brazil, Colombia, Ecuador, and Mexico, all members of the International Orthopaedic Trauma Association.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4 Suppl","pages":"e414"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839296","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}