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

{"title":"International trauma care forum supplement of the Orthopaedic Trauma Association 2022","authors":"H. Pape","doi":"10.1097/oi9.0000000000000254","DOIUrl":"https://doi.org/10.1097/oi9.0000000000000254","url":null,"abstract":"","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47176567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in implementation of evidence-based hip fracture management in a major Canadian city.","authors":"Martina Vergouwen,&nbsp;Michael G James,&nbsp;Daniel Z You,&nbsp;Neil J White","doi":"10.1097/OI9.0000000000000274","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000274","url":null,"abstract":"<p><strong>Aims: </strong>The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature.</p><p><strong>Methods: </strong>Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. <i>ICD-10</i> diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends.</p><p><strong>Results: </strong>In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems.</p><p><strong>Conclusion: </strong>Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e274"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/6c/oi9-6-e274.PMC10503671.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311085","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":"Humerus fractures: selecting fixation for a successful outcome.","authors":"Utku Kandemir,&nbsp;Emily H Naclerio,&nbsp;Michael D McKee,&nbsp;David J Weatherby,&nbsp;Peter A Cole,&nbsp;Kevin Tetsworth","doi":"10.1097/OI9.0000000000000259","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000259","url":null,"abstract":"<p><p>Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e259"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/12/oi9-6-e259.PMC10392438.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9987104","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 fractures: Current treatment perspective.","authors":"Hiroaki Minehara,&nbsp;Akihiro Maruo,&nbsp;Rafael Amadei,&nbsp;Achille Contini,&nbsp;Adriano Braile,&nbsp;Michael Kelly,&nbsp;Lydia Jenner,&nbsp;Geoffrey W Schemitsch,&nbsp;Emil H Schemitsch,&nbsp;Theodore Miclau","doi":"10.1097/OI9.0000000000000240","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000240","url":null,"abstract":"<p><p>Severe open fractures present challenges to orthopaedic surgeons worldwide, with increased risks of significant complications. Although different global regions have different resources and systems, there continue to be many consistent approaches to open fracture care. Management of these complex injures continues to evolve in areas ranging from timing of initial operative debridement to the management of critical-sized bone defects. This review, compiled by representative members of the International Orthopaedic Trauma Association, focuses on several critical areas of open fracture management, including antibiotic administration, timing of debridement, bone loss, soft tissue management, and areas of need for future investigation.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e240"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/59/oi9-6-e240.PMC10392445.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935361","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":"Avoiding deformity in proximal tibial nailing: risk factors, deformity rules, tips, and tricks.","authors":"Christian Krettek,&nbsp;Elton Edwards","doi":"10.1097/OI9.0000000000000257","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000257","url":null,"abstract":"<p><p>Malalignment is one of the most common problems linked to nailing of proximal tibial fractures. This review will cover technical aspects of intramedullary nailing and will help explain the various risk factors. Deformity rules aid in identifying the likely deformity and help to develop management strategies. Various tools and techniques are discussed which can help optimize the outcome.</p><p><strong>Level of evidence: </strong>Therapeutic Level V.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e257"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/65/oi9-6-e257.PMC10392440.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307881","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 use of a laminar spreader for the reduction of extra-articular distal radius fractures: A technical trick.","authors":"Tarek A Taha","doi":"10.1097/OI9.0000000000000263","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000263","url":null,"abstract":"<p><p>Extra-articular distal radius fractures are often accompanied with shortening, loss of radial height, and radial displacement of the articular segment relative to the shaft of the radius, all seen in the coronal plane. Reduction can be somewhat challenging when reliance on traction and ligamentotaxis fails, especially in subacute or osteoporotic fractures. In this technical report, we describe a technique where application of a laminar spreader between the radius and the ulna in the metaphyseal region can easily reduce the fracture and help attain anatomic alignment in the coronal plane. An acute and a subacute fracture are shown for illustration of the technique.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e263"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/4f/oi9-6-e263.PMC10503670.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309155","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":"Early hip fracture surgery is safe for patients on direct oral anticoagulants.","authors":"Nicholas L Kolodychuk,&nbsp;Brian Godshaw,&nbsp;Michael Nammour,&nbsp;Hunter Starring,&nbsp;James Mautner","doi":"10.1097/OI9.0000000000000252","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000252","url":null,"abstract":"<p><strong>Objectives: </strong>To determine how preoperative direct oral anticoagulant (DOAC) use affects rates of blood transfusion, clinically important blood loss, and 30-day mortality in patients with hip fracture undergoing surgery within 48 hours of presentation to the emergency department.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic trauma center.</p><p><strong>Patients: </strong>A total of 535 patients with hip fracture who underwent open cephalomedullary nail fixation or arthroplasty either taking a direct oral anticoagulant or no form of chemical anticoagulant/antiplatelet agent before presentation (control).</p><p><strong>Main outcome measures: </strong>Demographics, time to surgery, type of surgery, blood transfusion requirement, clinically important blood loss, and 30-day mortality.</p><p><strong>Results: </strong>Forty-one patients (7.7%) were taking DOACs. DOAC patients were older (81.7 vs. 77 years, <i>P</i> = 0.02) and had higher BMI (26.9 vs. 24.2 kg/m², <i>P</i> = 0.01). Time from admission to surgery was similar between DOAC users (20.1 hours) and the control (18.7 hours, <i>P</i> > 0.4). There was no difference in receipt of blood transfusion (<i>P</i> = 0.4), major bleeding diagnosis (<i>P</i> = 0.2), acute blood loss anemia diagnosis (<i>P</i> = 0.5), and 30-day mortality (<i>P</i> = 1) between the DOAC and control group. This was true when stratifying by type of surgery as well.</p><p><strong>Conclusions: </strong>Our results suggest that early surgery may be safe in patients with hip fracture taking DOACs despite theoretical risk of increased bleeding. Because early surgery has previously been associated with decreased morbidity and mortality, we suggest that hip fracture surgery should not be delayed because a patient is taking direct oral anticoagulants.</p><p><strong>Level of evidence: </strong>Prognostic Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e252"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/6e/oi9-6-e252.PMC10079331.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10312620","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":"Implications of COVID-19 on hip fracture care discharge locations during the early stages of the pandemic.","authors":"Sanjit R Konda,&nbsp;Garrett W Esper,&nbsp;Ariana T Meltzer-Bruhn,&nbsp;Abhishek Ganta,&nbsp;Philipp Leucht,&nbsp;Nirmal C Tejwani,&nbsp;Kenneth A Egol","doi":"10.1097/OI9.0000000000000277","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000277","url":null,"abstract":"<p><strong>Objectives: </strong>To document discharge locations for geriatric patients treated for a hip fracture before and during the COVID pandemic and subsequent changes in outcomes seen between each cohort.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Academic medical center.</p><p><strong>Patients/participants: </strong>Two matched cohorts of 100 patients with hip fracture treated pre-COVID (February-May 2019) and during COVID (February-May 2020).</p><p><strong>Intervention: </strong>Discharge location and COVID status on admission. Discharge locations were home (home independently or home with health services) versus facility [subacute nursing facility (SNF) or acute rehabilitation facility].</p><p><strong>Main outcome measurements: </strong>Readmissions, inpatient and 1-year mortality, and 1-year functional outcomes (EQ5D-3L).</p><p><strong>Results: </strong>In COVID+ patients, 93% (13/14) were discharged to a facility, 62% (8/13) of whom passed away within 1 year of discharge. Of COVID+ patients discharged to an SNF, 80% (8/10) died within 1 year. Patients discharged to an SNF in 2020 were 1.8x more likely to die within 1 year compared with 2019 (<i>P</i> = 0.029). COVID- patients discharged to an SNF in 2020 had a 3x increased 30-day mortality rate and 1.5x increased 1-year mortality rate compared with 2019. Patients discharged to an acute rehabilitation facility in 2020 had higher rates of 90-day readmission. There was no difference in functional outcomes.</p><p><strong>Conclusions: </strong>All patients, including COVID- patients, discharged to all discharge locations during the onset of the pandemic experienced a higher mortality rate as compared with prepandemic. This was most pronounced in patients discharged to a skilled nursing facility in 2020 during the early stages of the pandemic. If this trend continues, it suggests that during COVID waves, discharge planning should be conducted with the understanding that no options eliminate the increased risks associated with the pandemic.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e277"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/01/oi9-6-e277.PMC10145965.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9448959","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":"Illicit drug and alcohol use and measures of musculoskeletal function and mental health in orthopaedic trauma patients.","authors":"James Spratt,&nbsp;Zachary Adkins,&nbsp;Danny Warda,&nbsp;Michele Smith,&nbsp;Jennifer Bruggers,&nbsp;Paul Weiss,&nbsp;Stephen Becher","doi":"10.1097/OI9.0000000000000270","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000270","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to describe the relationship between positive toxicology screens and measures of preinjury mental health and physical function in an orthopaedic trauma population.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Setting: </strong>Urban Level 1 trauma center.</p><p><strong>Patients: </strong>A total of 125 trauma patients gave written consent for this study.</p><p><strong>Main outcome measurements: </strong>Questionnaires such as, Patient Health Questionnaire-9, General Anxiety Disorder-7, PCL-5, and Short Musculoskeletal Function Assessment, were used to survey patients after surgical intervention.</p><p><strong>Results: </strong>Patient Health Questionnaire-9 (<i>P</i> = 0.05) and PCL-5 (<i>P</i> = 0.04) were not found to have significant differences between positive and negative toxicology screens. Both General Anxiety Disorder-7 (<i>P</i> = 0.004) and Short Musculoskeletal Function Assessment function (<i>P</i> = 0.006) were significantly higher in patients with positive toxicology screens.</p><p><strong>Conclusions: </strong>Positive toxicology seems to be associated with preinjury anxiety. Patient reported preinjury function was not adversely affected by the presence of illicit substances or alcohol, nor were levels of post-traumatic stress disorder and depression found to be higher in patients with positive toxicology screens.</p><p><strong>Level of evidence: </strong>Level IV Cross-Sectional Study.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e270"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/50/oi9-6-e270.PMC10503674.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311087","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":"Erectile dysfunction after acetabular fracture.","authors":"Iain S Elliott,&nbsp;Conor Kleweno,&nbsp;Julie Agel,&nbsp;Max Coale,&nbsp;Joseph T Patterson,&nbsp;Reza Firoozabadi,&nbsp;Michael Githens,&nbsp;Niels V Johnsen","doi":"10.1097/OI9.0000000000000276","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000276","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the rate of erectile dysfunction in male patients who have sustained an acetabular fracture with no previously identified urogenital injury.</p><p><strong>Design: </strong>Cross-sectional survey.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patients/participants: </strong>All male patients treated for acetabular fracture without urogenital injury.</p><p><strong>Intervention: </strong>The International Index of Erectile Function (IIEF), a validated patient-reported outcome measure for male sexual function, was administered to all patients.</p><p><strong>Main outcome measurements: </strong>Patients were asked to complete the International Index of Erectile Function score for both preinjury and current sexual function, and the erectile function (EF) domain was used to quantify the degree of erectile dysfunction. Fractures were classified according the OTA/AO classification schema, fracture classification, injury severity score, race, and treatment details, including surgical approach were collected from the database.</p><p><strong>Results: </strong>Ninety-two men with acetabular fractures without previously diagnosed urogenital injury responded to the survey at a minimum of 12 months and an average of 43 ± 21 months postinjury. The mean age was 53 ± 15 years. 39.8% of patients developed moderate-to-severe erectile dysfunction after injury. The mean EF domain score decreased 5.02 ± 1.73 points, which is greater than the minimum clinically important difference of 4. Increased injury severity score and associated fracture pattern were predictive of decreased EF score.</p><p><strong>Conclusion: </strong>Patients with acetabular fractures have an increased rate of erectile dysfunction at intermediate-term follow-up. The orthopaedic trauma surgeon treating these injuries should be aware of this as a potential associated injury, ask their patients about their function, and make appropriate referrals.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e276"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/99/oi9-6-e276.PMC10194699.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9505542","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}