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

{"title":"Evaluating trends among adult orthopaedic transfer volume and resource use.","authors":"Nathan Oommen, Michael Harrington, Rami Fedil, Ashar Ata, Andrew Rosenbaum, Denis Pauze, Ashley Telisky, Michael Waxman","doi":"10.1097/OI9.0000000000000473","DOIUrl":"10.1097/OI9.0000000000000473","url":null,"abstract":"<p><strong>Objectives: </strong>Understanding the demographics, time of day, day of the week, and specific characteristics of adult orthopaedic transfer patients may help to facilitate more efficient patient care.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Single center, academic, Level 1 trauma center in upstate New York.</p><p><strong>Patient selection criteria: </strong>Any adult patient (≥ 18 years old) from the transfer center database from 2016 to 2021 with musculoskeletal-related problems, as defined by ICD-10 codes, transferred from another facility to the emergency department.</p><p><strong>Outcome measures and comparisons: </strong>Demographic information, disposition, transferring facility, type of injury, means of arrival, case mix index (CMI), and day/time of the week were tabulated and analyzed using descriptive statistics.</p><p><strong>Results: </strong>All 3763 adult patients that met selection criteria were included in the analysis. There was a 37% increase in adult orthopaedic transfers over the 5-year study period (558 in 2016 and 746 in 2021). The average CMI of transfers increased over the study span by 10.2%. Among all patients, 76.6% (n = 2882) were admitted to the hospital, with an average length of stay of 7.74 days and an average CMI of 2.16. Transferred patients with femur fractures had the highest CMI (2.47) followed by lower leg fractures (2.11). The most frequent time of arrival for orthopaedic transfers was the evening between the hours of 3:00 pm and 11:00 pm (53.9%) and on the weekend [<i>P</i>-value = 0.0049 comparing weekend to weekday].</p><p><strong>Conclusions: </strong>The increase in transfers and CMI over the 5-year study period highlights the critical role tertiary centers play in the care of complex orthopaedic patients. The greater number of transfers during nonbusiness hours also suggests that referral centers may play an even greater role in the community during times when community orthopaedic services are not available.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 2","pages":"e473"},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12981743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464480","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":"Intramedullary nailing with absorbable antibiotic-eluting ceramic for fracture-related infection prophylaxis in high-risk open fractures: a case series and technique.","authors":"Scott M Sandilands, Akshay V Daji","doi":"10.1097/OI9.0000000000000478","DOIUrl":"10.1097/OI9.0000000000000478","url":null,"abstract":"<p><strong>Objectives: </strong>Fracture-related infection (FRI) is a devastating complication of open fractures and remains common even with ideal open fracture care including prompt systemic antibiotics and thorough surgical debridement. There is growing interest in the use of adjuvant local antibiotics; however, traditional carriers like polymethylmethacrylate (PMMA) are limited by subtherapeutic elution, biofilm formation, and the need for secondary removal. We describe a technique of in vivo augmentation of intramedullary nailing with Cerament G, a resorbable gentamicin-eluting calcium sulfate/hydroxyapatite ceramic, delivered through the 2-CAN device for targeted antibiotic prophylaxis.</p><p><strong>Methods: </strong>Nine patients (mean age 44 years; 22% female) with Gustilo-Anderson Type II (n = 3), IIIA (n = 4), IIIB (n = 1), and IIIC (n = 1) open fractures of the tibia, femur, or humerus underwent this technique at a Level 1 trauma center by a single fellowship-trained orthopaedic traumatologist. Postoperative outcomes included FRI incidence, fracture union, complications, and functional recovery.</p><p><strong>Results: </strong>At a mean follow-up of 9.1 months (2.6-17.1 months), all fractures achieved union with no cases of FRI. Two GA IIIB/C cases required flap coverage, including one flap failure successfully revised. Self-limiting serous drainage (n = 3) resolved within 1 week. No secondary procedures for infection, implant removal, or amputations occurred.</p><p><strong>Conclusion: </strong>Intramedullary nailing and intraoperative augmentation with Cerament G using the 2-CAN device offer a technically simple, time-efficient strategy for FRI prophylaxis in high-risk open fractures. The technique provides sustained local antibiotic delivery, avoids PMMA-related complications, and maximizes biomechanical stability by eliminating nail downsizing. Early results demonstrate promising infection prophylaxis, warranting further prospective trials to validate long-term efficacy and cost-effectiveness.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e478"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379375","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":"Lower extremity osseointegration for amputees with diabetes mellitus and vascular disease.","authors":"Jason S Hoellwarth, LaYow C Yu, Tyler D DeSena, Jidapa Wongcharoenwatana, Taylor J Reif, S Robert Rozbruch","doi":"10.1097/OI9.0000000000000472","DOIUrl":"10.1097/OI9.0000000000000472","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to describe outcomes of osseointegration in amputees with diabetes mellitus (DM) and/or peripheral vascular disease (PVD).</p><p><strong>Design: </strong>This was a case series.</p><p><strong>Setting: </strong>The study was conducted at an urban tertiary referral academic medical center.</p><p><strong>Patients/participants: </strong>Five patients (1 with DM, 3 with PVD, 1 with both; 4 transtibial, 1 transfemoral) with a follow-up duration of 4.1 ± 0.3 (3.6-4.3) years were included.</p><p><strong>Intervention: </strong>Revision amputation with press-fit osseointegration implant insertion was performed.</p><p><strong>Main outcome measurements: </strong>Primary outcomes included adverse events requiring nonsurgical or surgical intervention. Secondary outcomes included patient-reported outcome measures (PROMs) and mobility performance.</p><p><strong>Results: </strong>No patients experienced implant loosening, periprosthetic fracture, procedure-related systemic complications, or death. Three patients received additional surgery: one had osteomyelitis, prompting debridement after 9 months; 2 underwent refashioning to reduce redundant skin around the portal site at 4 years. All PROMs improved significantly. All patients improved by at least one K-level.</p><p><strong>Conclusion: </strong>Osseointegration appears safe to consider for appropriately selected patients with DM and/or PVD. Only one patient had an infection, requiring surgical debridement. The 2 refashioning cases were not infected and may have been avoidable with more aggressive tissue reduction at index surgery. No deaths or systemic complications occurred. Conscientious use and study of osseointegration may help optimize rehabilitation for amputees with DM and/or PVD.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e472"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357939","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":"Treatment of high-energy lower extremity trauma is explained by the Orthopaedic Trauma Association Open Fracture Classification.","authors":"Julie Agel, Lisa Reider, Saam Morshed, Anthony R Carlini, Renan C Castillo, Raymond A Pensy, Jason J Yoo, Michael J Bosse","doi":"10.1097/OI9.0000000000000469","DOIUrl":"10.1097/OI9.0000000000000469","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association of Orthopaedic Trauma Association Open Fracture Classification (AO FC-OFC) designation for a specific high-energy lower extremity fracture with the need for 3 or more surgeries, soft -tissue closure with a flap, or amputation.</p><p><strong>Design: </strong>Secondary analysis of multicenter prospective observational study.</p><p><strong>Setting: </strong>Thirty-two Level 1 trauma centers.</p><p><strong>Patient/participants: </strong>Adult patients admitted from July 2012 to October 2015 with open pilon, ankle, talus, calcaneus, foot crush, or blast injuries.</p><p><strong>Main outcome measurements: </strong>Multivariable regression analyses examined the association between the OTA-FC (contamination, bone loss, muscle, skin and arterial injury) with 3 or more trips to the OR before definitive fixation, soft-tissue closure with a flap, and amputation within 18 months of injury.</p><p><strong>Results: </strong>A total of 447 patients comprised the study population. In adjusted models, embedded contamination [odds ratio (OR) = 3.0, 95% confidence interval (CI): 1.54-5.99], functional muscle loss (OR = 2.6, 95% CI: 1.60-4.23), skin that cannot be approximated (OR = 10.0, 95% CI: 5.02-19.79), and degloving (OR = 5.9, 95% CI: 2.94-11.61) were significantly associated with 3+ OR trips. Embedded contamination (OR = 2.2, 95% CI: 1.00-4.86), skin that cannot be approximated (OR = 23.8, 95% CI: 11.73-48.12), and degloving (OR = 12.4, 95% CI: 5.87-26.05) were significantly associated with soft tissue closure with a flap. Dead muscle (OR = 12.9, 95% CI: 4.78-34.89), arterial injury with ischemia (OR = 12.0, 95% CI: 3.22-44.27), skin that cannot be approximated (OR = 2.4, 95% CI: 1.03-5.37), and degloving (OR = 3.0, 95% CI: 1.25-6.98) were significantly associated with amputation.</p><p><strong>Conclusions: </strong>The OTA-FC variables that were most important for predicting treatment intervention varied. The severity of skin injury was associated with all outcomes.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e469"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357983","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":"Intramedullary nailing with an absorbable antibiotic bone graft substitute in fracture-related infections and osteomyelitis: a case series.","authors":"Scott M Sandilands, Akshay V Daji","doi":"10.1097/OI9.0000000000000470","DOIUrl":"10.1097/OI9.0000000000000470","url":null,"abstract":"<p><strong>Objectives: </strong>Fracture-related infections (FRI), infected nonunions, and osteomyelitis with bony instability require aggressive treatment involving systemic antibiotics and surgical debridement. Adjuvant local antibiotic therapy delivers higher and sustained concentrations directly to the site of infection while minimizing systemic toxicity. Antibiotic-loaded poly-methyl methacrylate remains a standard option but presents significant limitations, including nonbiodegradability, reduced antibiotic elution over time, and the need for subsequent removal. Cerament G is a bioabsorbable bone void filler composed of calcium sulfate, hydroxyapatite, and gentamicin sulfate. It provides sustained high-dose antibiotic release, promotes osteoconduction, and remodels into bone within 6 to 12 months, eliminating the need for removal. This makes Cerament G a compelling option for the treatment of FRI and osteomyelitis.</p><p><strong>Methods: </strong>We describe a technique and case series using the Reamer-Irrigator-Aspirator (RIA) system, Cerament G injection via the 2Can device, and, when necessary, intramedullary nailing for the treatment of FRI and osteomyelitis. The technique was applied to 7 patients at a single Level-1 Trauma Center from 2022 to 2024 with FRI or osteomyelitis. Intramedullary nailing was performed in cases of nonunion or bony instability.</p><p><strong>Results: </strong>The mean age of patients was 35 years, with a mean body mass index of 29.2. Three patients required adjuvant intramedullary nailing for stabilization. All patients were weight bearing as tolerated after surgery. At a mean follow-up of 14.4 months (6-21 months), there were no recurrence of infection, major complications, or amputations.</p><p><strong>Conclusion: </strong>The combination of Cerament G and the RIA system represents a viable solution for FRI and osteomyelitis providing effective infection control and sustained antibiotic elution. This technique presents a promising alternative to traditional methods, although larger and longer-term studies are needed to confirm its efficacy.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e470"},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12935411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313309","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":"Effect of nonsteroidal anti-inflammatory drugs on union, opioid utilization, and pain management for tibial fractures (NSAID Trial): a pragmatic randomized clinical trial protocol.","authors":"Thomas F Higgins, Lucas S Marchand, Richard E Thompson, Katherine P Frey, Tara J Taylor, Robert V O'Toole, Renan C Castillo","doi":"10.1097/OI9.0000000000000468","DOIUrl":"10.1097/OI9.0000000000000468","url":null,"abstract":"<p><strong>Objectives: </strong>The orthopaedic community has largely avoided the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the management of pain after fractures based on a combination of animal and clinical data, which suggest their association with impeded fracture healing. Given the significant deleterious effects of opiate analgesics, the use of NSAIDs for pain management in fracture care would be advantageous if potential concerns related to bone healing could be resolved. This study is designed to determine whether planned use of scheduled NSAIDs after fracture leads to a difference in fracture union rates, which in turn provides evidence regarding whether prohibition of NSAID use is justified.</p><p><strong>Design: </strong>This was a prospective, two-arm, pragmatic, randomized-controlled multicenter Phase III noninferiority trial.</p><p><strong>Setting: </strong>The study was conducted at 14 Level I trauma centers across the United States and Canada.</p><p><strong>Patients: </strong>Patients aged 18 to 80 years with open (Gustilo Type I, II, or IIIA) or closed tibia fractures treated with intramedullary nailing were included.</p><p><strong>Intervention: </strong>Patients received 600 milligrams of ibuprofen, 3 times daily, for up to 6 weeks.</p><p><strong>Main outcome measurements: </strong>Secondary surgery to achieve union within 12 months of definitive fixation was recorded.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e468"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273054","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 crest-pillar-column method for percutaneous fixation of the posterior column using a curved intramedullary device: surgical technique.","authors":"Grayson A Domingue, Christian V DeMaio, John Michael Yingling","doi":"10.1097/OI9.0000000000000471","DOIUrl":"10.1097/OI9.0000000000000471","url":null,"abstract":"<p><p>Treatment of posterior column fractures can be treated with open reduction internal fixation via plate osteosynthesis or with screw fixation. Due to common fracture planes and fixation trajectories, traditional anterograde posterior column screw fixation requires an open approach to access the starting point on the inner table. Retrograde posterior column implantation requires a start point in areas that are difficult to drape and access with familiar patient positioning and confident sterility. The advent of curved intramedullary implants allows implantation in nonlinear osseous fixation pathways. This technical paper describes a novel minimally invasive approach to placing a curved intramedullary implant within the posterior column from the readily identifiable iliac tubercle via the gluteal pillar (\"Crest-Pillar-Column\" technique).</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e471"},"PeriodicalIF":0.0,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273025","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":"Topical antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: TOBRA-a multicenter randomized controlled trial protocol.","authors":"Robert V O'Toole, Anthony R Carlini, Gregory M Schrank, Nathan N O'Hara, Suna Chung, Joshua L Gary, William Obremskey, Paul E Matuszewski, David Teague, Roman M Natoli, Yasmin Degani, Susan C Collins, Andrea L Howe, Richard E Thompson, Renan C Castillo","doi":"10.1097/OI9.0000000000000459","DOIUrl":"10.1097/OI9.0000000000000459","url":null,"abstract":"<p><strong>Introduction: </strong>Complex articular fractures of the proximal (plateau) and distal (pilon) tibia carry a substantial risk of deep surgical site infections (SSIs), often resulting in serious complications and hospital readmissions. The TOBRA study is a multicenter, randomized controlled trial designed to determine if the combination of vancomycin plus tobramycin powder is more effective than vancomycin alone in decreasing the risk of deep SSIs after definitive fixation of these high-risk fractures.</p><p><strong>Methods and analysis: </strong>Adults aged 18-80 years with at least one risk factor for infection (eg, open fracture, fasciotomy) are randomized 1:1 to receive either 1 gram of vancomycin alone or 1 gram of vancomycin plus 1.2 grams of tobramycin applied directly into the wound at the time of closure. The primary outcome is a deep SSI requiring surgery within 182 days of fixation, adjudicated by an expert panel blinded to treatment allocation. Secondary outcomes include infection subtypes (gram-negative, culture-negative), wound complications, and adverse drug reactions. The study uses Bayesian Cox regression to evaluate the primary end point, with superiority defined as a posterior probability greater than 0.95. The trial will enroll 1550 participants across sites in the Major Extremity Trauma Research Consortium (METRC). Findings will help guide antibiotic prophylaxis strategies in orthopaedic trauma patients at high risk of infection.</p><p><strong>Ethics and dissemination: </strong>Ethical approval has been granted by the Pearl Institutional Review Board, the Department of Defense Human Research Protections Office, and the local Institutional Review Board at each participating site. Alongside journal publications, dissemination activities include sharing results with participating trial sites and patients and data sharing (upon reasonable request) with researchers.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e459"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12737861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835551","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":"Outcomes after surgical fixation of lower extremity fractures in patients with chronic kidney disease.","authors":"Alexander D Jeffs, Kristin A Toy, Beau R White, Feng-Chang Lin, Di Hu, Margaret D Fisher, Jason McCartney, Judith A Siegel, Andrew T Chen","doi":"10.1097/OI9.0000000000000457","DOIUrl":"10.1097/OI9.0000000000000457","url":null,"abstract":"<p><strong>Objectives: </strong>Assess mortality and complications in patients with chronic kidney disease (CKD) after fixation of lower extremity fractures.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Setting: </strong>Single academic level 1 trauma center.</p><p><strong>Patients: </strong>Four hundred seventy-six patients with CKD and operative lower extremity fractures (pelvis to ankle).</p><p><strong>Intervention: </strong>Patients were grouped according to preoperative glomerular filtration rate (GFR) per the National Kidney Foundation Guidelines. Patients with moderate-to-severe CKD and end stage renal disease (ESRD) were compared with those with predisease state CKD.</p><p><strong>Outcome measurements: </strong>Mortality and complication rates at time points up to 2 years or until death.</p><p><strong>Results: </strong>Patients with predisease state CKD were significantly less likely to have a complication within 2 years than patients with ESRD but not patients with moderate-to-severe CKD. One-year and 2-year mortality rate were significantly higher in the moderate-to-severe CKD (36.1%) and ESRD (49.0%) groups than in the predisease state CKD group. Compared to the patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD both had increased odds of 1-year mortality, 2-year mortality, and a complication at 2 years after operative fixation of a lower extremity fracture. Patients with ESRD also had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD.</p><p><strong>Conclusions: </strong>Compared to patients with predisease state CKD, patients with moderate-to-severe CKD and ESRD had increased odds of 1-year mortality and 2-year mortality, as well as a complication at 2 years. Patients with ESRD had increased odds of 30-day and 90-day mortality compared with patients with predisease state CKD. Two-year mortality rate was 49% in the ESRD group.</p><p><strong>Level of evidence: </strong>Therapeutic level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e457"},"PeriodicalIF":0.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12680424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703110","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":"Outcomes after infected humeral shaft nonunion surgery.","authors":"Patrick Pallitto, Nathaniel Koutlas, Noah Harrison, Elsa Rodriguez, William Obremskey, Alexander Hysong, Samuel L Posey, Joseph R Hsu, Roman M Natoli, Rachel B Seymour, Andrew T Chen","doi":"10.1097/OI9.0000000000000454","DOIUrl":"10.1097/OI9.0000000000000454","url":null,"abstract":"<p><strong>Objectives: </strong>This study looks to report overall union rate after surgical treatment of infected humeral shaft nonunions.</p><p><strong>Design: </strong>Retrospective.</p><p><strong>Setting: </strong>Eight Level 1 trauma centers.</p><p><strong>Patients/participants: </strong>Twenty-six patients with infected humeral shaft nonunions and ≥180-day follow-up. A nonunion was considered infected in the presence of a draining sinus or positive intraoperative cultures.</p><p><strong>Intervention: </strong>Surgical treatment of infected humeral nonunion.</p><p><strong>Main outcome measurements: </strong>The primary outcome was union rate, and subanalysis was performed comparing planned single stage versus staged surgery. Secondary outcomes included overall postoperative complications.</p><p><strong>Results: </strong>The mean follow-up time was 20.7 months; median age was 39.5 years. The initial fixation construct in most patients was plate and screws (81%). After revision surgery, only 50% (n = 13) of these went on to union. Preplanned staged treatment does not appear to be associated with successful union. Postoperative complications were high including persistent nonunion and infection. Tobacco use, diabetes, BMI, and bone grafting did not affect union.</p><p><strong>Conclusions: </strong>This study supports our hypothesis that infected humeral nonunions are challenging to treat and are at high risk for recalcitrant nonunion (50%). Further research is warranted to determine whether staged treatment is associated with a higher rate of union.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4","pages":"e454"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145566623","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}