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

{"title":"Classification of open tibia fractures: the rationale for a new classification system.","authors":"Sehar Resad Ferati, Abhishek Ganta","doi":"10.1097/OI9.0000000000000318","DOIUrl":"10.1097/OI9.0000000000000318","url":null,"abstract":"<p><p>Open tibial shaft fractures are one of the most common long bone injuries encountered. Current existing classifications are designed to characterize the nature of the injury and guide clinical decision making. However, despite these advancements, there are areas in our current classification system that can be improved to not only make reliability more producible but also create prognostic factors that can help guide treatment.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4 Suppl","pages":"e318"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263532","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":"Prevention and treatment of osteomyelitis after open tibia fractures.","authors":"Devan D Mehta, Philipp Leucht","doi":"10.1097/OI9.0000000000000309","DOIUrl":"10.1097/OI9.0000000000000309","url":null,"abstract":"<p><p>Infection and chronic post-traumatic osteomyelitis of the tibia after open fracture are complex problems that cause significant morbidity and threaten the viability of a limb. Therefore, it is of utmost importance for the orthopaedic surgeon to understand both patient and treatment factors that modify the risk of developing these disastrous complications. Infection risk is largely based on severity of open injury in addition to inherent patient factors. Orthopaedic surgeons can work to mitigate this risk with prompt antibiotic administration, thorough and complete debridement, expedient fracture stabilization, and early wound closure. In the case osteomyelitis does occur, the surgeon should use a systematic multidisciplinary approach for eradication.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4 Suppl","pages":"e309"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263537","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":"Soft tissue coverage for IIIB fractures: from timing to coverage options.","authors":"Ali Azad, Jacques H Hacquebord","doi":"10.1097/OI9.0000000000000317","DOIUrl":"10.1097/OI9.0000000000000317","url":null,"abstract":"<p><p>Open tibia fractures are the most common open long bone injury. Most of these injuries involve a high-energy mechanism. Many standards for management have been created to provide guidance and a baseline for quality. There are several factors that must be considered when determining the timing of coverage for an open fracture with soft tissue compromise. Understanding the available options for soft tissue coverage, including local/rotational flaps and free tissue transfer, will allow for a tailored approach based on the personality of the injury. The aim of this review was to characterize the critical window of treatment based on the current literature and to provide a review of the available soft tissue coverage options.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4 Suppl","pages":"e317"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263540","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":"Tibial bone loss.","authors":"Benjamin C Schaffler, Sanjit R Konda","doi":"10.1097/OI9.0000000000000315","DOIUrl":"10.1097/OI9.0000000000000315","url":null,"abstract":"<p><p>Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4 Suppl","pages":"e315"},"PeriodicalIF":0.0,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263545","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":"Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation.","authors":"Fielding S Fischer, Hania Shahzad, Safdar N Khan, Carmen E Quatman","doi":"10.1097/OI9.0000000000000335","DOIUrl":"10.1097/OI9.0000000000000335","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of homelessness on surgical outcomes following ankle fracture surgery.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Mariner claims database.</p><p><strong>Patients/participants: </strong>Patients older than 18 years who underwent open reduction and internal fixation (ORIF) of ankle fractures between 2010 and 2021. A total of 345,759 patients were included in the study.</p><p><strong>Intervention: </strong>Study patients were divided into two cohorts (homeless and nonhomeless) based on whether their patient record contained International Classification of Disease (ICD)-9 or ICD-10 codes for homelessness/inadequate housing.</p><p><strong>Main outcome measures: </strong>One-year rates of reoperation for amputation, irrigation and debridement, repeat ORIF, repair of nonunion/malunion, and implant removal in isolation.</p><p><strong>Results: </strong>Homeless patients had significantly higher odds of undergoing amputation (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.08-2.27, <i>P</i> = 0.014), irrigation and debridement (aOR 1.22, 95% CI 1.08-1.37, <i>P</i> < 0.001), and repeat ORIF (aOR 1.16, 95% CI 1.00-1.35, <i>P</i> = 0.045). Implant removal was less common in homeless patients (aOR 0.65, 95% CI 0.59-0.72, <i>P</i> < 0.001). There was no significant difference between homeless and nonhomeless patients in the rate of nonunion/malunion repair (aOR 0.87, 95% CI 0.63-1.18, <i>P</i> = 0.41).</p><p><strong>Conclusions: </strong>Homelessness is a significant risk factor for worse surgical outcomes following ankle fracture surgery. The findings of this study warrant future research to identify gaps in surgical fracture care for patients with housing insecurity and underscore the importance of developing interventions to advance health equity for this vulnerable patient population.</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":"7 2","pages":"e335"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961123","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":"Management of open fracture and related complications: the Japanese way.","authors":"Hiroaki Minehara, Yukichi Zenke, Akihiro Maruo, Takashi Matsushita, Theodore Miclau","doi":"10.1097/OI9.0000000000000325","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000325","url":null,"abstract":"<p><p>Open fractures continue to be a challenging clinical problem throughout the world, and Japan is no exception. Surgeons are faced with critical decisions throughout the care of these injuries that can have significant effects in clinical outcome, ranging from the type and timing of antibiotic administration, fixation, soft-tissue management, and interventions for postfracture complications. In October 2022, the Japanese Society for Fracture Repair (JSFR) was invited to represent Japan as the Guest Nation society at the 38th Annual Meeting of the Orthopaedic Trauma Society held in Tampa, Florida. The JSFR organized a symposium, entitled \"Management of Open Fracture and related complications-the Japanese way,\" that featured cutting-edge approaches to open fractures in their country, including presentations on the \"fix-and-flap\" approach, local antibiotics perfusion delivery, and a \"chipping\" method for the stimulation of bone healing. This article summarizes the content of these 3 presentations from that symposium.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 3 Suppl","pages":"e325"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868319","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: evidence-based best practices.","authors":"Paul S Whiting, William Obremskey, Herman Johal, David Shearer, David Volgas, Zsolt J Balogh","doi":"10.1097/OI9.0000000000000313","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000313","url":null,"abstract":"<p><p>Open fracture management is a common challenge to orthopaedic trauma surgeons and a burdensome condition to the patient, health care, and entire society. Fracture-related infection (FRI) is the leading morbid complication to avoid during open fracture management because it leads to sepsis, nonunion, limb loss, and overall very poor region-specific and general functional outcomes. This review, based on a symposium presented at the 2022 OTA International Trauma Care Forum, provides a practical and evidence-based summary on key strategies to prevent FRI in open fractures, which can be grouped as optimizing host factors, antimicrobial prophylaxis, surgical site management (skin preparation, debridement, and wound irrigation), provision of skeletal stability, and soft-tissue coverage. When it is applicable, strategies are differentiated between optimal resource and resource-limited settings.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 3 Suppl","pages":"e313"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873753","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":"Geriatric proximal femur fracture updates.","authors":"Vincenzo Giordano, Pierre Marie Woolley, Martin J Heetveld, Carla S Smith, Victor de Ridder","doi":"10.1097/OI9.0000000000000323","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000323","url":null,"abstract":"<p><p>Proximal femur fractures in the aging population present a variety of challenges. Physiologically, patients incurring this fracture are typically frail, with significant medical comorbidities, yet require early surgical treatment to restore mobility to prevent deterioration. Socioeconomically, the occurrence of a fragility fracture may be the beginning of the loss of independence, and the burdens of rehabilitation and support are borne by the individual patient and health care systems.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 3 Suppl","pages":"e323"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11064807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873385","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 local and systemic effects of immune function on fracture healing.","authors":"Andrew R Evans, Peter V Giannoudis, Philip Leucht, Todd O McKinley, Greg E Gaski, Katherine P Frey, Joseph C Wenke, Christopher Lee","doi":"10.1097/OI9.0000000000000328","DOIUrl":"10.1097/OI9.0000000000000328","url":null,"abstract":"<p><p>The immune system plays an integral role in the regulation of cellular processes responsible for fracture healing. Local and systemic influences on fracture healing correlate in many ways with fracture-related outcomes, including soft tissue healing quality and fracture union rates. Impaired soft tissue healing, restricted perfusion of a fracture site, and infection also in turn affect the immune response to fracture injury. Modern techniques used to investigate the relationship between immune system function and fracture healing include precision medicine, using vast quantities of data to interpret broad patterns of inflammatory response. Early data from the PRECISE trial have demonstrated distinct patterns of inflammatory response in polytrauma patients, which thereby directly and indirectly regulate the fracture healing response. The clearly demonstrated linkage between immune function and fracture healing suggests that modulation of immune function has significant potential as a therapeutic target that can be used to enhance fracture healing.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 2 Suppl","pages":"e328"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133460","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":"Biomechanics of fracture healing: how best to optimize your construct in the OR.","authors":"Michael Hast, Vaida Glatt, Michael Archdeacon, Eric Ledet, Gregory Lewis, Jaimo Ahn, Justin Haller","doi":"10.1097/OI9.0000000000000304","DOIUrl":"10.1097/OI9.0000000000000304","url":null,"abstract":"<p><p>Orthopaedic surgeons routinely assess the biomechanical environment of a fracture to create a fixation construct that provides the appropriate amount of stability in efforts to optimize fracture healing. Emerging concepts and technologies including reverse dynamization, \"smart plates\" that measure construct strain, and FractSim software that models fracture strain represent recent developments in optimizing construct biomechanics to accelerate bone healing and minimize construct failure.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 2 Suppl","pages":"e304"},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10936157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133437","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}