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

{"title":"Musculoskeletal trauma rehabilitation: a global comparison.","authors":"Brian Bernstein, Douglas W Lundy, Theodore A Miclau, Zsolt J Balogh, Shimpei Kitada, Ross Leighton, Guy Putzeys, Luis G Padilla Rojas, Inger Schipper, Linda Vallejo, Jonathan Tamayo-Cosio, Dario E Garin Zertuche, Cristian A Rojas Herrera, José Octavio Soarez Hungria, Jaime A Leal Camacho, Marcelo T Caiero, Horacio Tabares Neyra, Vincenzo Giordano, Hans-Christoph Pape, Theodore Miclau","doi":"10.1097/OI9.0000000000000437","DOIUrl":"10.1097/OI9.0000000000000437","url":null,"abstract":"<p><p>Rehabilitation after musculoskeletal trauma is globally acknowledged as essential for restoring function and improving quality of life; however, significant variation exists in rehabilitation frameworks and services worldwide. Although certain principles-such as early intervention, structured care pathways, and multidisciplinary approaches-are universally recognized as important determinants of outcomes in trauma patients, their implementation and effectiveness vary considerably due to differences in health care infrastructure, economic resources, policy frameworks, and cultural contexts. Drawing on comparative analyses of rehabilitation frameworks across regions, including North America, Latin America, Europe, Asia-Pacific, and Africa, this paper identifies structural variations, systemic challenges, and innovations that can inform global rehabilitation efforts. Strategic international collaboration focusing on shared learning, standardized protocols, technology integration, and targeted investments is key to creating equitable and sustainable rehabilitation models, especially in resource-limited settings and aging populations.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e437"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304909","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":"Guest nation symposium: management of musculoskeletal war injuries.","authors":"Roman Hayda, Oleksandr Rikhter, Oleksii Horehliad, Petro Nikitin, Kostiantyn Romanenko, Vasyl Makhovskyi, Serhiy Hariyan, Oleksandr Tsybulskyi","doi":"10.1097/OI9.0000000000000443","DOIUrl":"10.1097/OI9.0000000000000443","url":null,"abstract":"<p><p>For the last 2.5 years, Ukrainian surgeons have faced a vast number of war casualties generated by the Russian full-scale invasion in 2022. Despite being a middle-income country with limited medical resources, both the military and civilian Ukrainian health care systems were forced to respond to save lives and limbs of those injured by the destructive battlefield munitions. Development of educational resources to include on-line platforms were used on an unprecedented scale to educate civilian surgeons in the principles of war injury care, which differ from most civilian care practices. War trauma care principles of initial stabilization, debridement, external fixation with conversion to internal fixation where appropriate with bone and soft tissue defect management principles were implemented. Infection control measures were also important in mitigating infections associated with these severe injuries. These models and lessons can be useful in other conflict zones across the globe.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e443"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304898","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 bigger picture: unconventional open fractures in Colombia.","authors":"Diego Luis Carvajal Lievano, Jaime Andres Leal, Cristian Alberto Rojas, Fredy Santisteban, Miguel S Daccarett","doi":"10.1097/OI9.0000000000000440","DOIUrl":"10.1097/OI9.0000000000000440","url":null,"abstract":"<p><p>The management of open fractures in Colombia is influenced by special conditions shaped by the unique medical, social, and infrastructural environment that exists within the many varied regions of the country. These factors make the treatment of open fractures and associated injuries particularly complex.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e440"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304900","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":"Navigation and intraoperative imaging in pelvic and acetabular trauma.","authors":"Lynn Hutchings, Douglas Haase, Sven Meylaerts, Frank Ijpma, Ashraf El Naga, Kornelis J Ponsen","doi":"10.1097/OI9.0000000000000432","DOIUrl":"10.1097/OI9.0000000000000432","url":null,"abstract":"<p><p>The introduction of 3D technology in pelvic and acetabular surgery has the potential to change preoperative and intraoperative management. This technology is being developed in a number of areas, including improved preoperative planning and the development of patient-specific implants, and intraoperative visualization and assistance in traditionally technically challenging procedures. This expanding field holds exciting avenues for future changes in practice but requires knowledge of its limitations for appropriate application.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e432"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304941","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 before 12 days prevents fracture-related infection in IIIB open tibial fractures in young and healthy patients.","authors":"Álvaro I Zamorano, Matías A Vaccia, Rodrigo I Parra, Tomás Turner, Ignacio Rivera, Tomás Errázuriz, Andrés Oyarzún, Luis A Bahamonde","doi":"10.1097/OI9.0000000000000435","DOIUrl":"10.1097/OI9.0000000000000435","url":null,"abstract":"<p><strong>Introduction: </strong>Gustilo-Anderson type IIIB open tibial fractures carry a high risk of fracture-related infection (FRI) due to extensive soft tissue damage and frequent delays in coverage. Although early orthoplastic intervention lowers infection rates, many trauma centers lack the resources for same-day or early flap coverage. This study aimed to assess the relationship between timing of flap coverage and FRI risk in a young, healthy population, and to define a clinically relevant therapeutic window.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted at a single Level I trauma center (2012-2023). Patients with GA IIIB tibial fractures were treated under a standardized protocol with strict inclusion criteria. Timing of flap coverage was analyzed using Levene test, Student <i>t</i> test, and ROC curve analysis with the Youden index to determine the optimal infection-risk threshold.</p><p><strong>Results: </strong>Out of 332 open tibial fractures, 41 patients with GA IIIB injuries met inclusion criteria. Mean time to coverage was 24.6 days. FRI occurred in 15 patients (36.6%). Delayed coverage was significantly associated with FRI (<i>P</i> < 0.001). ROC analysis showed an AUC of 0.83; the Youden index identified <12 days as the optimal cutoff (100% sensitivity, 34.6% specificity). None of the 10 patients treated within 12 days developed FRI, versus 56.6% in those treated later (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>Coverage within 12 days minimizes infection risk in GA IIIB tibial fractures. Although immediate coverage remains ideal, a defined 12-day window offers practical guidance, especially where early orthoplastic care is not feasible.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e435"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304910","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 of intramedullary nailing for traumatic adult femoral shaft fractures in low-and-middle-income countries; a systematic review.","authors":"Marcella F D Ryan-Coker, Rekha Batura, Hilary Kubai, Martha Y E Forde, Juan C Perdomo-Lizarraga, Kebba Marenah, Hassan Haghparast-Bidgoli","doi":"10.1097/OI9.0000000000000434","DOIUrl":"10.1097/OI9.0000000000000434","url":null,"abstract":"<p><strong>Objective: </strong>This review reports on the radiologic and functional outcomes and complications of managing adult traumatic femur shaft fractures (FSFs) with intramedullary nailing (IMN) in Low-and-Middle-Income Countries (LMICs) and evaluates the quality of existing evidence.</p><p><strong>Methodology: </strong>A thorough literature search was conducted across several databases, including reference lists of selected articles. Screening was done per the PRISMA guidelines. Peer-reviewed articles published in English between January 2011 and December 2022 that reported radiologic or functional outcomes in adults with isolated traumatic FSFs managed with IMN in LMICs were included for review. The quality and level of evidence were assessed using modified Critical Appraisal Skills Program checklists and the modified Oxford Centre for Evidence-Based Medicine criteria.</p><p><strong>Findings: </strong>Forty studies from 13 LMICs were included in this review. The mean time to union was 15.4 weeks, with a mean union rate of 88.1%. Functional outcomes scores showed >70% excellent outcomes. The Radiographic Union Scale in Tibia score and Thoresen criteria were the most used assessment tools. Mean infection rates were 4.8%, and limb shortening (of varying amounts) occurred in 3.5% of patients. The findings revealed variability in measuring and reporting IMN outcomes in FSFs, but overall, the existing evidence was of satisfactory quality.</p><p><strong>Conclusion: </strong>Despite the data limitations, methodological differences, and outcome discrepancies, this review demonstrates a trend favoring IMN for FSFs, with low failure rates in low-resources settings. However, more robust studies using standardized radiographic and functional outcomes measures in LMICs are needed.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e434"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304899","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":"2024 international trauma care forum guest nation symposium: gunshot injuries.","authors":"Jaime A Leal, Roman Hayda, Volodymyr Biliavskyi, Yurii Klapchuk, Amparo Gomez, Paul Whiting","doi":"10.1097/OI9.0000000000000444","DOIUrl":"10.1097/OI9.0000000000000444","url":null,"abstract":"<p><p>The Orthopaedic Trauma Association (OTA/AO) 2024 International Trauma Care Forum held in Montreal focused on the management of gunshot-related extremity trauma in both conventional and irregular warfare. Key presentations addressed the full-scale Russo-Ukrainian war and Colombia's enduring internal conflict, emphasizing the disproportionate burden of complex civilian injuries. In Ukraine, since the 2022 invasion, high-velocity ballistic and explosive trauma has resulted in injuries with extensive skeletal and soft tissue damage, often necessitating staged surgical debridement, external fixation, limb reconstruction, or amputation. Innovative techniques, including 3D-printed implants and regional or free flap coverage, have been incorporated into multidisciplinary protocols, despite significant limitations in subspecialty access and surgical resources. Conversely, Colombia's conflict-ongoing for over 7 decades-has resulted in over 2 million registered victims who have sustained physical injuries caused by bullets, explosions, or other war-related trauma, including both combatants and civilians. Urban areas primarily see low-energy gunshot wounds, whereas rural zones are affected by higher-energy injuries caused by improvised landmines and other unconventional weapons. Treatment is complicated by delayed evacuation, lack of trauma system infrastructure, and biologically contaminated injuries leading to high infection rates. The forum highlighted the importance of adaptable, evidence-based protocols, antimicrobial stewardship, and long-term rehabilitation strategies. The consensus of the expert panel was that the persistent burden of extremity trauma in conflict settings demands coordinated global trauma systems and equitable access to limb preservation and reconstructive care.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e444"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304940","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":"Unstable pelvic fractures in patients with hemodynamic instability: global treatment controversies.","authors":"Zsolt J Balogh, Kornelis J Ponsen, Katherine R Miclau, Rafael Amadei, Alessandro Casiraghi, Stefano Cattaneo, Leo M G Geeraedts, Vincenzo Giordano, Mahmoud Jammal, Jaime Andres Leal Camacho, Yoram Weil, Theodore Miclau","doi":"10.1097/OI9.0000000000000436","DOIUrl":"10.1097/OI9.0000000000000436","url":null,"abstract":"<p><p>Pelvic fractures associated with hemodynamic instability present a major challenge in trauma care, carrying mortality rates up to 30%. Successful management requires a multidisciplinary approach focused on resuscitation, mechanical stabilization, and hemorrhage control. Based on the 2024 International Orthopaedic Trauma Association (IOTA) Annual Meeting Pelvic Symposium, this review summarizes current recommendations for the management of hemodynamically unstable patients with pelvic fractures. Initial skeletal stabilization typically involves noninvasive pelvic binding devices, such as sheets or commercially available binders, employed in both pre-hospital and hospital settings. Subsequent resuscitation strategies include hypotensive resuscitation-restricting fluid administration to maintain lower blood pressure until bleeding is controlled-and damage control resuscitation-consisting of rapid surgical interventions aimed at achieving hemostasis. Current best practice also includes early empirical administration of balanced transfusion products guided by massive transfusion protocols, with targeted adjustments based on point-of-care testing results. Hemorrhage control methods vary depending on available resources: angioembolization effectively manages arterial bleeding in well-resourced facilities, whereas preperitoneal pelvic packing offers a quick, accessible solution for venous and bone-related hemorrhage, particularly in low-resource environments. Although the timing of pelvic binder removal and definitive invasive skeletal stabilization remains controversial, recent evidence supports early definitive internal fixation within 24 hours post-injury.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e436"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304943","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":"Percutaneous exposure for tibia osseointegration: reduced antibiotics, improved perioperative metrics, and greater pain reduction versus open exposure.","authors":"Jason S Hoellwarth, Andrew G LoPolito, Michael D Greenstein, Taylor J Reif, Robert S Rozbruch","doi":"10.1097/OI9.0000000000000428","DOIUrl":"10.1097/OI9.0000000000000428","url":null,"abstract":"<p><strong>Introduction: </strong>This article compared outcomes of patients who received transtibial osseointegration through percutaneous incision (Perc and existing amputation by definition), open exposure (Open) of an existing amputation, or simultaneous transtibial amputation and osseointegration (Amp).</p><p><strong>Methods: </strong>Retrospective chart review evaluated the aims. Adverse events: subsequent antibiotic administration and additional relevant surgery. Perioperative care: length of operation, estimated blood loss, infusion volume, and length of hospital stay. Patient-reported outcomes: preoperative versus postoperative scores of the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) and PROMIS patient-reported outcome measures. Comparisons were made at short term (first 6 months) and longer term (6 months and beyond).</p><p><strong>Results: </strong>The demographics of the 7 Amp, 15 Open, and 14 Perc patients were similar with the exception of time between amputation and osseointegration, etiology of amputation, and laterality. Perc patients had significantly lower antibiotic prescription versus Amp patients in the first 6 months (21% vs. 100%, <i>P</i> = 0.001) and versus Open beyond 6 months (21% vs. 66%, <i>P</i> = 0.025). Additional surgery for debridement or removal was minimal and similar among the 3 groups. Operative time was significantly shorter for Perc versus Amp (66.9 vs. 173.6 minutes, <i>P</i> < 0.001) and Perc versus Open (66.9 vs. 166.7 minutes, <i>P</i> < 0.001). Estimated blood loss was significantly less for Open versus Amp (87.1 vs. 257.1 mL, <i>P</i> = 0.001) and Perc versus Open (40.0 vs. 257.1 mL, <i>P</i> < 0.001). Inpatient stay was significantly shorter for Perc versus Open (2.5 vs. 3.5 days, <i>P</i> = 0.022). Perc patients also had significantly better improvement versus Open group for LD-SRS pain subscore (1.5 vs. 0.6, <i>P</i> = 0.010), PROMIS pain intensity score (-14.7 vs. -4.3, <i>P</i> = 0.005), and PROMIS pain interference score (-17.1 vs. -4.8, <i>P</i> = 0.007). Interestingly, the Amp group had a significantly better improvement in PROMIS pain intensity score versus the Open group (-21.1 vs. -4.3, <i>P</i> = 0.009).</p><p><strong>Conclusions: </strong>Although a percutaneous approach may not always be possible, surgeons may want to actively consider whether their patients can have a smaller surgical approach that may confer measurable benefits.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4","pages":"e428"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282125","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":"Fracture nonunions.","authors":"Vu Le, Clifford Jones, Zachary M Working, Georg Duda, Christopher Evans, Andrew Evans","doi":"10.1097/OI9.0000000000000441","DOIUrl":"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}