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

{"title":"Consensus statement on the prevention, diagnosis, and management of infection following transcutaneous osseointegration for patients with limb loss: current state-of-the-art and proposed future studies.","authors":"Jason S Hoellwarth, Colin Harrington, S Robert Rozbruch, Benjamin K Potter","doi":"10.1097/OI9.0000000000000369","DOIUrl":"10.1097/OI9.0000000000000369","url":null,"abstract":"<p><p>The diagnosis, risk factors, treatment algorithms, and long-term sequelae of superficial and deep, implant-related infections in transdermal, bone-anchored osseointegration are not well-defined. In contrast to the robust experience diagnosing and managing periprosthetic joint infections in total joint arthroplasty, osseointegration surgery has only recently been adopted at a small number of osseointegration centers in the United States, contributing to the lack of long-term outcomes. Through the pooled experience from these osseointegration centers, we present a consensus statement on the perioperative management, incidence, treatment, and diagnostic workup for infectious complications following transdermal, bone-anchored osseointegration.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e369"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607463","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":"Screening and patient selection for bone-anchored limb implantation and rehabilitation: what makes a good candidate?","authors":"Jason W Stoneback, Meghan K Wally, Angela Abernethy, Dan Milius, Mohamad E Awad","doi":"10.1097/OI9.0000000000000368","DOIUrl":"10.1097/OI9.0000000000000368","url":null,"abstract":"<p><p>Osseointegration of a bone-anchored limb (BAL) is an emerging rehabilitation technique that offers significant advantages over traditional socket prostheses. By addressing functional limitations and recurrent cutaneous complications, BAL systems have shown an 82%-90% increase in daily prosthesis use among patients, who also report improvements in functional ability, balance, comfort, and overall quality of life. Despite these benefits, the process of patient selection for BAL remains underdeveloped, with evidence-based guidelines still in their infancy. This article aims to propose a workflow for patient selection and screening in BAL osseointegration, leveraging the current literature, interdisciplinary clinical experience, and established models. A comprehensive evaluation process is suggested that incorporates anatomical, physiological, psychological, and lifestyle factors. These include radiological evaluation, amputation history, prosthetic component assessment, laboratory tests, psychiatric history, cognitive assessments, and considerations of home safety and postoperative care. The evaluation should ideally be conducted by an interdisciplinary team to ensure a balanced consideration of risks and benefits for each candidate. As the understanding of BAL osseointegration advances, it is expected that patient indications will expand and contraindications will be more clearly defined. The proposed workflow aims to standardize patient selection, thereby optimizing surgical outcomes and rehabilitation processes. This approach is essential for maximizing the benefits of BAL systems while ensuring patient safety and improving long-term rehabilitation outcomes.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e368"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606736","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":"A conceptual framework for soft tissue management of transdermal bone-anchored implants in extremity prostheses.","authors":"Matthew Wordsworth, Colin J Harrington, Luke Juckett, Jason M Souza","doi":"10.1097/OI9.0000000000000370","DOIUrl":"10.1097/OI9.0000000000000370","url":null,"abstract":"<p><p>Soft tissue complications are among the most common reasons for revision surgery following transdermal, bone-anchored osseointegration. While many orthopaedic surgeons are familiar and experienced with the use of intramedullary implants, the soft tissue management surrounding a percutaneous and permanent implant in continuity with the outside environment remains a challenging problem. With this in mind, we present our rationale and a framework for soft tissue considerations in preparation for bone-anchored osseointegration based on early experiences with most commercially available osseointegration systems.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e370"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607451","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":"Rabbit model of a biofilm-contaminated, percutaneous orthopaedic endoprosthesis.","authors":"Christopher Rivet, Jonathan Thomas Elliott, Jason R Gunn, J Scott Sottosanti, Bailey V Fearing, Joseph R Hsu, Ida Leah Gitajn","doi":"10.1097/OI9.0000000000000384","DOIUrl":"10.1097/OI9.0000000000000384","url":null,"abstract":"<p><p>Preclinical models of osseointegrated orthopaedic implants tend to focus on implant stability, surface modifications to enhance integration with host tissue, and reduction in iatrogenic contamination through antibiotic-eluting/bacteria-resistant coatings. While these studies are imperative to early success in osseointegration, continued success of percutaneous devices throughout the lifespan of the patient is also critically important. A perpetual challenge to the implant is formation of bacterial biofilm on the abutment. Once adhered, biofilm-based bacteria are recalcitrant and readily contaminate the subcutaneous soft tissue of the stoma. To this end, the rabbit model reported herein replicates the clinical scenario of a patient with a biofilm-contaminated abutment. This model enables preclinical testing of advanced therapeutics beyond the traditional antibiotic-based approach, potentially increasing the longevity of the device.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e384"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606066","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":"Osseointegration programmatic development: interdisciplinary team with a patient-centered approach.","authors":"Amber Stanley, Meghan K Wally, Christine Churchill, Kristine McGuire, Tarey Strickland, Angela Abernethy, Toby Perkins, Angelica M Melendez, Kevin Hickey, Rachel B Seymour","doi":"10.1097/OI9.0000000000000372","DOIUrl":"10.1097/OI9.0000000000000372","url":null,"abstract":"<p><p>Successful implementation of an osseointegration program requires a skilled and committed interdisciplinary team engaged in supporting patients and their families throughout the OI process. The roles and responsibilities of clinical and ancillary team members are described in detail, along with a discussion of the needed patient and family support resources. Time spent developing the interdisciplinary team, with strong regulatory support and engagement of hospital administration and the health system, will promote higher patient satisfaction and outcomes and innovative future directions.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1 Suppl","pages":"e372"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607466","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":"Predicting discharge destination and length of stay after open reduction internal fixation of distal femur fractures.","authors":"Akash A Shah, Brian K Zukotynski, Chohee Kim, Brendan Y Shi, Changhee Lee, Sai K Devana, Alexander Upfill-Brown, Erik N Mayer, Nelson F SooHoo, Christopher Lee","doi":"10.1097/OI9.0000000000000364","DOIUrl":"10.1097/OI9.0000000000000364","url":null,"abstract":"<p><strong>Introduction: </strong>Prediction of nonhome discharge after open reduction internal fixation (ORIF) of distal femur fractures may facilitate earlier discharge planning, potentially decreasing costs and improving outcomes. We aim to develop algorithms predicting nonhome discharge and time to discharge after distal femur ORIF and identify features important for model performance.</p><p><strong>Methods: </strong>This is a retrospective cohort study of adults in the American College of Surgeons National Surgical Quality Improvement Program database who underwent distal femur ORIF between 2010 and 2019. The primary outcome was nonhome discharge, and the secondary outcome was time to nonhome discharge. We developed logistic regression and machine learning models for prediction of nonhome discharge. We developed an ensemble machine learning-driven survival model to predict discharge within 3, 5, and 7 days.</p><p><strong>Results: </strong>Of the 5330 patients included, 3772 patients were discharged to either a skilled nursing facility or rehabilitation hospital after index ORIF. Of all tested models, the logistic regression algorithm was the best-performing model and well calibrated. The ensemble model predicts discharge within 3, 5, and 7 days with fair discrimination. The following features were the most important for model performance: inpatient status, American Society of Anesthesiology classification, preoperative functional status, wound status, medical comorbidities, age, body mass index, and preoperative laboratory values.</p><p><strong>Conclusion: </strong>We report a well-calibrated algorithm that accurately predicts nonhome discharge after distal femur ORIF. In addition, we report an ensemble survival algorithm predicting time to nonhome discharge. Accurate preoperative prediction of discharge destination may facilitate earlier discharge, reducing the costs and complications associated with prolonged hospitalization.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 2","pages":"e364"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588497","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 Impact of National Orthopaedic Fracture Registries: A Systematic Review.","authors":"Nicolas Jozefowski, Carlo Eikani, Nithya Lingampalli, Patrick Lawler, Athena Barrett, Aaron Hoyt, Andrew Pickles, Elizabeth Huggins, Julie Agel, Rachel Seymour, Mai Nguyen, Meir Marmor, Ashley E Levack","doi":"10.1097/OI9.0000000000000361","DOIUrl":"10.1097/OI9.0000000000000361","url":null,"abstract":"<p><strong>Purpose: </strong>Large-scale registry data efforts are common in orthopaedic surgery; however, there is wide variation between registries and little known about registry impact. The purpose of this study was to assess the publication or \"scholarly\" impact of current national trauma/fracture registries.</p><p><strong>Methods: </strong>A search was executed to identify potential national and international trauma/fracture registries and create a comprehensive list of registries. Thirty-four relevant national registries were identified. Searches were executed to identify any published articles published by or affiliated with the selected registries. Over 13,000 abstracts were screened by at least 2 reviewers. The full text of 650 articles were screened by at least 2 reviewers, and data were extracted from 383 articles. Citations were excluded if they were reviews and meta-analyses; referencing non-trauma-specific, insurance, institutional, or state-wide databases; describing facial, spine, or rib trauma; reporting nonregistry data; and did not report on fracture patients. Data were collected at the article level and registry level.</p><p><strong>Results: </strong>The median number of articles per registry was 3.5 (range: 1-66) with a median impact factor of 3.2 (range per registry: 1.4-11.0). The National Hip Fracture Database (United Kingdom) had the highest publication rate per year of any registry (3.9). Twenty-four percent of registries had a publication rate of greater than 1 article per year, whereas only 8.8% had a publication rate over 2 per year. Only 8 registries had 10 or more publications in total. The National Trauma Data Bank (United States) had the highest number of fracture-specific publications overall (66) and an average citation rate of 29 per publication. The National Hip Fracture Database had the second highest number of article (62) with an average citation per article of 23.6.</p><p><strong>Conclusion: </strong>With the exception of a few registries, most national trauma/fracture registries have low yearly publication and citation rates. Researchers must consider the utility of resources needed to sustain registry efforts in the context of the impact of registry data. Future studies will seek to identify salient features of the highest impact registries.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 1","pages":"e361"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11789904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124165","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":"Clinical relevance of current patient-reported outcome measures for ankle fracture: surgeons' perspective.","authors":"Kyle Schweser, Emily Leary, Ashley E Levack, Meir T Marmor","doi":"10.1097/OI9.0000000000000349","DOIUrl":"10.1097/OI9.0000000000000349","url":null,"abstract":"<p><strong>Objectives: </strong>Determine the relevance of the most frequently used patient-reported outcome measures (PROMs) for monitoring patient recovery after ankle fracture, from the clinical perspective of orthopaedic trauma surgeons, given lack of validated PROMs.</p><p><strong>Design: </strong>Prospective cohort.</p><p><strong>Setting: </strong>Orthopaedic Trauma Association committee meetings, electronic correspondence.</p><p><strong>Patients/participants: </strong>Orthopaedic trauma surgeons.</p><p><strong>Intervention: </strong>Delphi method for consensus activities.</p><p><strong>Level of evidence: </strong>IV.</p><p><strong>Main outcome measurements: </strong>Most clinically relevant PROMs for ankle fracture recovery.</p><p><strong>Results: </strong>Several English-language PROMs were identified based on use in literature and relevance to ankle fractures. 7 were selected by expert consensus. These are the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), Foot and Ankle Ability Measure (FAAM), American Academy of Orthopaedic Surgeons (AAOS), Foot and Ankle Disability Index (FADI) Score, Lower Extremity Functional Scale (LEFS), Olerud-Molander Ankle Score (OMAS), and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). The most clinically relevant PROM is the A-FORM, followed by the AAOS, LEFS, PROMIS PF, FADI, and OMAS, and the least clinically relevant overall, the FAAM.</p><p><strong>Conclusions: </strong>Understanding which PROM best matches physician expectations for tracking recovery is an important step toward a robust, evidence-based approach to patient care. The A-FORM was identified as the most clinically relevant among the most used PROMs. These results will aid surgeons, clinicians, and scientists to identify a uniformly, clinically relevant PROM for the treatment and study of outcomes and recovery after isolated ankle fracture.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4","pages":"e349"},"PeriodicalIF":0.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549411","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":"Hypertrophic nonunion management with distraction osteogenesis: a scoping review of the literature.","authors":"Benjamin J Rouse, Gerard A Sheridan, Brian J Page, Austin T Fragomen, S Robert Rozbruch","doi":"10.1097/OI9.0000000000000342","DOIUrl":"10.1097/OI9.0000000000000342","url":null,"abstract":"<p><strong>Introduction: </strong>Traditionally, stiff hypertrophic nonunions have been managed with open preparation of the nonunion site, which is then secured with internal fixation. Alternative surgical options are available including distraction osteogenesis with an external fixator. There is currently a limited amount of literature pertaining to the use of distraction osteogenesis in the management of hypertrophic nonunion. The aim of this systematic review was to collate and assess the effectiveness of distraction osteogenesis (DO) in the management of hypertrophic nonunions and to evaluate the complications that are commonly reported in the literature.</p><p><strong>Methods: </strong>We searched for articles pertaining to the treatment of hypertrophic nonunion using distraction osteogenesis. Several electronic bibliographic databases and clinical trial registries were searched using the MeSH terms \"hypertrophic non-union,\" \"distraction osteogenesis,\" \"stiff non-union,\" and \"External Fixation\" in various combinations to return the maximal number of studies for review. We performed a systematic review and identified a total of 11 studies eligible for review.</p><p><strong>Results: </strong>The review of the literature demonstrated that this technique is highly effective in achieving bony union with minimal complications. The most common complication is mild superficial pin site infections, usually managed with oral antibiotics and effective wound hygiene. Other complications reported were deep pin tract infections, broken hardware, and deformity recurrence due to collapse of regenerate bone.</p><p><strong>Conclusion: </strong>The use of distraction osteogenesis with external fixator devices is an effective and safe method for producing bony union in hypertrophic nonunions. There were minimal associated complications.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 4","pages":"e342"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11410321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302851","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":"Medial augmentation of distal femur fractures using the contralateral distal femur locking plate: A technical note.","authors":"Jaime Andrés Leal","doi":"10.1097/OI9.0000000000000347","DOIUrl":"10.1097/OI9.0000000000000347","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral locking plates are commonly employed for the fixation of distal femur fractures. However, scenarios involving medial comminution, extremely distal fractures, periprosthetic fractures, or nonunion could necessitate medial augmentation. This study explores the possibility of using lateral distal femoral locking plate systems for medial fixation by employing the contralateral plate.</p><p><strong>Methods: </strong>This study presents a technical note on the application of lateral distal femur locking systems for medial augmentation in patients as indicated by current literature findings. Postoperative imaging modalities, including radiography and computed tomography (CT), were used to assess the plates' fit to the distal femur. Three cases following the specified technical note are presented.</p><p><strong>Results: </strong>The various plate systems, all comprising distal femur locking systems, demonstrated adaptability to the medial femur anatomy as confirmed by intraoperative visualization and postoperative radiographs, including two-dimensional and three-dimensional CT scans. It has also been possible to achieve at least 3 independent fixation points regardless of the size of the medial condyle.</p><p><strong>Conclusions: </strong>Locking distal femoral plates can be a viable option for medial augmentation in indicated cases, achieving anatomical adaptation to the distal femur. This provides robust augmentation without the need for additional instruments beyond those used for the lateral cortex.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"7 3","pages":"e347"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142127497","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}