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

{"title":"Sagittal deformity of Garden type I and II geriatric femoral neck fractures is frequently misclassified by lateral radiographs.","authors":"Madeline S Tiee,&nbsp;Andrew G Golz,&nbsp;Andrew Kim,&nbsp;Joseph B Cohen,&nbsp;Hobie D Summers,&nbsp;Anup J Alexander,&nbsp;William D Lack","doi":"10.1097/OI9.0000000000000273","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000273","url":null,"abstract":"<p><p>The objective of this study was to determine the validity and inter-rater reliability of radiographic assessment of sagittal deformity of femoral neck fractures.</p><p><strong>Design: </strong>This is a retrospective cohort study.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patients/participants: </strong>Thirty-one patients 65 years or older who sustained low-energy, Garden type I/II femoral neck fractures imaged with biplanar radiographs and either computed tomography or magnetic resonance imaging were included.</p><p><strong>Main outcome measurements: </strong>Preoperative sagittal tilt was measured on lateral radiographs and compared with the tilt identified on advanced imaging. Fractures were defined as \"high-risk\" if posterior tilt was ≥20 degrees or anterior tilt was >10 degrees.</p><p><strong>Results: </strong>Of 31 Garden type I/II femoral neck fractures, advanced imaging identified 10 high-risk fractures including 8 (25.8%) with posterior tilt ≥20 degrees and 2 (6.5%) with anterior tilt >10 degrees. Overall, there was no significant difference between sagittal tilt measured using lateral radiographs and advanced imaging (<i>P</i> = 0.84), and the 3 raters had good agreement between their measurements of sagittal tilt on lateral radiographs (interclass correlation coefficient 0.79, 95% confidence interval [0.65, 0.88], <i>P</i> < 0.01). However, for high-risk fractures, radiographic measurements from lateral radiographs alone resulted in greater variability and underestimation of tilt by 5.2 degrees (95% confidence interval [-18.68, 8.28]) when compared with computed tomography/magnetic resonance imaging. Owing to this underestimation of sagittal tilt, the raters misclassified high-risk fractures as \"low-risk\" in most cases (averaging 6.3 of 10, 63%, range 6 - 7) when using lateral radiographs while low-risk fractures were rarely misclassified as high-risk (averaging 1.7 of 21, 7.9%, range 1 - 3, <i>P</i> = 0.01).</p><p><strong>Conclusions: </strong>Lateral radiographs frequently lead surgeons to misclassify high-risk sagittal tilt of low-energy femoral neck fractures as low-risk. Further research is necessary to improve the assessment of sagittal plane deformity for these injuries.</p><p><strong>Level of evidence: </strong>Level IV diagnostic study.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e273"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f6/e7/oi9-6-e273.PMC10113109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9386262","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":"Are Canadian orthopaedic surgeons and American orthopaedic surgeons on par? A Canadian practice survey of orthopaedic traumatologists.","authors":"Stephen Doxey,&nbsp;Arthur J Only,&nbsp;Michael Milshteyn,&nbsp;Brian P Cunningham,&nbsp;Lisa K Cannada","doi":"10.1097/OI9.0000000000000272","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000272","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to obtain information on Canadian orthopaedic trauma surgeon practices and salary demographics. It was hypothesized that most of the practicing surgeons recognize specific practice aspects (compensation, call schedule, operating room availability, and provided support staff) as key factors in employment opportunity evaluation.</p><p><strong>Design: </strong>Cross-sectional survey study.</p><p><strong>Setting: </strong>Orthopaedic Trauma Association (OTA) practice surveys.</p><p><strong>Participants: </strong>All active Canadian members of the OTA were eligible to participate.</p><p><strong>Main outcome measurement: </strong>A 50-question survey was sent through email to OTA members assessing physician, practice, and compensation metrics of Canadian orthopaedic traumatologists.</p><p><strong>Results: </strong>Fifty-two of 113 Canadian OTA members participated giving a response rate of 46%. All surgeons worked in an academic practice, either for a university (83%) or community hospital (17%). Only 2% of surgeons have changed jobs in the last 5 years, and over 73% of surgeons maintain the same place of employment during their careers. Most had an available dedicated orthopaedic trauma operating room (73%). The majority indicated having residents (71%) and fellows (63%) as support staff. Many reported completing 300-500 cases per year (42%), which decreased during COVID-19 for 50% of surgeons. The most common reported compensation was between $400,000 and $600,000 US dollars (25%) with many working 4-6 call shifts a month (48%) and 51-70 hours a week (48%).</p><p><strong>Conclusion: </strong>This study demonstrated the varying practice and physician economic variables currently in Canada. The identification and continued surveillance of these employment variables will allow for transparency in job market evaluation by applicants.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e272"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/19/88/oi9-6-e272.PMC10069860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9256542","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":"Orthopaedic Trauma Association Global Outreach Task Force Proceedings.","authors":"Emily Benson","doi":"10.1097/OI9.0000000000000269","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000269","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, the Orthopaedic Trauma Association (OTA) adopted an updated strategic plan emphasizing global outreach. A task force was appointed to better understand the current global orthopaedic trauma educational demand and how the organization may better partner with our global colleagues. This article provides a description of the process and the results of the findings.</p><p><strong>Methods: </strong>First, the current international demographics of the OTA membership were reviewed. Then, 2 surveys were distributed. The first was sent to all current members of the OTA to determine how important the members believe that global orthopaedics should be to the organization's mission. The second survey was sent out to our international orthopaedic trauma colleagues. The results of both surveys were reviewed, analyzed, and summarized in an executive summary report which was presented to the OTA Board of Directors earlier this year.</p><p><strong>Results: </strong>The responses from the membership survey indicated a keen interest in the development of global outreach within our organization. The global outreach survey received 72 responses from 28 different countries, mostly lower and lower-middle income countries. This included many countries in Asia and Africa who had no prior relationship with the OTA. Most respondents were already using online educational materials and expressed a desire for more high-quality online offerings as well as regional resource-specific orthopaedic trauma courses.</p><p><strong>Conclusion: </strong>The overwhelming majority of member respondents believe that global orthopaedics is highly important and central to our mission. Similarly, a majority of the international respondents believed that global orthopaedics is necessary and worthwhile. They expressed a need for more educational opportunities and collaboration, particularly in the areas of online offerings as well as regional, resource-specific courses.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e269"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/3c/oi9-6-e269.PMC10503673.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309154","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 aseptic nonunions and severe bone defects: let us get this thing healed!","authors":"Aaron Nauth,&nbsp;Brett D Crist,&nbsp;Saam Morshed,&nbsp;J Tracy Watson,&nbsp;Hans-Christoph Pape","doi":"10.1097/OI9.0000000000000258","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000258","url":null,"abstract":"<p><p>Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or bone defect treatments including bone grafts, bone graft substitutes, the induced membrane technique, and distraction osteogenesis. A summary of these concepts and guidelines for an overall approach to management are also provided.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e258"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/ce/oi9-6-e258.PMC10392436.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289977","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":"Orthopaedic infections: what have we learned?","authors":"Christopher Lee, Erik Mayer, Nicholas Bernthal, Joseph Wenke, Robert V O'Toole","doi":"10.1097/OI9.0000000000000250","DOIUrl":"10.1097/OI9.0000000000000250","url":null,"abstract":"<p><p>Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall estimates of infection after orthopaedic surgery with internal devices has been estimated at 5%, with hospital costs eight times that of those without fracture-related infections and with significantly poorer functional and pain interference PROMIS scores. Orthopaedic infection interventions have been focused on prevention and treatment options. The creation of new modalities for orthopaedic infection treatment can benefit from the understanding of the temporal relationship between bacterial colonization and host-cell integration, a concept referred to as \"the race for the surface.\" Regarding prevention, host modulation and antibiotic powder use have been explored as viable options to lower infection rates. Orthopaedic infection treatment has additionally continued to evolve, with PO antibiotics demonstrating equivalent efficacy to IV antibiotics for the treatment of orthopaedic infections in recent studies. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e250"},"PeriodicalIF":0.0,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/b4/oi9-6-e250.PMC10166335.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9452805","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":"Great debates in trauma biomechanics.","authors":"Vaida Glatt,&nbsp;Robert O'Toole,&nbsp;Samir Mehta,&nbsp;William Ricci,&nbsp;Aaron Nauth,&nbsp;Emil Schemitsch,&nbsp;Michael W Hast","doi":"10.1097/OI9.0000000000000249","DOIUrl":"10.1097/OI9.0000000000000249","url":null,"abstract":"<p><p>At the 2021 annual meeting of the Orthopaedic Trauma Association, the Basic Science Focus Forum hosted its first ever debate-style symposium focused on biomechanics and fracture repair. The 3 subjects of debate were \"Mechanics versus Biology-Which is 'More Important' to Consider?\" \"Locked Plate versus Forward Dynamization versus Reverse Dynamization-Which Way Should I Go?\" and \"Sawbones versus Cadaver Models-What Should I Believe Most?\" These debates were held because fracture healing is a highly organized synergistic response between biological factors and the local mechanical environment. Multiple studies have demonstrated that both factors play roles in governing bone healing responses, and the causal relationships between the 2 remain unclear. The lack of clarity in this space has led to a spectrum of research with the common goal of helping surgeons make good decisions. Before reading further, the reader should understand that the questions posed in the debate titles are unanswerable and might represent a false choice. Instead, the reader should appreciate that the debates were held to gain a more thorough understanding of these topics based on the current state of the art of experimental and clinical studies, by using an engaging and thought-provoking format.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e249"},"PeriodicalIF":0.0,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/84/oi9-6-e249.PMC10166369.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9446073","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":"Posttraumatic osteoarthritis: from basic science to clinical implications.","authors":"Justin M Haller, Marjolein C H van der Meulen, Steven Olson, Donald Anderson, J Lawrence Marsh, Zachary Working","doi":"10.1097/OI9.0000000000000232","DOIUrl":"10.1097/OI9.0000000000000232","url":null,"abstract":"<p><p>Posttraumatic osteoarthritis (PTOA) is a subset of osteoarthritis that occurs after joint injury and is associated with degradation of articular cartilage and subchondral bone. As compared with primary osteoarthritis, PTOA occurs in a time window initiated by a traumatic event resulting in damage to layers of joint structure and alterations in joint shape. As techniques in open reduction and internal fixation continue to mature, our success in preventing posttraumatic osteoarthritis has not kept pace. Advances in research in the subchondral bone, inflammatory response, and joint mechanics continue to open our understanding of this posttraumatic process. In addition, there are possibilities emerging as biological agents to therapeutically alter the progression of PTOA.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e232"},"PeriodicalIF":0.0,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/f1/oi9-6-e232.PMC10166366.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9452806","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 healing-orthobiologics: from basic science to clinical application.","authors":"Joey P Johnson,&nbsp;Jaimo Ahn,&nbsp;Douglas R Dirschl,&nbsp;John J Wixted,&nbsp;Andrew R Evans","doi":"10.1097/OI9.0000000000000262","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000262","url":null,"abstract":"<p><p>Orthopaedics as a field and a profession is fundamentally concerned with the treatment of musculoskeletal disease, in all of its many forms. Our collective understanding of the cellular mechanisms underlying musculoskeletal pathology resulting from injury continues to evolve, opening novel opportunities to develop orthobiologic treatments to improve care. It is a long path to move from an understanding of cellular pathology to development of successful clinical treatment, and this article proposes to discuss some of the challenges to achieving translational therapies in orthopaedics. The article will focus on challenges that clinicians will likely face in seeking to bring promising treatments forward to clinical practice and strategies for improving success in translational efforts.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e262"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/4b/oi9-6-e262.PMC10166332.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9446068","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":"Comparing the volume of vascular intersection of two femoral neck fracture fixation implants using an <i>In silico</i> technique.","authors":"Matthew D Putnam,&nbsp;Andrew Rau,&nbsp;Michael Frohbergh,&nbsp;Kevin Ong,&nbsp;Michael Bushelow,&nbsp;Michael Blauth","doi":"10.1097/OI9.0000000000000256","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000256","url":null,"abstract":"<p><p>Femoral neck fracture displacement with subsequent vascular disruption is one of the factors that contribute to trauma-induced avascular necrosis of the femoral head. Iatrogenic damage of the intraosseous arterial system during fixation of femoral neck fracture is another possible cause of avascular necrosis that is less well understood. Recently, Zhao et al (2017) reconstructed 3D structures of intraosseous blood supply and identified the epiphyseal and inferior retinacular arterial system to be important structures for maintaining the femoral head blood supply after femoral neck fracture. The authors therefore recommended placing implants centrally to reduce iatrogenic vascular injuries. Our in vitro study compared the spatial footprint of a traditional dynamic hip screw with an antirotation screw versus a newly developed hip screw with an integrated antirotation screw on intraosseous vasculature.</p><p><strong>Methods: </strong>Three dimensional (3D) µCT angiograms of 9 cadaveric proximal femora were produced. Three segmented volumes-porous or cancellous bone, filled or cortical bone, and intraosseous vasculature-were converted to surface files. 3D in silico models of the fixation systems were sized and implanted in silico without visibility of the vascular maps. The volume of vasculature that overlapped with the devices was determined. The ratio of the vascular intersection to the comparator device was calculated, and the mean ratio was determined. A paired design, noninferiority test was used to compare the devices.</p><p><strong>Results: </strong>Results indicate both significant (<i>P</i> < 0.001) superiority and noninferiority of the hip screw with an integrated antirotation screw when compared with a dynamic hip screw and antirotation screw for the volume of vasculature that overlapped with each device in the femoral neck.</p><p><strong>Conclusions: </strong>Combining established methods of vascular visualization with newer methods enables an implant's impact on vascular intersection to be assessed in silico. This methodology suggests that when used for femoral neck fracture management, the new device intersects fewer blood vessels than the comparator. Comparative clinical studies are needed to investigate whether these findings correlate with the incidence of avascular necrosis and clinical outcomes.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e256"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/50/oi9-6-e256.PMC10166339.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9452807","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":"Simple design and analysis strategies for solving problems in observational orthopaedic clinical research.","authors":"Kelsey E Brown,&nbsp;Michael J Flores,&nbsp;Gerard Slobogean,&nbsp;David Shearer,&nbsp;Ida Leah Gitajn,&nbsp;Saam Morshed","doi":"10.1097/OI9.0000000000000239","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000239","url":null,"abstract":"<p><p>Randomized controlled trials are the gold standard to establishing causal relationships in clinical research. However, these studies are expensive and time consuming to conduct. This article aims to provide orthopaedic surgeons and clinical researchers with methodology to optimize inference and minimize bias in observational studies that are often much more feasible to undertake. To mitigate the risk of bias arising from their nonexperimental design, researchers must first understand the ways in which measured covariates can influence treatment, outcomes, and missingness of follow-up data. With knowledge of these relationships, researchers can then build causal diagrams to best understand how to control sources of bias. Some common techniques for controlling for bias include matching, regression, stratification, and propensity score analysis. Selection bias may result from loss to follow-up and missing data. Strategies such as multiple imputation and time-to-event analysis can be useful for handling missingness. For longitudinal data, repeated measures allow observational studies to best summarize the impact of the intervention over time. Clinical researchers familiar with fundamental concepts of causal inference and techniques reviewed in this article will have the power to improve the quality of inferences made from clinical research in orthopaedic trauma surgery.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2 Suppl","pages":"e239"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/86/a0/oi9-6-e239.PMC10166364.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9446067","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}