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

{"title":"How to get the most out of your gastrocnemius and soleus flaps.","authors":"Paul E Matuszewski,&nbsp;Gary L Ulrich","doi":"10.1097/OI9.0000000000000255","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000255","url":null,"abstract":"<p><p>Gastrocnemius and soleus flaps represent the workhorse local flaps to cover soft tissue defects of the proximal 1/3 and middle 1/3 of the leg, respectively. An important consideration before conducting a local flap is whether the flap can provide adequate coverage. The utility of the gastrocnemius flap can be increased using multiple techniques to increase the arc of rotation including the posterior midline approach, dissection at the pes anserinus and medial femoral condyle origin, scoring the fascia, and inclusion of a skin paddle. Concerning the soleus flap, the hemisoleus flap represents a technique to increase the arc of rotation. With a soleus flap, one must consider the soft tissue defect location, size, and perforator blood supply because these factors influence what soleus flap technique to use. This article discusses how to make the most out of gastrocnemius flaps and soleus flaps regarding maximizing coverage and ensuring successful flap outcome.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e255"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2e/dd/oi9-6-e255.PMC10337844.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877683","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":"Acute shortening and angulation for complex open fractures: an updated perspective.","authors":"Sarah N Pierrie,&nbsp;Michael J Beltran","doi":"10.1097/OI9.0000000000000245","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000245","url":null,"abstract":"<p><p>Reestablishing an intact, healthy soft tissue envelope is a critical step in managing lower extremity injuries, particularly high-grade open tibia fractures. Acute shortening and angulation can be used independently or together to address complex soft tissue injuries, particularly when bone loss is present. These techniques facilitate management of difficult wounds and can be combined with local soft tissue rearrangement or pedicled flaps as needed, avoiding the need for free tissue transfer. After angular deformity correction, adjacent bone loss can be addressed with bone grafting or distraction histogenesis. This article discusses the indications for, surgical technique for, and limitations of acute shortening and angulation for management of open lower extremity fractures.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e245"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e1/fc/oi9-6-e245.PMC10337845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9877688","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":"Simplified soft tissue coverage of the distal lower extremity: The reverse sural flap.","authors":"George A Puneky,&nbsp;Kathryn A Batchler,&nbsp;Sai S Kollapaneni,&nbsp;James A Blair,&nbsp;Jana M Davis","doi":"10.1097/OI9.0000000000000235","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000235","url":null,"abstract":"<p><p>Soft tissue defects involving the distal lower extremity present challenging problems for orthopaedic surgeons to manage. Historically, wounds not amenable to primary closure have necessitated assistance from multidisciplinary teams using plastic surgeons to obtain adequate soft tissue coverage through rotational flap or free tissue transfer procedures. Techniques related to soft tissue rearrangement and local rotational flap coverage have advanced over the years with a growing knowledge of local anatomy and vasculature. The reverse sural flap may be performed to cover soft tissue defects within 10 cm of the foot or ankle region, negating the need for microvascular intervention. The simplistic nature of the reverse sural flap is appealing to orthopaedic surgeons as a means to provide timely patient care without additional support because it does not require microvasculature work or the need for intraoperative microscopes and has been popularized among orthopaedic trauma surgeons as a necessary tool to possess. Here, we discuss the reverse sural flap to include history, relevant anatomy, clinical indications, and a description of the technique for application.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e235"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/46/oi9-6-e235.PMC10337849.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10199015","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 use of xenogenic dermal matrices in the context of open extremity wounds: where and when to consider?","authors":"Nainisha Chintalapudi,&nbsp;Olivia M Rice,&nbsp;Joseph R Hsu","doi":"10.1097/OI9.0000000000000237","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000237","url":null,"abstract":"<p><p>Optimal treatment of orthopaedic extremity trauma includes meticulous care of both bony and soft tissue injuries. Historically, clinical scenarios involving soft tissue defects necessitated the assistance of a plastic surgeon. While their expertise in coverage options and microvascular repair is invaluable, barriers preventing collaboration are common. Acellular dermal matrices represent a promising and versatile tool for orthopaedic trauma surgeons to keep in their toolbox. These biological scaffolds are each unique in how they are used and promote healing. This review explores some commercial products and offers guidance for selection in different clinical scenarios involving traumatic wounds.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 4 Suppl","pages":"e237"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/c9/oi9-6-e237.PMC10337846.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823251","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":"Duodenal injury: A challenging diagnostic enigma for clinicians","authors":"Ravindranath Thyyar M","doi":"10.17352/ojt.000040","DOIUrl":"https://doi.org/10.17352/ojt.000040","url":null,"abstract":"The objective of the article is to familiarize clinicians with duodenal injury and to recognize timely intervention to prevent morbidity and mortality associated with such injury. Although uncommon, duodenal injury challenges a clinician’s ability to diagnose and treat it in a timely fashion to prevent any associated mortality. The retroperitoneal anatomy makes duodenal injury difficult to diagnose. However, a high degree of suspicion based on the mechanism of injury and appropriate, timely diagnostic study leads to the correct identification of injury to the duodenum. The specific treatment depends on the type of injury that is detected. In conclusion, early recognition, and timely intervention of duodenal injury leads to a successful outcome.","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89786030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilon fractures: Consensus and controversy.","authors":"Michael Flores, Matthew Ciminero, Stephen A Kottmeier, Daniel Botros, Boris A Zelle, David W Shearer","doi":"10.1097/OI9.0000000000000236","DOIUrl":"10.1097/OI9.0000000000000236","url":null,"abstract":"<p><p>Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction. A subset of cases may be amenable to early definitive or provisional open reduction and internal fixation based on fracture pattern. In some cases of severe articular comminution where reconstruction is not possible, primary ankle arthrodesis may be a good alternative.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e236"},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/da/oi9-6-e236.PMC10392439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10289975","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":"Adjunct neutralization plating in patella fracture fixation: a technical trick-Erratum.","authors":"","doi":"10.1097/OI9.0000000000000265","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000265","url":null,"abstract":"","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e265"},"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/a4/4f/otai-6-e265.PMC10005821.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9538085","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":"International trauma care forum supplement of the Orthopaedic Trauma Association 2022","authors":"H. Pape","doi":"10.1097/oi9.0000000000000254","DOIUrl":"https://doi.org/10.1097/oi9.0000000000000254","url":null,"abstract":"","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47176567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in implementation of evidence-based hip fracture management in a major Canadian city.","authors":"Martina Vergouwen,&nbsp;Michael G James,&nbsp;Daniel Z You,&nbsp;Neil J White","doi":"10.1097/OI9.0000000000000274","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000274","url":null,"abstract":"<p><strong>Aims: </strong>The importance of hip fracture care has resulted in an abundance of hip fracture management literature. The degree this evidence is incorporated into clinical practice is unknown. We examined 5 trends in hip fracture management: arthroplasty versus fixation, total hip arthroplasty (THA) versus hemiarthroplasty (HA), cemented versus uncemented femoral stem fixation, short versus long cephalomedullary nail (CMN) fixation, and time from admission to surgery. Our primary aim was to understand and assess hip fracture management trends in relation to pertinent literature.</p><p><strong>Methods: </strong>Data were collected from acute hip fractures in patients aged 50 years or older who presented from 2008 to 2018. <i>ICD-10</i> diagnostic codes were assigned using preoperative radiographs. Surgical management was confirmed using intraoperative and postoperative radiographs and split into 6 categories: (1) short CMN, (2) long CMN, (3) cannulated screws, (4) dynamic hip screw, (5) HA, and (6) THA. Appropriate statistical tests were used to analyze trends.</p><p><strong>Results: </strong>In 4 assessed trends, hip fracture management aligned with high-level evidence. This was the case for a trend toward arthroplasty for displaced femoral neck fractures, increased use of THA relative to HA, increased use of short relative to long CMNs, and consistent decrease in surgical wait times. Despite the literature highlighting the disadvantages of uncemented femoral stems, our data demonstrated increased use of uncemented femoral stems.</p><p><strong>Conclusion: </strong>Evidence to guide orthopaedic practice is constantly emerging but may not be effectively used by clinicians. Our findings demonstrate the successes and failures of integrating evidence into hip fracture management and highlight that orthopaedic surgeons have an ongoing responsibility to strive for evidence-based practice.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 2","pages":"e274"},"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/95/6c/oi9-6-e274.PMC10503671.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10311085","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":"Humerus fractures: selecting fixation for a successful outcome.","authors":"Utku Kandemir,&nbsp;Emily H Naclerio,&nbsp;Michael D McKee,&nbsp;David J Weatherby,&nbsp;Peter A Cole,&nbsp;Kevin Tetsworth","doi":"10.1097/OI9.0000000000000259","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000259","url":null,"abstract":"<p><p>Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"6 3 Suppl","pages":"e259"},"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/2b/12/oi9-6-e259.PMC10392438.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9987104","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}