Fracture nonunions

OTA International The Open Access Journal of Orthopaedic Trauma · 2025-10-01

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.

Oral vs Intravenous Antibiotics for Fracture-Related Infections

JAMA Surgery · 2025-01-22 · 18 citations

Importance: Fracture-related infection (FRI) is a serious complication following fracture fixation surgery. Current treatment of FRIs entails debridement and 6 weeks of intravenous (IV) antibiotics. Lab data and retrospective clinical studies support use of oral antibiotics, which are less expensive and may have fewer complications than IV antibiotics. Objective: To evaluate the effectiveness of treatment of FRI with oral vs IV antibiotics. Design, Setting, and Participants: The POvIV multicenter, prospective randomized clinical trial was conducted across 24 trauma centers in the US among patients aged 18 to 84 years who had fracture repair or arthrodesis with fixation with implants and developed an FRI without radiographic evidence of osteomyelitis. Patients were enrolled between March 2013 and September 2018 and followed up for 12 months after hospitalization for treatment of their FRI. Intervention: Oral vs IV antibiotics following FRI. Main Outcomes and Measures: The primary outcome was number of surgical interventions, and the primary hypothesis was noninferiority of oral vs IV antibiotics with respect to the number of study injury-related surgical interventions by 1 year. Unadjusted modified intent-to-treat (mITT) and adjusted per-protocol (PP) analyses were prespecified. A post hoc adjusted mITT analysis was conducted to resolve discrepancies between the results of the prespecified mITT and PP analyses. Recurrence of a deep surgical site infection was a key secondary outcome. Results: Among 233 total patients, mean (SD) age was 46.0 (13.9) years, and 53 patients were female (22.7%). The mean number of surgical interventions within 1 year was 1.3 and 1.1 for the oral and IV groups, respectively. The upper bound of the 95% confidence interval of the mean difference with unadjusted mITT analysis was 0.59, which was lower than the prespecified noninferiority margin of 0.67, indicating noninferiority of oral to IV antibiotics. Adjusted PP analysis did not support noninferiority of the number of reoperations. A post hoc adjusted mITT analysis also showed noninferiority. The treatment effects estimates for the key secondary outcome of reinfection showed a similar pattern as those for the primary outcome. Conclusions and Relevance: In this prospective randomized clinical trial, oral antibiotic treatment was noninferior to IV treatment with respect to the primary outcome of number of surgical interventions based on mITT analysis. However, there is some uncertainty in these findings based on preplanned and post hoc secondary analyses. A similar pattern of treatment effect estimates was observed for the secondary outcome of recurrence of infection. Trial Registration: ClinicalTrials.gov Identifier: NCT01714596.

CS3 Experiment 7 Abalone growth in a Land Based IMTA system on commercial feeds incorporating biosecure IMTA grown algae

Zenodo (CERN European Organization for Nuclear Research) · 2023-10-21

CS3 Experiment 7 Abalone growth in a Land Based IMTA system on commercial feeds incorporating biosecure IMTA grown algae

CS3 Experiment 8 IMTA grow product analysis

Zenodo (CERN European Organization for Nuclear Research) · 2023-10-21

CS3 Experiment 8 IMTA grow product analysis - proximate analysis of Ulva and abalone grown in land based IMTA.

Introducing the Patient-Reported Outcome Measures Workgroup and How It Is Helping Patients and Physicians Harness the Benefits

Journal of the American Academy of Orthopaedic Surgeons · 2023-08-11 · 1 citations

Shapiro, Lauren M. MD, MS; Koh, Jason MD, MBA; Jones, Clifford MD; Seiden, Richard F. JD; Spindler, Kurt MD Author Information

Anterior Hook Plating of Patella Fractures: A Biomechanical Analysis and Clinical Series

Journal of Orthopaedic Trauma · 2023-02-02 · 8 citations

OBJECTIVES: To compare anterior hook plating with established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique. DESIGN: Laboratory-based biomechanical study and clinical multicenter retrospective cohort study. SETTING: 2 US Level 1 trauma centers. PATIENTS/PARTICIPANTS: 51 patients (28 M and 23 F) with 30 simple transverse and 21 comminuted patella fractures. Thirty-six cadaveric patellae were used for the biomechanical study. INTERVENTION: Biomechanical-dorsal plating was compared with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested at 0° and 45 degrees of flexion. Clinical-we reviewed a consecutive series of patella fractures in 2 centers for outcome and complications. MAIN OUTCOME MEASUREMENTS: Biomechanical-construct stiffness. Clinical-reduction, union, complications, and range of motion. RESULTS: Stiffness was greatest in dorsal plating at both 0° and 45 degrees. Dorsal plating (976 N, 1643 N) > modified tension band (317 N, 297 N) > cerclage (89.8 N, 150.3 N) at 0 and 45 degrees, respectively. 51 patients with patella fractures had them fixed with dorsal 2.7-mm mini fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 cases were small distal fragments not easily managed with screws and cables. All patients were followed up to union. There were 2 infections (1 superficial and 1 deep with nonunion), and 5 had implant removal (9.8%). CONCLUSIONS: Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Locked Plating versus Nailing for Proximal Tibia Fractures: A Multicenter RCT

Journal of Orthopaedic Trauma · 2023-02-02 · 15 citations

OBJECTIVES: The main 2 forms of treatment for extraarticular proximal tibial fractures are intramedullary nailing (IMN) and locked lateral plating (LLP). The goal of this multicenter, randomized controlled trial was to determine whether there are significant differences in outcomes between these forms of treatment. DESIGN: Multicenter, randomized controlled trial. SETTING: 16 academic trauma centers. PATIENTS/PARTICIPANTS: 108 patients were enrolled. 99 patients were followed for 12 months. 52 patients were randomized to IMN, and 47 patients were randomized to LLP. INTERVENTION: IMN or lateral locked plating. MAIN OUTCOME MEASUREMENTS: Functional scoring including Short Musculoskeletal Functional Assessment, Bother Index, EQ-5Dindex and EQ-5DVAS. Secondary measures included alignment, operative time, range of motion, union rate, pain, walking ability, ability to manage stairs, need for ambulatory aid and number, and complications. RESULTS: Functional testing demonstrated no difference between the groups, but both groups were still significantly affected 12 months postinjury. Similarly, there was no difference in time of surgery, alignment, nonunion, pain, walking ability, ability to manage stairs, need for ambulatory support, or complications. CONCLUSIONS: Both IMN and LLP provide for similar outcomes after these fractures. Patients continue to improve over the course of the year after injury but remain impaired even 1 year later. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

CS3 WP6 Environmental performance of land based IMTA at WiCoAb

Zenodo (CERN European Organization for Nuclear Research) · 2023-10-21

Carbon, nitrogen and phosphorus levels in ulva and water quality of land based monoculture and IMTA production on a commercial-scale farm.

CS3 Experiment 7 Abalone growth in a Land Based IMTA system on commercial feeds incorporating biosecure IMTA grown algae

Zenodo (CERN European Organization for Nuclear Research) · 2023-10-21

CS3 Experiment 7 Abalone growth in a Land Based IMTA system on commercial feeds incorporating biosecure IMTA grown algae

CS3 WP6 Environmental performance of land based IMTA at WiCoAb

Zenodo (CERN European Organization for Nuclear Research) · 2023-10-21

Carbon, nitrogen and phosphorus levels in ulva and water quality of land based monoculture and IMTA production on a commercial-scale farm.