Abstract. The 2025 Orthopaedic Trauma Association's Basic Science Focus Forum featured a symposium on regenerative biomaterials and translational strategies for orthopaedic trauma. Four experts presented complementary perspectives on the next generation of bone and soft tissue repair: Dr. J. Tracy Watson described how orthobiologics and refined spacer design can be used to engineer a better Masquelet induced membrane; Dr. Lauren Priddy presented evidence that hydroxyapatite coatings can mitigate the rapid degradation of additively manufactured magnesium scaffolds; Dr. Vaida Glatt described the development and clinical translation of the Biomimetic Hematoma scaffold for bone and muscle regeneration; and Dr. Katherine Hixon outlined how the 3R principles (Replacement, Reduction, Refinement) can serve as a framework to accelerate musculoskeletal regenerative engineering. Collectively, the symposium underscored a shift toward biologically informed, clinically predictive, and ethically responsible engineering solutions for the patients who sustain musculoskeletal trauma.
Abstract. Polytrauma patients are a challenging cohort to treat because their multiple, potentially life-threatening injuries act synergistically with surgeries to affect cellular pathways necessary for survival. Current treatment algorithms and blood tests often fail to predict which patients will tolerate early fracture fixation and which patients will continue to deteriorate because of their injuries. Traditional laboratory tests in polytrauma patients have not been able to capture the nuances of cellular energy depletion, and lipidomics are now emerging as potential biomarkers to better categorize disease severity. Definitive treatment of fractures in polytrauma patients within 36 hours is recommended, but there is little consensus on the parameters necessitating “damage control” strategies. The IMPACT group recommends fixation within 24 hours and a dynamic treatment strategy rather than strict guideline adherence. In particular, patients with moderate to severe traumatic brain injury require cautious, individualized decision-making given their neurologic risks. The purpose of this review is to describe emerging diagnostic tools and treatment algorithms that are shifting the management of polytrauma patients from rigid protocols towards dynamic, individualized assessments.
Abstract. Artificial Intelligence (AI) is an ascendant technical field with potential to revolutionize health care and orthopaedics. This paper highlights ways in which AI is already affecting members of the Orthopaedic Trauma Association (OTA), while identifying paths to clinical application, as presented at the 2025 OTA Annual Meeting's Basic Science Focus Forum. A report from the OTA AI Task Force shared some initial accomplishments, including the crafting of a position statement. Areas of AI application in orthopaedic trauma were discussed, including the prediction of fall risk in the elderly, capabilities for automated image-based diagnosis and outcome assessment, and efforts toward creating a framework for in silico clinical trials that rely upon virtual patient cohorts. Together these applications show how AI is emerging as a foundational tool in orthopaedic trauma research. Over the next few years, these products will be moving from the research laboratory to the clinic. For the tools to be of greatest benefit, a measured development approach using teams of data scientists partnered with orthopaedic trauma surgeons must be adopted. Academia and Industry are both progressing in this direction—the best path forward will likely involve shared development efforts. As these efforts progress, OTA members will undoubtedly be involved. Both they and their patients stand to be the primary beneficiaries of many of these developments.
Abstract. Fracture-related infections (FRIs) remain a significant challenge in orthopaedic trauma, as they are a consistent source of poor patient outcomes and elevated health care costs. FRIs have traditionally been diagnosed using findings from physical examination, blood tests, and advanced imaging, and the mainstay of treatment has been bony debridement, removal of hardware, and local and systemic antibiotic therapy. Although patients with FRIs were historically treated with IV antibiotics, randomized clinical trials have since demonstrated that oral antibiotics can be just as effective while mitigating the risks associated with prolonged IV antibiotics. Emerging biomarkers for infection, including molecular methods such as transcriptomics, proteomics, metabolomics, and next-generation sequencing, offer the ability to more precisely identify infection from a wider range of microbes. Fluorescence-guided debridement surgery presents a strategy to better visualize infected tissue and decrease surgeon reliance on subjective intraoperative findings. The purpose of this review is to present emerging tools and treatment algorithms that might be able to increase the accuracy and precision with which FRIs are diagnosed and managed.
Abstract Objectives: Open tibial shaft fractures are a major source of morbidity in low- and middle-income countries, yet outcome data after Surgical Implant Generation Network (SIGN) intramedullary nailing (IMN) remain few. The study aimed to determine the radiographic union rate and identify predictors of nonunion after primary SIGN IMN for Gustilo–Anderson (GA) grade I through IIIA open tibial shaft fractures at a large trauma center in Addis Ababa, Ethiopia. Methods: A retrospective cross-sectional study was conducted at AaBET Hospital, reviewing records and radiographs of patients treated between July 2016 and July 2022. Radiographic union was assessed at minimum 1 year using the Radiographic Union Scale for Tibial Fractures (RUST). Associations between clinical variables and union were analyzed with Fisher exact test, Mann–Whitney U test, and binary logistic regression. Results: Eighty-seven patients met inclusion criteria (mean age 32.9 years; 86.2% male). Road traffic accidents accounted for 78.2% of injuries. The radiographic union rate was 89.7% (78 of 87). On multivariable analysis, GA grade IIIA (odds ratio [OR]: 36.2; 95% confidence interval [CI]: 4.21–90; P = 0.013), postoperative infection (OR: 20.2; 95% CI: 2.15–189; P = 0.023), and surgical delay beyond 48 hours (OR: 16.5; 95% CI: 1.88–144; P = 0.009) were independently associated with nonunion. Conclusions: Primary SIGN IMN yielded a high union rate for GA I to IIIA open tibial shaft fractures in this low- and middle-income countries setting. GA grade, postoperative infection, and delay to surgery were the principal barriers to union. These findings support early surgical intervention and rigorous infection control in resource-limited settings. Level of Evidence: Prognostic Level IV.
