Publications by authors named "Kevin Tetsworth"

Article Synopsis
  • Lower-extremity amputations are commonly caused by complications from diabetes mellitus and peripheral vascular disease, with traditional socket prostheses being the standard, while transcutaneous osseointegration for amputees (TOFA) is emerging as a potential alternative, particularly needing research for diabetic patients.* -
  • A study reviewed 17 patients with well-controlled diabetes who underwent unilateral transfemoral TOFA, tracking perioperative complications, additional surgeries, mobility, and quality of life over two years, finding no major systemic complications or deaths.* -
  • Results indicated that some patients experienced minor complications, but the majority showed significant improvements, such as an increase in daily prosthesis wear time from 36% to 79% of patients wearing it
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Background: Non-tuberculous mycobacteria (NTM) are rare causes of bone and joint infection (BJI) and there is limited evidence on which to base management decisions. This study describes 1 year of experience from a multi-disciplinary BJI team which collects data on all cases reviewed at a tertiary referral centre in Queensland, Australia.

Methods: The database was interrogated for all cases in which NTM were recovered from operative samples.

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Article Synopsis
  • Rotational malalignment after lower extremity fracture treatment can lead to increased pain and functional issues, but there are no standard guidelines for how to manage it.
  • A scoping review was conducted to gather and synthesize existing evidence on diagnosing and treating these rotational deformities, analyzing 50 relevant studies out of an initial pool of 3929 records.
  • Most studies focused on the femur and tibia, primarily used CT scans for diagnosis, and commonly employed internal fixation for treatment, showing that revision surgeries generally yielded positive outcomes with low complication rates.
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Background: Some amputees with transfemoral osseointegration (TFOI) have ipsilateral hip arthritis which can be addressed with total hip arthroplasty (THA). This study reported the medium-term outcomes of THA in association with TFOI (THA + TFOI).

Methods: Retrospective review was performed for eight patients with THA + TFOI performed at least 2 years prior.

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Article Synopsis
  • Upper limb (UL) amputation is a significant disability affecting daily life, with many patients dissatisfied with existing prosthetic options due to issues like lack of sensation and comfort.
  • Transcutaneous osseointegration (PFOI) offers a promising solution by surgically implanting a device that allows direct bone anchoring, improving prosthetic control and wear time without the bulk of a traditional socket.
  • The article outlines a surgical method for PFOI after forearm amputation, emphasizing careful technique to protect nerves and vessels, and highlights the importance of a motivated patient and engaged prosthetist for successful rehabilitation.
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Importance: Most patients use a traditional socket prosthesis (TSP) to ambulate independently following transtibial amputation. However, these patients generally require prosthesis repairs more than twice annually and an entirely new prosthesis every two years. Furthermore, transtibial amputation patients have four times the skin ulceration rate of transfemoral patients, prompting more frequent prosthesis refitting and diminished use.

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Article Synopsis
  • Transcutaneous osseointegration following amputation (TOFA) improves mobility and quality of life compared to traditional socket prosthetics, but peri-TOFA infections are a common complication with no established diagnostic method.
  • A study analyzed data from 83 surgeries to identify preoperative factors linked to positive cultures indicating infection, assessing patient history, physician findings, and lab results.
  • Key predictors for infection included limb pain, erythrocyte sedimentation rate (ESR), preoperative swab results, and signs of local inflammation, achieving an 85% positive predictive value, emphasizing the importance of clinical examination in diagnosis.
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3D printing and modeling has continued to grow in popularity over the past decade because the technology has matured and become more affordable and widely available. The main indications for nonbiological reconstruction of large bone defects are principally those patients where the candidate is unlikely to be successful if reconstructed by other means. Bespoke, custom, patient-specific implants can be designed to very effectively address bone loss, incorporating design elements that are particular to the needs of any given unique clinical condition.

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Transcutaneous osseointegration for amputees (TOFA) is an evolving technology that has the potential to revolutionize the interface between the amputee and their prosthesis, showing potential at many levels of amputation. While no amputation is without its challenges, TOFA requires a highly specialized prosthesis and a multidisciplinary team that includes specialized surgeons, physical therapists, wound care teams, and social workers who guide the amputee through surgery, postoperative rehabilitation, and the chronic wound care that goes into maintaining the prosthesis. The infrastructure required to facilitate care pathways that lead to reliable, successful outcomes are unique in each health care setting, including those in advanced health care systems such as the United States and Australia.

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Objectives: To assess if a suprapatellar (SP) approach, when compared with an infrapatellar (IP) approach, yielded less patient-reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months postoperatively, when treating tibial fractures with intramedullary nailing.

Design: Prospective, parallel-group randomized control trial.

Setting: Tertiary level 1 trauma care center, Brisbane, Australia.

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Article Synopsis
  • The systematic review examined outcomes of two salvage options for failed total knee replacements: transfemoral amputation (TFA) and knee arthrodesis (KA), focusing on factors like ambulatory status, infections, and quality of life.
  • A total of 44 studies were analyzed, revealing that TFA patients had lower ambulatory capacity and higher infection rates compared to KA patients, but similar rates of needing revision surgery.
  • The lack of randomized controlled trials highlights possible selection bias in the data, suggesting that KA patients generally have better outcomes in terms of mobility compared to those undergoing TFA.
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Aims: The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI).

Methods: This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information.

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Almost all prior mouse fracture healing models have used needles or K-wires for fixation, unwittingly providing inadequate mechanical stability during the healing process. Our contention is that the reported outcomes have predominantly reflected this instability, rather than the impact of diverse biological conditions, pharmacologic interventions, exogenous growth factors, or genetic considerations. This important issue becomes obvious upon a critical review of the literature.

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Objectives: Distal femur fractures can exhibit extensive comminution, and open fractures may result in bone loss. These injuries are under high mechanical demands when stabilized with a lateral locked plate (LLP), and are at risk of non-union or implant failure. This study investigates the optimal LLP screw configuration for distal femur fractures with a large metadiaphyseal gap of 5 cm.

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Objective: Mechanical alignment of the lower limbs has been suggested to cause abnormal uneven loading across the compartments at the knee, but its contribution to the initiation and progression of arthritis remains controversial. This study aimed to establish whether malalignment of the lower limb after trauma is associated with worsened arthritis scores in the theoretically overloaded compartment, and if arthritis scores continuously correlate with the degree of malalignment and time with deformity.

Design: After screening 1160 X-rays, 60 patients were identified with long-leg radiographs > 2 years after fracture.

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The management of bone defects and nonunions creates unique clinical challenges. Current treatment alternatives are often insufficient and frequently require multiple surgeries. One promising option is bone morphogenetic protein-2 (BMP-2), which is the most potent inducer of osteogenesis.

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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.

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Background: The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis.

Methods: A systematic review of MEDLINE, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the visual analog scale (VAS).

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Context: Rehabilitation following lower extremity amputation presents multiple challenges, many related to the traditional prosthesis (TP) socket. Without skeletal loading, bone density also rapidly decreases. Transcutaneous osseointegration for amputees (TOFA) surgically implants a metal prosthesis attachment directly into the residual bone, facilitating direct skeletal loading.

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Prosthetic Joint Infection (PJI) causes significant morbidity and mortality for patients globally. Delivery of antibiotics to the site of infection has potential to improve the treatment outcomes and enhance biofilm eradication. These antibiotics can be delivered using an intra-articular catheter or combined with a carrier substance to enhance pharmacokinetic properties.

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