Alexander Joeris

AO Foundation · AO Innovation Translation Center

Aims To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery. Methods We undertook a systematic review of qualitative studies. Five databases were searched from inception to 1 February 2022. All titles and abstracts were screened, and a subset were independen...

Unlabelled: This study aimed to determine the efficiency and accuracy of computerized adaptive testing (CAT) models of the Oswestry Disability Index (ODI) and Neck Disability Index (NDI). Methods: The study involved simulation using retrospectively collected real-world data. Previously developed CAT models of the ODI and NDI were applied to the...

Aims To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of distal tibia and/or ankle fractures. Methods Five electronic databases and three clinical trial registries were searched (January 2000 to February 2022). Trials including patients with distal tibia and/or ankle fractures without conc...

Background: A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determin...

Background Proximal humerus fractures (PHF) should be subject to standardized monitoring during treatment, whether non-operative or operative, to document and adequately assess bone healing. The purpose of this study was to develop a standardized protocol for an image-based monitoring of PHF for joint-preserving treatment options, including a minim...

Introduction Identifying objective performance metrics for surgical training in orthopedic surgery is imperative for effective training and patient safety. The objective of this study was to determine if an internationally agreed, metric-based objective assessment of video recordings of an unstable pertrochanteric 31A2 intramedullary nailing proced...

Objective: To report veterinarians' familiarity with and perceptions of owner/observer-reported outcome measures (OROMs) and their applications in routine clinical practice. Study design: Cross-sectional online survey. Animals or sample population: A total of 441 veterinarians with a caseload of companion animal orthopedic patients. Methods:...

Objectives The management of pilon fractures is a challenge and the outcome depends on multiple factors, one of which is the quality of reduction. In the literature, there is no assessment of anatomical reduction in pilon fractures. We also lack standard radiological parameters in large patient groups to measure the reduction. The main aim of this...

Objective To systematically review the currently available validated owner-reported outcome measures (OROMs) for assessing pain and function in dogs with osteoarthritis and other joint diseases. Study design Systematic review. Methods A systematic literature search of PubMed and Web of Science was performed in December, 2019, using search terms r...

Patient-reported outcomes (PROs) capture data related to a patients' perception of their health status and aspects of health care delivery. In parallel, digital innovations have advanced the administration, storage, processing, and accessibility of PROs, allowing these data to become actively incorporated in day-to-day clinical practice along the e...

Background Proximal humerus fracture (PHF) complications, whether following surgery or nonoperative management, require standardization of definitions and documentation for consistent reporting. We aimed to define an international consensus core event set (CES) of clinically-relevant unfavorable events of PHF to be documented in clinical routine pr...

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the...

Purpose The current understanding of the factors associated with a second surgery or loss of alignment after operative treatment of a proximal humerus fracture has relied on small sample studies with stepwise regression analysis. In this study, we used a powerful regression analysis over a large sample and with many variables to test the null hypot...

Background Ankle fracture is a common injury with a strong evidence base focused on effectiveness of treatments. However, there are no reporting guidelines on distal tibia and ankle fractures. This has led to heterogeneity in outcome reporting and consequently, restricted the contribution of evidence syntheses. Over the past decade, core outcome se...

Objective The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes. Design Cohort study recruiting patients be...

Validated performance metrics are the fundamental building block of a successful and effective proficiency-based progression training program. We recently demonstrated face and content validity of the metrics for internal fixation of an OTA/AO 31-A2 pertrochanteric fracture with a short cephalomedullary nail. We then conducted an international mult...

Background Tibial shaft fractures (TSFs) are among the most common long bone injuries often resulting from high-energy trauma. To date, musculoskeletal complications such as fracture-related infection (FRI) and compromised fracture healing following fracture fixation of these injuries are still prevalent. The relatively high complication rates prov...

Introduction: Hip arthroplasty (HA) is commonly performed to treat various hip pathologies. Its volume is expected to rise further due to the increasing age of the population. Complication rates are low; however, periprosthetic femoral fractures (PFF) are a rare, albeit serious, complication with substantial economic impact. While current guidelin...

Background: The most frequently used surgical procedures for treating a proximal humeral fracture (PHF) are plate osteosynthesis, nail osteosynthesis and arthroplasty. Evidence-based recommendations for an appropriate surgical procedure after PHF requires transparent and valid safety data. We performed a systematic review to examine reported terms...

Aim: To estimate the health economic impact of osteosynthesis (OS) in fracture care over six decades in 17 high-income countries. Patients & methods: Applying a decision tree model, we assumed a hypothetical absence of OS and compared OS (intervention) with conservative treatment (CONS; comparator). We included patients with femur, tibia and radius...

A recent systematic search of orthopedic surgery literature suggests that scientific risk reporting often deviates from best practices in specific ways (Petrova, Joeris, Sanchez, Salamanca-Fernandez, & Garcia-Retamero, 2018). These deviations could cause dangerous biases in health professionals' risk interpretations and risk communication practices...

Objectives: Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business. Design/methods: Impact evaluations were...

Background: Critical-size bone defects are defined as bone defects where spontaneous regeneration is not expected without treatment1. The characteristics of bone defects (etiology, location, size, presence of infection, and soft-tissue conditions) vary greatly and, to be effective, the treatment method should address this variability. The induced-...

Background A majority of proximal humeral fractures can be managed without surgery. Recent randomized clinical trials and meta-analyses even question the benefit of surgical treatment for displaced 3-, and 4-part fractures. However, evidence-based treatment recommendations, balancing benefits and harms, presuppose a common reporting of complication...

Introduction: In the open-book, rotationally unstable (OTA/AO type 61-B1.1) pelvic ring injury, the posterior sacroiliac complex is believed to remain intact. Therefore, anterior ring stabilization alone has been the standard treatment recommendation. However, treatment failures using this method have caused a reconsideration of this management st...

Purpose The numerical format in which risks are communicated can affect risk comprehension and perceptions of medical professionals. We investigated what numerical formats are used to report absolute risks in empirical articles, estimated the frequency of biasing formats and rated the quality of figures used to display the risks. Design Descriptiv...

Background: The foundations of an effective and evidence-based training program are the metrics, which characterize optimal performance. Purposes: To develop, operationally define, and seek consensus from procedure experts on the metrics that best characterize a reference approach to the performance of a closed reduction and internal fixation of...

Objective To gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful implementation of PROMs. Design Online survey. Participants Surgeons who are members of the A...

Objective: Although orthopaedic surgeons frequently utilize intraoperative imaging, there is a lack of knowledge about their patterns of radiation protection. The goal of this study was thus to fill this gap by evaluating the use of protection against radiation in relation to concerns, safety guidelines and instructions. Methods: A survey addressin...

BACKGROUND Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support t...

Background Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support t...

Introduction: Formal training for surgeons regarding intraoperative imaging is lacking. This project investigated the effect of an educational intervention focusing on obtaining and assessing a standardized lateral view of the proximal femur during intramedullary nailing of a pertrochanteric fracture. Materials and methods: Anatomical landmarks...

Implants used to correct pathological varus-valgus deformities (VVD) and leg length discrepancies (LLD) may not be optimized for the specific treatment, as suggested by their off-label use. Detailed analysis of this issue has been limited by the poorly understood mechanical behavior of the growing physis and ignorance of the loads acting on the imp...

Introduction We report a case of an infected bone defect in the tibia in which the treatment was stopped in the first stage of the induced membrane technique. The polymethylmethacrylate (PMMA) spacer, retained in the bone defect, was encapsulated by the bone regeneration. Case report A 37-year-old male patient with a 7-cm infected bone defect in t...

Introduction A considerable number of clinical studies experience delays, which result in increased duration and costs. In multicentre studies, patient recruitment is among the leading causes of delays. Poor site selection can result in low recruitment and bad data quality. Site selection is therefore crucial for study quality and completion, but c...

Introduction Treatment of fractures in the elderly population is a clinical challenge due partly to the presence of comorbidities. In a Geriatric Fracture Centre (GFC), patients are co-managed by a geriatrician in an attempt to improve clinical outcomes and reduce morbidity and mortality. Until now the beneficial effect of orthogeriatric co-managem...

Background: The recurrence rate of cervical chordomas is high, and hence it is important to discern the prognostic factors for local relapse and overall survival (OS). Methods: A retrospective review of 52 patients with cervical chordoma operated in our institution from January 1999 to March 2015 was performed. The association of clinicopatholog...

Background: Early identification of people at risk for a contralateral hip fracture would be desirable to favorably influence patients' prognosis. A recent systematic review failed to depict stringent patterns of risk parameters to be used for decision-making in clinical practice. Objective: To perform a consensus study using the Delphi method t...

Introduction Modern techniques in orthopaedic surgery using minimally invasive procedures, and increased use of fluoroscopic imaging present a potential increased risk to surgeons due to ionizing radiation exposure. This article is a systematic review of recent literature on radiation exposure of orthopaedic surgeons. Materials and methods Pubmed...

Treatment with a variable angle locking plate can, in theory, maintain near anatomic reduction of intra-articular distal radius fractures, but it is unknown to what extent reduction is maintained as measured by computed tomography. We assessed changes in radiographic fracture position 1 year post-operatively. We included 73 patients of whom 66 pati...

Background: The selection of the appropriate implant material, stainless steel or titanium, is still the decision of the surgeon and/or the affiliated institution. Additionally, remarkable international differences can be found between the different markets, which cannot really be explained. Objective: A systematic literature search was performe...

Background and purpose — To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the lower extremities of a representative population o...

Background and purpose — The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF) describes the localization and morphology of fractures, and considers severity in 2 categories: (1) simple, and (2) multifragmentary. We evaluated simple and multifragmentary fractures in a large consecutive cohort of children diagnosed with long bo...

Background and purpose — To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population o...

Background This meta-analysis aimed to determine the bone union rate of bone defects treated with the different autologous bone graft techniques. Methods The PubMed and the Cochrane Library databases were searched using the terms: ‘fracture’ AND (‘bone loss’ OR ‘defect’ OR ‘defects’) AND ‘bone graft’, restricted to English language, to human specie...

No large multicentre studies have yet been published on tension-band-like implants such as the Eight Plate to treat limb-length discrepancies and varus valgus deformities in children. Therefore, we carried out a retrospective international multicentre study including 126 patients to assess outcomes and to reliably quantify the incidence of implant-...

Background To test if complexity of acetabular fractures, pre-trauma health status, time from trauma to definitive surgery, severity of injury or job characteristics influence work resumption, return to the same professional position and time out of work. Materials and methodsWe performed a retrospective study on patients with surgically treated ac...

Background: Transient synovitis is the most common hip joint disorder in children. Perthes disease occurs around the same age and may not be distinguishable to an episode of transient synovitis in the early stage. Therefore all children in our clinic with transient synovitis underwent a follow-up X-ray 3 months later to detect Perthes disease at an...

Background: Visual aids tend to help diverse and vulnerable individuals understand risk communications, as long as these individuals have a basic understanding of graphs (i.e., graph literacy). Tests of objective graph literacy (OGL) can effectively identify individuals with limited skills, highlighting vulnerabilities and facilitating custom-tail...

Objectives: To compare reporting outcomes of radiolographic complications conducted by an independent review board and the responsible on-site study personnel in a multicenter study about locking plate fixation of proximal humeral fractures. Design: Prospective, multicenter study SETTING:: Nine Level I trauma centers PATIENTS:: 150 patients (age...

Purpose To review the evidence on safety of anterior lumbar interbody fusion (ALIF) and extreme lateral transpsoas interbody fusion (ELIF) in the treatment of degenerative spinal disorders with an emphasis on the association between neuromonitoring and complications. Methods We performed a systematic literature search in the Cochrane (CENTRAL), MED...

Objective: To evaluate the union rate of post-traumatic bone defects treated with the induced membrane technique. Design: Single center retrospective case series. Setting: Level I trauma center. Patients/participants: Thirty-three patients who sustained 34 post-traumatic bone defects (19 tibia, 15 femur). Intervention: Staged management us...

Introduction A systematic literature review on periprosthetic/interprosthetic fracture fixation after hip arthroplasties was performed to summarize available clinical data. Operation techniques and implants used were evaluated as possible risk factors for outcomes. Materials and methods MEDLINE and Cochrane databases were searched. Articles describ...

Introduction: Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the...

Objective: To effectively practice evidence-based medicine, surgeons need to understand and be able to communicate health-relevant numerical information. We present the first study examining risk literacy in surgeons by assessing numeracy and surgical risk comprehension. Our study also investigated whether visual aids improve risk comprehension in...

Background: Early identification of hip fracture (HF) patients bearing an increased risk for a contralateral occurrence would allow providing preventive measures timely. Objectives: To summarize the available evidence describing risk scores, prognostic instruments, or (groups of) parameters predicting contralateral HFs at the time point of the f...

Objective: This study explored whether acute serum marker S100B is related with post-concussive symptoms (PCS) and neuropsychological performance 4 months after paediatric mild traumatic brain injury (mTBI). Research design and methods: This prospective short-term longitudinal study investigated children (aged 6-16 years) with mTBI (n = 36, 16 m...

Objectives: To compare radiological complication reporting outcomes undertaken by an independent review board and the responsible on-site study personnel in a multicenter study about locking plate fixation of proximal humeral fractures. Design: prospective, multicenter study SETTING:: Level I trauma centers PATIENTS:: One-hundred and fifty patie...

Background: The WHO initiated the “Decade of Action for Road Safety” because the fatality on road traffic accidents could become the fifth leading cause of death in 2030. On the contrary, fatalities con- tinue to decrease in high income countries. The aim of the study was to find evidence for changes in injury severity of passenger car occupants af...