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A special issue of Bioengineering (ISSN 2306-5354). This special issue belongs to the section "Biomedical Engineering and Biomaterials".

Deadline for manuscript submissions: 30 November 2026 | Viewed by 10469

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Dr. Simon Kwoon-ho Chow

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Guest Editor

Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94304, USA
Interests: sarcopenia; fracture healing; osteoarthritis; microCT
Special Issues, Collections and Topics in MDPI journals

Dr. Stuart Goodman

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Guest Editor

Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94305, USA
Interests: joint replacement; biomaterials; inflammation; musculoskeletal tissue engineering and regenerative medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Orthopaedic surgery is a multi-disciplinary surgical specialism focused on repairing and reconstructing damaged tissues to solve clinical problems. Advancements in biomechanics, biomaterial research, and our understanding of the biological principles of musculoskeletal regeneration and repair are of paramount importance in the discovery and invention of novel diagnostic tools and treatments options that will eventually converge, improving patient outcomes.

Biomechanics represents the major function of the musculoskeletal system. It is also the study of the mechanical behaviour of bones, joints, and tissues under various loads and conditions. By studying the forces and movements that bones and joints experience, researchers can design prosthetics and orthopaedic implants that mimic natural movement, improve stability, and reduce wear over time. This understanding also aids in diagnosing musculoskeletal disorders and developing effective treatment plans. Biomaterial research is vital in developing new scaffolds that can replace or support damaged tissues. In orthopaedics, this involves creating durable, biocompatible materials to support tissue regeneration by living cells, which ultimately supports prosthetic joints, bone grafts, and fixation devices. Biomaterials need to be robust, resistant to wear and corrosion, and capable of integrating into the body without causing adverse reactions. Advances in polymers, ceramics, and metals have revolutionised implant design, extended lifespans, and improved the function of orthopaedic devices.

Biology underpins all aspects of orthopaedics by providing insights into the body's natural healing processes and the behaviour of cells and tissues. A deeper understanding of cellular responses to injury, inflammation, and mechanical stress can provide guiding principles for designs that not only restore functions but also promote tissue regeneration. By incorporating biological principles, bioengineers can develop devices that enhance tissue healing, encourage tissue integration, and reduce complications such as infection or rejection.

In this Special Issue, we will cover recent advances in these key areas of bioengineering for orthopaedic applications.

Dr. Simon Kwoon-ho Chow
Dr. Stuart Goodman
Guest Editors

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Keywords

orthopaedics
biomechanics
biomaterials
tissue engineering
regenerative medicine

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Published Papers (12 papers)

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Research

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16 pages, 22003 KB

Open AccessArticle

Stress as a Common Integrative Measure Between Biology and Engineering in Bone Healing and Remodeling

by Nenad Šešić, Marijo Bekić, Maro Jelić, Miho Klaić, Antun Bekić, Cecilija Rotim and Petra Bagavac

Bioengineering 2026, 13(7), 758; https://doi.org/10.3390/bioengineering13070758 (registering DOI) - 29 Jun 2026

Abstract

This study proposes mechanical stress as a common integrative parameter that connects biological bone adaptation with engineering mechanics. In engineering, stress is defined as the internal reactive force per unit area within a loaded body; in clinical practice, its biological consequences can be observed on radiographs, CT, and MRI as callus formation, hypertrophy, or oedema, and perceived by the patient as localised pain. Three-dimensional geometry models were constructed in Autodesk Fusion and Inventor, and stress distributions were visualised using Abaqus finite element analysis. Representative clinical cases (n = 5) were drawn from the radiographic archive of Dubrovnik County Hospital. The analysis showed that regions of elevated stress predicted by finite element models corresponded spatially with areas of callus growth observed on clinical radiographs, and that the presence or absence of stress correlated with subjective pain reports. These findings suggest that stress may serve as a clinically and biomechanically relevant parameter bridging radiographic observation and engineering analysis of bone healing and remodelling. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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15 pages, 1034 KB

Open AccessArticle

Vacuum-Compression Therapy as an Adjunct to Physical Therapy in Patients with Knee Osteoarthritis: A Pilot Comparative Study

by Diana-Lidia Tache-Codreanu, Ana-Maria Tache-Codreanu, Lucian Bobocea, Teodor Dan Poteca, Andrei Tache-Codreanu, Cosmin-Alec Moldovan and Corina Sporea

Bioengineering 2026, 13(5), 563; https://doi.org/10.3390/bioengineering13050563 - 16 May 2026

Viewed by 567

Abstract

Background: Knee osteoarthritis (OA) is one of the leading causes of disability in older adults. As definitive treatment often involves knee replacement surgery, effective non-invasive approaches capable of alleviating symptoms and preserving mobility are needed to delay surgical intervention or bridge waiting periods for surgery. Methods: Thirty-two patients with knee OA were included in this pilot comparative study. Patients underwent either a standardized physical therapy program (10 sessions) or the same program supplemented with vacuum-compression therapy (VCT), according to treatment received during routine clinical care. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and the Physical and Mental Component Summary scores of the SF-12 questionnaire (PCS, MCS). Assessments were performed at baseline and at 1-month follow-up, with WOMAC additionally evaluated immediately after treatment. Responder analysis based on minimal clinically important difference (MCID) thresholds was also performed. Results: Both groups demonstrated significant improvement across most outcomes. Between-group analysis showed greater improvements in the intervention group, with statistically significant differences observed for functional outcomes (WOMAC and PCS). Conclusions: In this pilot comparative study, the addition of VCT to standard physical therapy was associated with greater functional improvement in patients with knee OA. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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13 pages, 2014 KB

Open AccessArticle

In Vitro Experimental Study of Biofiligree^® Osteosynthesis in Calcaneus Fracture Fixation

by António Ramos, Olga Noronha, Orlando Simões, José Noronha and José Simões

Bioengineering 2026, 13(4), 460; https://doi.org/10.3390/bioengineering13040460 - 14 Apr 2026

Viewed by 540

Abstract

Surgical fixation techniques for bone fracture healing are well established and effective; however, opportunities remain to improve both functional outcomes and the patient experience. The Biofiligree^® concept integrates medicine, engineering, and design by reimagining conventional osteosynthesis plates as both therapeutic and aesthetic devices. Inspired by traditional Portuguese filigree, these plates allow patient participation through personalized geometries, patterns, or engravings and may later be transformed into wearable jewellery after removal, preserving them as symbolic artefacts of recovery. This study introduces and biomechanically evaluates a novel calcaneal fixation plate incorporating the biofiligree geometry concept. A biofiligree plate was designed for calcaneus fracture fixation and manufactured in stainless steel 306L. Experimental testing was conducted on synthetic composite calcaneus bone models to simulate anatomical conditions and compare the new design with a standard commercial plate. The biofiligree plate, 2 mm thick, was fixed using five screws and two percutaneous screws positioned at 45° to compress the fracture line. Results demonstrated comparable biomechanical performance between both systems, with similar strain distributions and fracture stabilization. The biofiligree plate showed stresses around 430 MPa and fracture displacement below 0.7 mm. Fixation stiffness values were 1445 N/mm for intact calcaneus, 1065 N/mm for the commercial plate, and 725 N/mm for the biofiligree plate, indicating adequate support for bone healing. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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15 pages, 1670 KB

Open AccessArticle

Patient-Specific Finite Element Analysis of Tibialis Anterior Tendon Insertion Variability and Its Impact on First Ray Biomechanics

by Recep Taşkin, İrfan Kaymaz, Osman Yazici and Fatih Ugur

Bioengineering 2026, 13(4), 389; https://doi.org/10.3390/bioengineering13040389 - 27 Mar 2026

Viewed by 598

Abstract

Background: Hallux valgus (HV) is a complex forefoot deformity influenced by interactions between osseous alignment, ligamentous restraint, and muscle–tendon forces. While the biomechanical role of ligament laxity and bone geometry has been extensively investigated, the contribution of tibialis anterior (TA) tendon insertion variability to medial column mechanics remains insufficiently understood. Materials and Methods: A patient-specific finite element model of the foot was developed from high-resolution computed tomography data. Five anatomically documented TA distal insertion configurations were modeled, representing different distributions of attachment to the medial cuneiform and first metatarsal base. All simulations were performed under identical boundary and loading conditions representative of the stance phase of gait. Global (full-foot) and local (first bone and first metatarsal) mechanical responses were quantified using total deformation, equivalent von Mises stress, and strain distributions. Results: Marked differences in mechanical behavior were observed across TA insertion types. The metatarsal-dominant configuration (Type 3) demonstrated the highest global and local deformation values (global deformation: 1.0928 mm; first bone deformation: 1.0928 mm) and elevated strain distributions, whereas the medial-dominant configuration (Type 2) showed minimal deformation (global: 0.0727 mm; first bone: 0.0350 mm) but the highest global equivalent von Mises stress (5.7698 MPa). The single-band insertion to the medial cuneiform (Type 5) produced the greatest localized stress in the first bone region (3.8634 MPa). Representative strain maps revealed distinct spatial redistribution patterns within the medial column associated with TA insertion geometry. Conclusions: This patient-specific finite element analysis indicated that distal TA insertion variability alone can substantially modify deformation, stress, and strain patterns within the medial column. These findings suggested that TA insertion anatomy may act as a biomechanical modulator of first-ray mechanics and should be considered in future studies investigating hallux valgus pathomechanics and personalized treatment strategies. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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19 pages, 23281 KB

Open AccessArticle

A Multiscale Evaluation of Erbium-Doped Yttrium-Aluminum-Garnet Laser Osteotomy: Integrating Macroscopic and Cellular Analyses

by Anjie Shen, Boxuan Huang, Hang Bao, Teng Zhang, Kaijun Zhang, Bin Zhao, Haoyuan Du, Junqiang Wang and Wei Han

Bioengineering 2026, 13(2), 237; https://doi.org/10.3390/bioengineering13020237 - 18 Feb 2026

Viewed by 866

Abstract

Background: Traditional high-speed mechanical osteotomes cause substantial thermal and mechanical trauma, impairing bone healing. Erbium-doped yttrium-aluminum-garnet (Er:YAG) lasers, with water-mediated non-contact ablation, offer precise osteotomy potential with minimal collateral damage. This study demonstrated the feasibility of Er:YAG laser use for complex osteotomies and elucidated its multi-scale biological impacts on bone. Methods: A custom Er:YAG laser performed Z/arc-shaped osteotomies on fresh ovine bone (oscillating saw as control); paired rat tibial osteotomies; and compared laser vs. saw resection. Osteotomy surfaces were characterized by SEM/micro-CT; histological staining quantified thermal/mechanical damage. Bone marrow-derived mesenchymal stem cell (BMSC) adhesion, viability, and infiltration on cut surfaces were evaluated via LSCM. Result: In the ex vivo ovine model, the Er:YAG laser enabled precise execution of complex osteotomies (Z-shaped and arc-shaped), producing significantly narrower gaps than the oscillating saw (1.14 mm vs. 2.70 mm, p < 0.001) with high geometric fidelity and smooth surfaces free of burrs, micro-cracks, or debris. In the in vivo rat model, laser ablation simultaneously minimized both thermal and mechanical damage at the osteotomy interface: it reduced the thermal damage depth (154 vs. 592 µm, p < 0.001) and empty lacunae rate (16.8% vs. 41.8%, p < 0.001) while completely avoiding the mechanical damage zone (297 µm) induced by sawing. Furthermore, the laser-ablated surface established a highly bioactive interface, which significantly enhanced the adhesion (606 vs. 389 cells), viability (86.9% vs. 46.6%), and infiltration depth (196 vs. 75 µm) of bone marrow-derived mesenchymal stem cells (all p < 0.001). Conclusions: In conclusion, this proof-of-concept study demonstrates that the Er:YAG laser has the potential to enable precise bone resection while preserving microstructure. By establishing a pro-regenerative microenvironment, this technology shows promise as a biologically favorable alternative to conventional sawing, although further technical refinement and long-term validation are essential for its clinical translation. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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22 pages, 1746 KB

Open AccessArticle

WMCA-Net: Wavelet Multi-Scale Contextual Attention Network for Segmentation of the Intercondylar Notch

by Yi Wu, Xiangxin Wang, Hu Liu, Quan Zhou, Lingyan Zhang, Yujia Zhou and Qianjin Feng

Bioengineering 2026, 13(2), 236; https://doi.org/10.3390/bioengineering13020236 - 18 Feb 2026

Viewed by 559

Abstract

Accurate segmentation of the intercondylar notch of the femur is of great significance for the diagnosis of knee joint diseases, surgical planning, and anterior cruciate ligament (ACL) reconstruction. Among them, the obvious anatomical heterogeneity, the interference of structurally similar tissues, and the blurred boundaries in MRI images make the segmentation of the intercondylar notch challenging. The segmentation of the intercondylar notch is often regarded as a standard semantic segmentation problem, but doing so leaves the inherent high-order internal variation and low-contrast features of its anatomical structure unresolved. We proposed a new Wavelet Multi-scale Contextual Attention Network (WMCA-Net). We have coordinated the Shallow High-frequency Feature Dense Extraction Block (SHFDEB) and Wavelet Split and Fusion Block (WSFB) modules with each other. The SHFDEB intensively extracts high-frequency detailed features at the shallowest layer of the network, while the WSFB effectively splits and fuses features at various resolutions, suppressing noise while better preserving the high-frequency detailed structural information we need. The Multi-scale Depth-wise Convolution Block (MDCB) captures cross-scale features from the narrow intercondylar notch (5–8 mm wide) to the surrounding femoral structure (approximately 50 mm diameter), dynamically adapting to different morphologies, including pathological changes caused by osteophyte formation. The Contextual-Weighted Attention Module (CWAM) establishes long-term semantic associations between fuzzy regions and clear anatomical landmarks by precisely locating uncertain regions through foreground and background decomposition. The Dice Similarity Coefficient of WMCA-Net on the intercondylar notch dataset is 93.16%, and the 95% Hausdorff Distance is 1.42 mm, demonstrating its advanced segmentation performance and good anatomical adaptability. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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15 pages, 4670 KB

Open AccessArticle

A Novel Murine Model to Study the Early Biological Events of Corticosteroid-Associated Osteonecrosis of the Femoral Head

by Issei Shinohara, Yosuke Susuki, Simon Kwoon-Ho Chow, Pierre Cheung, Abraham S. Moses, Masatoshi Murayama, Mayu Morita, Tomohiro Uno, Qi Gao, Chao Ma, Takahiro Igei, Corinne Beinat and Stuart B. Goodman

Bioengineering 2026, 13(1), 116; https://doi.org/10.3390/bioengineering13010116 - 20 Jan 2026

Viewed by 1038

Abstract

This study establishes a murine model of corticosteroid-associated osteonecrosis of the femoral head (ONFH) using a sustained-release prednisolone pellet and evaluates mitochondrial stress using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and changes in key histologic markers of bone over a 6-week period. Sixteen 12-week-old Balb/C mice were divided into two groups: a prednisolone group (PRED) and a control group (SHAM). The PRED group received a subcutaneous 60-day sustained-release pellet containing 2.5 mg of prednisolone, while the SHAM group received placebo pellets. PET/CT imaging was performed at 1, 3, and 6 weeks. Bone mineral density (BMD) measurements, and histomorphological analyses for the number of empty lacunae, osteoblasts, osteoclasts, and NADPH oxidase (NOX) 2, a marker for oxidative stress, were conducted at 4 or 6 weeks. PET/CT imaging demonstrated increased uptake in the femoral head at 3 weeks in the PRED group. This was accompanied by increased numbers of empty lacunae and osteoclasts, increased oxidative stress, and decreased alkaline phosphatase staining at 4 weeks in the PRED group. We have successfully established and validated a small murine model of ONFH. The findings of this preclinical study suggest a critical timeline for potential interventions to mitigate the early adverse effects of continuous corticosteroid exposure on bone. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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17 pages, 936 KB

Open AccessArticle

Predicting Long-Term Pain Resilience in Knee Osteoarthritis: An Osteoarthritis Initiative Nomogram

by Ahmad Alkhatatbeh, Tariq Alkhatatbeh, Jiechen Chen, Hongjiang Chen, Jiankun Xu and Jun Hu

Bioengineering 2026, 13(1), 96; https://doi.org/10.3390/bioengineering13010096 - 14 Jan 2026

Cited by 1 | Viewed by 1153

Abstract

Knee osteoarthritis prognostic tools often target structural progression or surgery and require imaging or biomarker inputs that are not routinely available. Using Osteoarthritis Initiative data, we developed a fully clinical nomogram to estimate both the probability of long-term pain non-resilience (clinically important worsening) and, by complement, maintenance of acceptable pain in radiographic knee osteoarthritis. We included participants with radiographic knee osteoarthritis and complete worst-knee WOMAC pain scores at baseline, 24 and 48 months; non-resilience was defined as a ≥9-point increase on the 0–100 WOMAC pain scale over 4 years. A six-predictor Firth logistic regression model (age, body mass index, Kellgren–Lawrence grade, baseline pain, 0–24-month pain change and Center for Epidemiologic Studies Depression Scale score) was fitted and translated into a point-based nomogram. Among 2365 eligible participants, 527 (22.3%) were non-resilient. The model showed good performance, with optimism-corrected AUC 0.74 and Brier score 0.15, and decision-curve analysis indicated positive net benefit versus treat-none across 1–15% thresholds and small gains versus treat-all. Early pain worsening and higher depressive symptoms were the strongest predictors of non-resilience. This six-variable, clinic-ready nomogram provides a simple, well-calibrated tool for prognostic counseling and risk stratification in radiographic knee osteoarthritis and requires external validation before wider clinical use. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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33 pages, 2135 KB

Open AccessEditor’s ChoiceReview

The Osteoimmunologic Basis of Biologic and Bioengineered Scaffolds in Fracture Healing

by Hannah Shelby, Sarah Bergren, Julian Wier, Edward M. Schwarz and Jay R. Lieberman

Bioengineering 2026, 13(2), 223; https://doi.org/10.3390/bioengineering13020223 - 14 Feb 2026

Cited by 1 | Viewed by 917

Abstract

Fracture nonunion or delayed union remains a significant clinical problem that burdens both the patient and the healthcare system. Defined as failure for bone to unite 9 months post injury or 3 months with no progression toward union, the pathology of nonunion may require multiple surgical interventions with associated morbidity. Increasing evidence has highlighted that nonunion is a multifaceted problem, not only a result of mechanical failure, but also a product of persistent dysregulation of the osteoimmune microenvironment manifested as impaired osteogenesis and bone healing. While current approaches focus on enhanced fixation and various bone grafting strategies, these treatments often fail to coordinate healing with osteoimmune regulation. This review summarizes the emerging biologic and bioengineering approaches that target osteoimmunology to enhance fracture repair. Scaffold systems, including metals, bioceramics, hydrogels, and micro/nanoparticle formulations, are being increasingly engineered to provide structural support while directing macrophage polarization and stimulating osteogenic signaling. We also review cell-based therapies and gene-modified constructs that are being developed to introduce osteoimmunology cues that halt chronic inflammation and promote an osteogenic microenvironment. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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17 pages, 5294 KB

Open AccessReview

Bioengineering Innovations for Personalized Care in Low Back Pain: From Sensors to Smart Therapeutics

by Jiri Gallo, Michal Stefancik, Petr Mik and Lenka Lhotska

Bioengineering 2026, 13(2), 212; https://doi.org/10.3390/bioengineering13020212 - 12 Feb 2026

Viewed by 911

Abstract

Low back pain (LBP) remains one of the most prevalent and disabling musculoskeletal conditions worldwide, shaped by interacting mechanical, neurophysiological, inflammatory, vascular, and behavioral factors. Conventional care often relies on generalized exercise programs and episodic, predominantly subjective assessment, which can underrepresent inter-individual heterogeneity and longitudinal change. Recent bioengineering advances enable continuous, multimodal monitoring of objective correlates of function—neuromuscular activation and coordination (sEMG/polyEMG), movement patterns and activity exposure (IMU), and complementary physiological context (e.g., autonomic and perfusion-related signals). Rather than measuring pain directly, these signals can contextualize symptoms, support treatment stratification within non-surgical care, and enable trajectory monitoring with early non-response flags to guide timely rehabilitation adjustment under clinician oversight. When integrated with transparent, implementation-oriented analytics, biosensing can also support incremental closed-loop rehabilitation through patient-facing feedback and adaptive progression rules. This review synthesizes current and emerging biosensing approaches for LBP and highlights key translational requirements—outcome-linked validation, standardization, and workflow integration—to bridge engineering innovation with clinically usable, data-informed rehabilitation. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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22 pages, 398 KB

Open AccessReview

Cranial Bone Repair and Regeneration After Trauma: Forensic and Clinical Medico-Legal Consequences

by Sorin Hostiuc, Ionuț Negoi and Veronica Ciocan

Bioengineering 2025, 12(9), 915; https://doi.org/10.3390/bioengineering12090915 - 26 Aug 2025

Cited by 3 | Viewed by 1896

Abstract

Cranial bone defects caused by trauma present significant clinical challenges but also difficulties in their forensic analysis. The complexity of cranial anatomy, limited vascularization, and proximity to neural structures complicate natural bone regeneration, often requiring surgical intervention and the use of complex materials and techniques. This review aims to identify relevant data for forensic analysis regarding bone regeneration after trauma, with an emphasis on the materials used and their interpretation in medico-legal contexts. It moves beyond a simple clinical perspective, providing a detailed medico-legal analysis of cranial bone repair and regeneration after trauma. This review aims to give a comprehensive analysis of the forensic and medico-legal consequences associated with cranial reconstruction using autogenic, allogenic, xenogenic, and synthetic materials. It gives a pioneering focus regarding an understudied but critical aspect of forensic and legal medicine, both to postmortem and to clinical elements. By detailing the unique radiographic signatures and physical characteristics of various reconstruction materials, we provide the specialists with a go-to material for the interpretation of these materials in forensic contexts. Furthermore, we will provide a detailed analysis of medico-legal risks, mainly those associated with malpractice claims, focusing our attention on the process of informed consent but also the management and interpretation of surgery-related complications. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

Other

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12 pages, 10108 KB

Open AccessCase Report

Patient-Specific Virtual Surgical Planning and In-House CAD-/CAM-Guided Vascularized Bone Flaps for Salvage Extremity Reconstruction: A Case Series

by Jaideep Seth, Matthew D. Marquardt, Rachel Herster, Teri Snyder, David W. Nash, John Alexander, Angela C. Collins, Jason M. Souza, Humza S. Shaikh, Juan E. Santiago-Torres, Laura S. Phieffer, Tobin Eckel and Kyle VanKoevering

Bioengineering 2026, 13(7), 721; https://doi.org/10.3390/bioengineering13070721 (registering DOI) - 24 Jun 2026

Viewed by 159

Abstract

The surgical management of extremity bone defects, particularly post-traumatic nonunion wounds, remains a challenge. Vascularized bone flaps (VBFs), widely used for mandibular reconstruction in head and neck oncologic surgery, are less established in extremity reconstruction and are typically performed freehand, which has several limitations. In the past decade, virtual surgical planning (VSP) and computer-aided design and modeling (CAD-CAM) technology have enabled patient-specific 3D-printed models to guide reconstruction. While this technology has been used extensively in head and neck reconstructive surgery, its application to extremity reconstruction is less well-documented. This case series evaluates the feasibility, safety, and surgical utility of VSP and in-house CAD-CAM manufacture of 3D-printed models and cutting guides for post-traumatic non-healing extremity reconstructions using VBFs. Eight patients at a single tertiary academic center underwent VBF reconstruction guided by patient-specific models and cutting guides, with cases grouped into categories (humerus, femur, and tibia). The multi-disciplinary workflow supported preoperative visualization, osteotomy planning, and intraoperative execution. All vascularized flaps survived, and radiographic union was documented in patients with adequate follow-up. These findings suggest that integrating VSP and CAD-CAM into trauma-associated VBF extremity reconstruction is feasible and safe and may improve reconstructive accuracy and enhance multi-disciplinary team workflow, potentially contributing to improved clinical outcomes. Full article

(This article belongs to the Special Issue Application of Bioengineering to Orthopedics)

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