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Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 15 June 2026 | Viewed by 21507

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Special Issue Editors

Prof. Dr. Dirk Stengel

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Guest Editor

BG Kliniken—Klinikverbund der Gesetzlichen Unfallversicherung gGmbH (Hospital Group of the German Social Accident Insurance), Leipziger Pl. 1, 10117 Berlin, Germany
Interests: clinical trials; systematic reviews; meta-analyses; diagnostic tests; radiological imaging; ultrasonography; multiple trauma; musculoskeletal injuries; septic surgery

Prof. Dr. Paul Alfred Grützner

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Guest Editor

Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen on the Rhine, Ludwigshafen, Germany
Interests: polytrauma; joint fractures; imaging; orthogeriatrics
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Special Issue Information

Dear Colleagues,

In 2025, we look back on 25 years of evidence-based orthopaedic surgery. We will celebrate this anniversary by holding a scientific symposium with renowned guest-speakers at the BG Klinikum Unfallkrankenhaus Berlin, a leading tertiary-care trauma centre in the capital of Germany. This Special Issue is intended to accompany the event, depict the current state-of-the art, and pave the way for future research. Transferring the principles of evidence-based medicine to the surgical disciplines has already turned out to be difficult, and appeared almost impossible in the setting of orthopaedic and multiple trauma. Yet, major international consortia were formed, enabling cutting-edge multicentre trials which fundamentally changed our understanding of established care processes and improved patient outcomes. Novel clinical trial concepts, innovative methods to model large-scale routine data, molecular and personalized medicine, artificial intelligence, etc., will further boost our knowledge in future. We invite systematic reviews and meta-analyses on major issues in orthopaedic trauma, reports of randomized trials, and large-scale observational data.

We look forward to your submissions!

Prof. Dr. Dirk Stengel
Prof. Dr. Paul Alfred Grützner
Guest Editors

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Keywords

evidence-based medicine
orthopaedic surgery
clinical trials
systematic reviews
patient outcomes
multiple trauma
artificial intelligence
injuries

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Published Papers (11 papers)

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Research

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16 pages, 402 KB

Open AccessArticle

Practical Use of Wearable Activity Measurement Devices in Orthopaedic Surgery: A Qualitative Analysis of Multidisciplinary Expert Experience

by Dana Hazem, Emma Danielle Grellinger, Alex Youn, Seth Yarboro, Peter Richter, Sureshan Sivananthan, Bernd Grimm, Andrew Hanflik, WEARQ Group, Benedikt Braun and Meir Marmor

J. Clin. Med. 2026, 15(8), 3009; https://doi.org/10.3390/jcm15083009 - 16 Apr 2026

Viewed by 622

Abstract

Background/Objectives: Wearable activity monitors and sensor-based devices are increasingly used to quantify mobility, load, and recovery in orthopaedic patients, yet clinicians lack practical guidance on selection, implementation, and interpretation. This qualitative expert consensus study synthesized real-world experiences from leaders in orthopaedics, rehabilitation, biomechanics, and digital health who implemented wearables at scale. Methods: Semi-structured interviews were conducted with 16 experts (64% response rate) recruited via hybrid purposive and snowball sampling. Participants included orthopaedic surgeons and research scientists with 124 cumulative years of wearable experience across over 9000 monitored patients. Interviews addressed device selection, clinical workflow, data management, and adoption barriers. Data were charted into a structured extraction matrix and analyzed using Inductive Thematic Analysis and a Framework Approach, reported per COREQ guidelines. Results: Experts utilized diverse sensor platforms across arthroplasty, trauma, spine, and sports medicine. Four key themes emerged: (1) device selection prioritized usability and patient compliance over technical sophistication; (2) workflow required defined team roles to manage data volume and avoid clinical burden; (3) patient engagement favored simplified, actionable feedback amid divergent views on data transparency; (4) future outlook anticipated AI-driven proactive risk prediction. Conclusions: No single wearable suits all orthopaedic practices; success hinges on aligning sensor placement with clinical questions, rigorous data quality checks, and integration into care plans. This study offers a practical checklist and roadmap for point-of-care adoption. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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15 pages, 2975 KB

Open AccessArticle

The Power of Heuristics in Predicting Fracture Nonunion

by Jonas Armbruster, Eva Steinhausen, Simon Hackl, Marie K. Reumann, Dirk Stengel, Frank Niemeyer, Gregor Reiter, Paul Alfred Gruetzner and Holger Freischmidt

J. Clin. Med. 2025, 14(8), 2713; https://doi.org/10.3390/jcm14082713 - 15 Apr 2025

Cited by 2 | Viewed by 1341

Abstract

Background/Objectives: Although extensive research on risk factors for nonunion development has been published, clinicians frequently rely on heuristic reasoning—intuitive, experience-based decision-making—to predict nonunions. However, the accuracy of these intuitive assessments and the influence of clinician experience remain uncertain. This study aims to assess clinicians’ diagnostic accuracy in predicting nonunion, investigate the impact of experience on predictive performance, and identify patient-specific factors contributing to diagnostic errors. Methods: This retrospective, multi-center cohort study included 98 patients with surgically treated tibial shaft fractures between 2018 and 2023 from four level-one trauma centers in Germany. Fracture outcomes were classified as either nonunion (n = 20) or regular fracture healing (n = 78). Patient cases were presented to 24 clinicians. Each clinician independently assessed preoperative and postoperative biplanar X-rays and patient histories to predict fracture healing. Results: Clinicians’ sensitivity significantly improved from 50.4% to 60.2%, while specificity declined (74.0% to 70.7%) with the addition of postoperative information. No significant differences in predictive performance were observed across different levels of clinician experience. Changes in assessment after reviewing postoperative information were equally likely to be beneficial or detrimental. Certain patient factors, including obesity and smoking, influenced prediction errors. Conclusions: This study is the first to assess heuristic reasoning in nonunion prediction. The findings suggest that clinician experience does not significantly enhance diagnostic accuracy under limited-information conditions. Patients should be informed that predicting individual nonunion risk remains challenging. Larger studies are needed to explore the role of patient-specific factors and refine clinical decision-making in fracture healing prognosis. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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9 pages, 1209 KB

Open AccessArticle

Patient Recruitment Characteristics for Wearable-Sensor-Based Outcome Assessment in Trauma Surgery

by Benedikt J. Braun, Kira Hofmann, Chiara N. Meierhofer, Maximilian M. Menger, Tanja C. Maisenbacher, Carolina Vogel, Dannik Haas, Meir T. Marmor, Tina Histing, Eva-Marie Braun and The AO Smart Digital Solutions Task Force

J. Clin. Med. 2025, 14(3), 805; https://doi.org/10.3390/jcm14030805 - 26 Jan 2025

Cited by 3 | Viewed by 1658

Abstract

Background/Objectives: Using a patient’s own wearable sensor to obtain objective outcome data is a growing field in trauma allowing for the assessment of the recovery trajectory back toward the pre-injury performance. The aim of this study was to analyze recruitment characteristics and reasons for declined study participation in an orthopedic trauma study that measures postoperative recovery using wearables. Methods: Data from 225 patients screened for participation in a wearable-sensor-based outcome study were assessed. The influence of age, sex and injury location on study participation was analyzed. Reasons for patients declining to participate were investigated from the screening log. Availability and type of sensor system in patients agreeing to participate were analyzed. Results: Overall, 48% of patients agreed to participate. Age was the only significantly different factor between agreeing and declining patients (p < 0.05). The main reasons to decline study participation were technical difficulties with or inability to use the wearable device, lack of availability of a wearable, and general disinterest to participate in a study. Notably, 7% declined due to data safety concerns. Conclusions: The results show that age, availability of the wearable, and technical ability to use a wearable are the main obstacles impacting objective outcome measurement using a personal wearable device. In studies including geriatric patients, a dedicated device requiring no patient handling can be a valid option to improve enrollment. Understanding the reasons for declining to participate will facilitate the development of future sensor-based studies to address concerns of technical handling through alternative means of data harvesting and increase the inclusion rate. These outcomes will guide future study designs to optimize patient inclusion. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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11 pages, 880 KB

Open AccessArticle

Discrepancies in ChatGPT’s Hip Fracture Recommendations in Older Adults for 2021 AAOS Evidence-Based Guidelines

by Hong Jin Kim, Pil Whan Yoon, Jae Youn Yoon, Hyungtae Kim, Young Jin Choi, Sangyoon Park and Jun-Ki Moon

J. Clin. Med. 2024, 13(19), 5971; https://doi.org/10.3390/jcm13195971 - 8 Oct 2024

Cited by 9 | Viewed by 3046

Abstract

Background: This study aimed to assess the reproducibility and reliability of Chat-Based GPT (ChatGPT)’s responses to 19 statements regarding the management of hip fractures in older adults as adopted by the American Academy of Orthopaedic Surgeons’ (AAOS) evidence-based clinical practice guidelines. Methods: Nineteen statements were obtained from the 2021 AAOS evidence-based clinical practice guidelines. After generating questions based on these 19 statements, we set a prompt for both the GPT-4o and GPT-4 models. We repeated this process three times at 24 h intervals for both models, producing outputs A, B, and C. ChatGPT’s performance, the intra-ChatGPT reliability, and the accuracy rates were assessed to evaluate the reproducibility and reliability of the hip fracture-related guidelines. Regarding the strengths of the recommendation compared with the 2021 AAOS guidelines, we observed accuracy of 0.684, 0.579, and 0.632 for outputs A, B, and C, respectively. Results: The precision was 0.740, 0.737, and 0.718 in outputs A, B, and C, respectively. For the reliability of the strengths of the recommendation, the Fleiss kappa was 0.409, indicating a moderate level of agreement. No statistical differences in the strengths of the recommendation were observed in outputs A, B, and C between the GPT-4o and GPT-4 versions. Conclusion: ChatGPT may be useful in providing guidelines for hip fractures but performs poorly in terms of accuracy and precision. However, hallucinations remain an unresolved limitation associated with using ChatGPT to search for hip fracture guidelines. The effective utilization of ChatGPT as a patient education tool for the management of hip fractures should be addressed in the future. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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Review

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14 pages, 1998 KB

Open AccessReview

Fractures Around the Knee—Significant Achievements During the Past 25 Years and Major Questions to Be Solved

by Matthias Stockinger, Matthias Krause and Karl-Heinz Frosch

J. Clin. Med. 2026, 15(9), 3463; https://doi.org/10.3390/jcm15093463 - 1 May 2026

Viewed by 432

Abstract

Background: Over the past 25 years, advances in knee surgery have been driven by an improved understanding of fracture morphology and associated injuries, as well as by significant technological progress. The introduction of novel classification systems has led to the refinement of treatment strategies, particularly with respect to the selection of surgical approaches. Furthermore, advances in biomechanical understanding have facilitated the development of new osteosyntheses designed to promote earlier rehabilitation while simultaneously reducing complication rates. Research Question: Which key milestones over the last 25 years have significantly influenced treatment strategies for knee joint fractures, with a perspective on unresolved issues? Results: Recent advances in fracture management, osteosynthesis, imaging techniques, and biomechanical research have substantially improved clinical outcomes, including a reduction in infection rates and improved postoperative results. The implementation of new classification systems has enabled more precise preoperative planning, allowing surgeons to define approaches that ensure adequate visualization of the articular surface while facilitating optimal positioning of the osteosynthesis. In terms of osteosynthesis, the introduction of locking plate technology has become widely established and supported by biomechanical evidence and has largely replaced traditional methods such as tension-band wiring of the patella. Despite these advances, fracture management in geriatric patients remains a considerable challenge, as compromised bone quality frequently limits the ability to achieve sufficiently load-stable osteosynthesis. Direct visualization of the articular surface is essential for adequate assessment and reduction of the affected articular segment. However, there is currently no consensus on which surgical approach or possible extension is most appropriate while simultaneously ensuring a low complication rate. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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15 pages, 1349 KB

Open AccessReview

Evolving Burn Care: The Transition from Life Preservation to Life Restoration―A Narrative Review

by Tobias Niederegger, Jule Brandt, Thomas Schaschinger, Alen Palackic, Valentin Haug, Felix Klimitz, Ulrich Kneser, Christoph Hirche, Benjamin Ziegler, Martin Aman, Leila Harhaus-Wähner and Gabriel Hundeshagen

J. Clin. Med. 2026, 15(8), 3102; https://doi.org/10.3390/jcm15083102 - 18 Apr 2026

Viewed by 811

Abstract

Over the past years, burn care has evolved from a discipline focused on survival to one centered on restoring long-term health, function, and quality of life. Significant advances in critical care, early excision and grafting, infection control, and metabolic support have transformed survival outcomes for even the most severe injuries. As a result, the field now faces a new frontier: understanding and managing the long-term physical, psychological, and systemic sequelae of survival. This review traces the evolution of burn care over the last century and outlines the challenges and priorities for the next 25 years. The first era of progress, defined by innovations in resuscitation, surgery, and critical care, has given rise to a growing cohort of long-term survivors. Research over the past decade has revealed that major burns induce chronic multisystem alterations, including metabolic, cardiovascular, neurocognitive, and immunological dysfunctions. Emerging concepts such as burn-associated heart failure exemplify this shift from acute to chronic disease understanding. Looking ahead, the future of burn medicine lies in personalized and lifelong care, supported by translational research, digital health, regenerative therapies, and interdisciplinary collaboration. Overall, burn care stands at a pivotal crossroads. By integrating precision medicine, rehabilitation science, and psychosocial care, we aim to move the field from survival toward sustained, holistic recovery over the next 25 years. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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10 pages, 993 KB

Open AccessReview

Management of Fractures of the Thoracolumbar Spine―A Narrative Review

by Sven Y. Vetter, Andreas Badke, Sandra Buchmann, Stefan Hauck, Peter Heumann, Frank Kandziora, Philipp Kobbe, Sebastian Krüger, Christiane Kruppa, Bernhard W. Ullrich and Philipp Schleicher

J. Clin. Med. 2026, 15(3), 1008; https://doi.org/10.3390/jcm15031008 - 27 Jan 2026

Cited by 1 | Viewed by 1277

Abstract

The thoracolumbar region affects 60 to 80% of the 4 million spine fractures occurring annually, making them a global health threat. Management has evolved from early fixation systems to minimally invasive techniques, reducing muscle trauma and recovery time. Fractures are classified into compression, distraction, and translation types, with stability guiding treatment decisions. Surgical options include open and minimally invasive procedures, each with benefits and drawbacks. The choice of treatment depends on fracture type, neurological deficits, and patient factors. Advances in technology continue to improve outcomes, but further research is needed to determine optimal management strategies. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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21 pages, 2802 KB

Open AccessReview

Managing Nonunions and Fracture-Related Infections—A Quarter Century of Knowledge, and Still Curious: A Narrative Review

by Jonas Armbruster, Benjamin Thomas, Dirk Stengel, Nikolai Spranger, Paul Alfred Gruetzner and Simon Hackl

J. Clin. Med. 2025, 14(21), 7767; https://doi.org/10.3390/jcm14217767 - 1 Nov 2025

Viewed by 2361

Abstract

Nonunions and fracture-related infections represent a significant complication in orthopedic and trauma care, with their incidence rising due to an aging, more comorbid global population and the escalating threat of multi-resistant pathogens. This narrative review highlights pivotal advancements in diagnostics and therapeutic approaches, while also providing an outlook on future directions. Diagnostic methodologies have significantly evolved from traditional cultures to sophisticated molecular techniques like metagenomic next-generation sequencing and advanced imaging. Simultaneously, therapeutic strategies have undergone substantial refinement, encompassing orthoplastic management for infected open fractures and the innovative application of antibiotic-loaded bone substitutes for local drug delivery. The effective integration of these possibilities into daily patient care critically depends on specialized centers. These institutions play an indispensable role in managing complex cases and fostering innovation. Despite considerable progress over the past 25 years, ongoing research, interdisciplinary collaboration, and a steadfast commitment to evidence-based practice remain crucial to transforming management for the future. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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23 pages, 729 KB

Open AccessReview

From Past to Future: Emergent Concepts of Anterior Cruciate Ligament Surgery and Rehabilitation

by Christian Schoepp, Janina Tennler, Arthur Praetorius, Marcel Dudda and Christian Raeder

J. Clin. Med. 2025, 14(19), 6964; https://doi.org/10.3390/jcm14196964 - 1 Oct 2025

Cited by 3 | Viewed by 6003

Abstract

Background/Objectives: Anterior cruciate ligament (ACL) injuries continue to present significant clinical and rehabilitative challenges. Despite advances in surgical techniques and rehabilitation protocols, persistent reinjury rates and increased pressure for early return to sport require a critical reassessment of current practices. This narrative review provides a comprehensive overview of the evolution, current standards, and future directions of ACL surgery and rehabilitation. Content: The literature search was conducted primarily in PubMed/MEDLINE and Web of Science using ACLRelated keywords, with emphasis on systematic reviews, randomized controlled trials, registry data, and consensus guidelines published within the past two decades. The evolution of ACL treatment is shaped by the transition from open to arthroscopic and anatomic reconstructions, as well as the refinement of fixation and augmentation techniques. In parallel, rehabilitation concepts shifted from rigid, time-based schedules to criteria-driven, individualized approaches. Key aspects include early mobilization, prehabilitation, and the integration of innovative tools such as anti-gravity treadmill and blood flow restriction training. Evidence on bracing suggests no routine benefit, while structured prevention programs have proven effective. Return-to-play strategies now emphasize objective functional criteria and psychological readiness. Conclusions: ACL therapy has evolved toward personalized, function-oriented rehabilitation. Future developments—including markerless motion analysis, AI-supported rehabilitation, and digital health applications promise for further individualization of care and optimization of long-term outcomes. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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Other

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18 pages, 1188 KB

Open AccessSystematic Review

Aspirin for Venous Thromboembolism Prevention in Orthopaedic Surgery with Focus on Trauma and Arthroplasty: A Structured Evidence-Based Review of Randomised Trials, Guidelines, and Contemporary Practice Considerations

by Christian Riediger, Mark Ferl and Maria Schönrogge

J. Clin. Med. 2026, 15(12), 4550; https://doi.org/10.3390/jcm15124550 - 11 Jun 2026

Viewed by 99

Abstract

Background: Venous thromboembolism (VTE) remains a clinically relevant complication following major orthopaedic procedures, particularly total hip arthroplasty (THA), total knee arthroplasty (TKA), and fracture surgery. Although low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) are widely regarded as standard pharmacological options, aspirin (acetylsalicylic acid, ASA) has gained renewed attention because of its low cost, oral administration, and favourable bleeding profile. However, the available evidence is heterogeneous, and its interpretation is complicated by differences in patient selection, timing and duration of prophylaxis, diagnostic methodology, aspirin dosing regimens, and the increasing adoption of modern fast-track arthroplasty pathways. Methods: A structured evidence-based review was conducted in accordance with PRISMA 2020 principles. PubMed, Embase, Web of Science, and the Cochrane Library were searched through September 2025 for randomised controlled trials (RCTs), major international clinical practice guidelines, and selected high-level studies relevant to the interpretation of aspirin-based orthopaedic thromboprophylaxis. Nine RCTs, four major guideline documents, and sixteen additional Level I–II studies were included. Outcomes of interest were symptomatic deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, and mortality. Risk of bias was assessed using the Cochrane ROB 2 framework. Owing to marked methodological heterogeneity, no formal pooled meta-analysis was undertaken. Results: The available RCT evidence suggests that aspirin may perform adequately within structured sequential or risk-stratified prophylaxis strategies, but not in all clinical settings. In arthroplasty, EPCAT II demonstrated non-inferiority of aspirin when introduced after an initial five-day course of rivaroxaban, whereas CRISTAL showed higher early symptomatic VTE rates when aspirin was used as sole primary prophylaxis from postoperative day 0. Importantly, thromboembolic events in CRISTAL occurred earlier in the aspirin cohort, supporting the concept that anticoagulant therapy remains important during the immediate postoperative hypercoagulable phase. In trauma surgery, PREVENT CLOT established non-inferiority of aspirin compared with LMWH for 90-day mortality; however, the predominantly young study population and the inclusion of upper-extremity fractures limit extrapolation to elderly hip fracture patients. Several smaller RCTs reported no major differences between aspirin and anticoagulants, but these studies were frequently underpowered and relied on less sensitive diagnostic strategies. Historical and contemporary guidelines remain heterogeneous, and evidence from modern fast-track arthroplasty pathways suggests that current trial-based conclusions may not be directly generalisable to short-duration prophylaxis settings. Conclusions: Aspirin may have a role in orthopaedic thromboprophylaxis when used within structured, risk-adapted or sequential protocols, particularly in standard-risk arthroplasty patients and selected trauma populations. However, current evidence does not support its universal use as sole primary prophylaxis in major orthopaedic surgery, especially during the early postoperative hypercoagulable phase or in high-risk patients. Furthermore, the available literature does not permit definitive recommendations regarding the optimal aspirin dose or duration of prophylaxis. The generalisability of the existing literature is further limited by methodological heterogeneity and by the absence of RCTs directly evaluating ultra-short anticoagulant regimens versus prolonged aspirin prophylaxis in modern fast-track arthroplasty. Further high-quality, standardised trials are required. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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33 pages, 7055 KB

Open AccessSystematic Review

E-Scooter-Associated Injury Types and Injury Severity: A Systematic Review and Meta-Analysis

by Wiebke Käckenmester, Alexander Hönning, Heinrich Bernhard Herman Voß, Cosima Prahm, Georg Osterhoff and Julia Seifert

J. Clin. Med. 2026, 15(6), 2154; https://doi.org/10.3390/jcm15062154 - 12 Mar 2026

Cited by 1 | Viewed by 1151

Abstract

Background: In the past ten years, the number of publications on injuries associated with electric scooters (e-scooters) has been increasing continuously. The aim of this systematic review and meta-analysis was to synthesize the original study results on injury types, injury severity, clinical care, accident mechanisms, risk factors, and patient characteristics associated with e-scooter accidents. Methods: The literature search was conducted in PubMed, EMBASE and Medline. We included quantitative clinical studies published between 07/2019 and 07/2024 that report e-scooter-associated injuries in patients who presented to an emergency department. Variables that were reported as proportions (e.g., frequency of extremity fractures) were summarized using a proportional meta-analysis. Parameters on a continuous scale were combined using a meta-analysis of the arithmetic means. Results: Among 524 unique records, 149 articles met the inclusion criteria, and 68 were eligible for quantitative analyses. Most e-scooter patients sustained injuries to the head and face with a pooled frequency of 42.1% (95% CI 38.7–45.4). Injuries of the upper extremities were estimated at 40.1% of patients (95% CI 35.8–44.4). Fractures of the extremities occurred with a pooled frequency of 25.7% (95% CI 22.5–28.9). An estimated proportion of 2.3% (95% CI 1.6–3.0) sustained severe traumatic brain injuries. Determined by the Injury Severity Score (ISS), 2.8% (95% CI 1.5–4.1) of the e-scooter patients were severely injured (ISS ≥ 16). Conclusions: Injuries to the head and face as well as the upper extremities are the most common causes for emergency department visits following e-scooter accidents. One in four patients presented with extremity fractures. Severe injuries, however, affect less than three percent of e-scooter patients. Full article

(This article belongs to the Special Issue Evidence-Based Clinical Management of Orthopaedic Trauma: 25 Years in Retrospect, and a Forecast of 25 Years to Come)

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