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Acute Trauma and Trauma Care in Orthopedics: 2nd Edition
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Acute Trauma and Trauma Care in Orthopedics: 2nd Edition

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

Deadline for manuscript submissions: 25 September 2026 | Viewed by 3153

Special Issue Editors

Prof. Dr. Pietro Maniscalco

E-Mail Website
Guest Editor
Orthopedics and Traumatology Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
Interests: orthopedics and traumatology; trauma; fractures; arthroplasty; arthroscopic; knee; hip; elbow
Special Issues, Collections and Topics in MDPI journals
Dr. Gianfilippo Caggiari

E-Mail Website
Guest Editor
Orthopaedic and Traumatology Department, Università degli Studi di Sassari, 07100 Sassari, Italy
Interests: orthopedics and traumatology; trauma; fractures; arthroplasty; knee; hip; elbow
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We sincerely invite you to contribute to the Special Issue "Acute Trauma and Trauma Care in Orthopedics: 2nd Edition". The first edition is available at https://www.mdpi.com/journal/jcm/special_issues/470IL9R42Q. This Special Issue combines original research and review papers with a focus on the recent advances in orthopedic and trauma surgery.

Orthopaedic and trauma surgery are clinically challenging and mainly deal with injuries and related diseases of the musculoskeletal system, which may be caused by trauma, accidents, sports injuries, degenerative diseases, infections, tumors and congenital diseases. We have witnessed the development of all aspects of orthopaedics, including the use of invasive surgical, non-invasive and non-surgical methods to correct and treat diseases, and trauma care requires rapid implementation through multidisciplinary collaboration. Early emergency treatment, accurate diagnosis (such as imaging examinations), judgment of injury severity (such as AO grading) and targeted treatment (including external fixation, internal fixation or minimally invasive techniques) are crucial. At the same time, attention should be paid to perioperative management, pain control, rehabilitation training and psychological support to maximize the restoration of patient function and reduce disability.

We welcome the submissions of your best research to update the latest progress in the field.

Prof. Dr. Pietro Maniscalco
Dr. Gianfilippo Caggiari
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • orthopedics
  • trauma
  • injury
  • musculoskeletal
  • surgery
  • knee
  • osteoarthritis
  • spinal deformity
  • fracture
  • joint replacement
  • hip fractur
  • fragility fracture
  • minimally invasive surgery
  • post-traumatic care and rehabilitation
  • pain management
  • emergency assessment

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Related Special Issue

Published Papers (4 papers)

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Research

15 pages, 877 KB  
Article
External Fixation in the Treatment of Proximal Humeral Fractures: A Retrospective Single-Center Case Series
by Gianfilippo Caggiari, Emanuele Ciurlia, Stefano Pescia, Alessandro Isola, Sebastiano Ortu, Andrea Donato, Edoardo Fantinato, Lucia Piras, Corrado Ciatti, Leonardo Puddu, Filippo Migliorini, Mario Manca and Carlo Doria
J. Clin. Med. 2026, 15(9), 3432; https://doi.org/10.3390/jcm15093432 - 30 Apr 2026
Viewed by 107
Abstract
Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of [...] Read more.
Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article
(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)
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15 pages, 1904 KB  
Article
Treatment Strategies and Complications in Reverse-Oblique Trochanteric Femur Fractures and Evaluation of a New Classification System
by Robert Breuer, Rainer Fiala, Theresa Dorner, Barbara Strasser-Kirchweger, Harald Kurt Widhalm, Mehdi Mousavi and Nikolaus Wilhelm Lang
J. Clin. Med. 2026, 15(4), 1502; https://doi.org/10.3390/jcm15041502 - 14 Feb 2026
Viewed by 390
Abstract
Background: Reverse-oblique femoral fractures are regarded as highly unstable and are still associated with high complication and failure rates. A new classification system is said to facilitate risk assessment and decision-making. Methods: Over ten years, 7804 patients with per/subtrochanteric fractures were screened in [...] Read more.
Background: Reverse-oblique femoral fractures are regarded as highly unstable and are still associated with high complication and failure rates. A new classification system is said to facilitate risk assessment and decision-making. Methods: Over ten years, 7804 patients with per/subtrochanteric fractures were screened in this retrospective analysis. A total of 552 patients with a reverse-oblique fracture pattern were included. The fractures were classified according to the new classification system. The choice of implants, complication rates, revision surgery, and time of surgery were recorded. Radiological outcome parameters and dislocation were measured. Results: For the classification, a good intra-rater reliability (r = 0.77) and inter-rater reliability (k = 0.64) were calculated. The complication rate was overall 19% (n = 105). More than 60% of complications needed revision surgery. The most common complications were cut-out and implant failure (3%); only Parker’s ratio, as a radiological parameter, had prognostic value. Malreduction had a negative impact on mal- or non-unions (p < 0.01), and a trend towards higher overall complications (p = 0.52). Prolonged time of surgery increased the overall complication rate (r = 0.2, p < 0.001). The same was found after open reduction (p = 0.005, OR 2.00). The use of cerclage wires had no positive or negative effects. The use of short or long implants did not influence the outcome. Conclusions: Reverse-oblique femoral fractures are associated with a high complication rate. Short implants can be safely used in cases without severe dislocation if a sufficient working length is considered. Anatomical reduction benefits the outcome as long as it can be performed closed. The classification system presents good inter- and intra-rater reliability. Full article
(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)
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17 pages, 11668 KB  
Article
Can the Spatial Heterogeneity in the Epiligament Explain the Differential Healing Capacities of the ACL and MCL?
by Lyubomir Gaydarski, Boycho Landzhov, Richard Shane Tubbs and Georgi P. Georgiev
J. Clin. Med. 2026, 15(2), 510; https://doi.org/10.3390/jcm15020510 - 8 Jan 2026
Cited by 1 | Viewed by 498
Abstract
Background: The anterior cruciate ligament (ACL) and medial collateral ligament (MCL) display strikingly different healing behaviors, despite their similar structural roles within the knee. The epiligament (EL)—a vascular and cellular envelope surrounding each ligament—has emerged as a critical determinant of repair capacity. The [...] Read more.
Background: The anterior cruciate ligament (ACL) and medial collateral ligament (MCL) display strikingly different healing behaviors, despite their similar structural roles within the knee. The epiligament (EL)—a vascular and cellular envelope surrounding each ligament—has emerged as a critical determinant of repair capacity. The aim of this study was to perform a region-specific, comparative analysis of EL molecular profiles in the ACL and MCL to elucidate the mechanisms underlying their contrasting reparative outcomes. Methods: Human ACL and MCL specimens were obtained from 12 fresh knee joints. Immunohistochemical labeling for CD34, α-smooth muscle actin (α-SMA), and vascular endothelial growth factor (VEGF) was performed across proximal, mid-substance, and distal EL regions. Quantitative image analysis using IHC Profiler for ImageJ generated semiquantitative (negative, low-positive, positive) distributions, and inter-ligament comparisons were quantified using t-tests (p  <  0.05). Results: Distinct, region-specific EL signatures were identified. The ACL EL exhibited strong proximal α-SMA expression (0% neg/66.8% low+/33.2%+) and notable distal CD34 positivity (0% neg/83.3% low+/16.7%+), while VEGF expression was confined to the mid-substance (≈55% low+/26%+). In contrast, the MCL EL was largely negative for CD34 and VEGF across all regions, showing a homogeneous but functionally oriented α-SMA profile: proximally negative, sparse mid positivity, and high distal low-positive staining (93.4% low+). Differences in proximal and distal CD34 and α-SMA expression between the ACL and MCL were highly significant (p  <  0.0001–0.001), confirming a mechanistic divergence in EL organization. Conclusions: The ACL EL is regionally heterogeneous, vascularly biased, and enriched in contractile α-SMA+ cells, suggesting localized but poorly coordinated reparative potential. In contrast, the MCL EL is structurally uniform, with distributed α-SMA activity supporting stable wound contraction and tissue continuity, despite limited angiogenic signaling. These findings indicate that the ACL’s failure to heal is not attributable to the absence of progenitor or angiogenic factors, but rather to its fragmented spatial organization and dominant contractile phenotype. Therapeutically, preserving and modulating the EL, particularly its CD34+ and α-SMA+ compartments, could be key to enhancing intrinsic ACL repair and improving outcomes in ligament reconstruction and regeneration. Full article
(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)
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9 pages, 468 KB  
Article
Early Surgery Reduces Infection Risk and Length of Hospital Stay in Closed Ankle Fractures: A Retrospective Cohort Study
by Roberta Laggner, Cornelia Gärtner, Emily Ghanbari, Florian Bur, Michael Humenberger and Thomas Haider
J. Clin. Med. 2025, 14(17), 6161; https://doi.org/10.3390/jcm14176161 - 31 Aug 2025
Cited by 1 | Viewed by 1713
Abstract
Background: The optimal timing of surgical treatment for ankle fractures remains a topic that is associated with clinical uncertainty. While delayed surgery is often necessary for safe wound closure, prolonged immobilization, impaired functional outcomes, protracted hospitalization, and an increased risk of infection are [...] Read more.
Background: The optimal timing of surgical treatment for ankle fractures remains a topic that is associated with clinical uncertainty. While delayed surgery is often necessary for safe wound closure, prolonged immobilization, impaired functional outcomes, protracted hospitalization, and an increased risk of infection are potential disadvantages. This study was aimed at investigating the interval between trauma, surgical fixation, and postoperative infections among patients with closed ankle fractures. Methods: We conducted a retrospective cohort study involving 224 patients treated surgically for fractures of the upper ankle joint between January 2020 and December 2023. The patients were stratified into two groups based on surgical timing: within 24 h of hospital admission (early surgery) or after 24 h (delayed surgery). The primary outcome was the incidence of postoperative infections. A multivariate logistic regression model was constructed to assess independent risk factors. Results: Of the 224 patients, 30 (13.4%) developed postoperative infections. Infection occurred in 11.1% of patients who underwent early surgery and 13.7% of those subjected to delayed surgery. This difference was not statistically significant in the unadjusted analysis (p = 0.747). However, an additional day of surgical delay was associated with an 11% increase in the odds of postoperative infection (OR = 1.11; 95% CI: 1.01–1.22; p = 0.034). Female patients had over threefold higher odds of infection than males (OR = 3.20; 95% CI: 1.32–8.09; p = 0.011), and diabetes was a significant risk factor, with diabetic individuals showing more than fivefold increased odds (OR = 5.56; 95% CI: 1.30–25.00; p = 0.019). Patients with delayed surgery had significantly longer hospital stays (+2.83 days, p < 0.05). Conclusions: Early surgical intervention appears to lower the risk of postoperative infections, is associated with hospitalization duration, and should be considered when clinically appropriate. Full article
(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics: 2nd Edition)
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