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Accelerating Fracture Healing: Clinical Diagnosis and Treatment

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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: closed (20 December 2025) | Viewed by 11329

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Dr. Seong-Eun Byun

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CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Republic of Korea
Interests: fracture; trauma surgery; orthopaedic surgery; osteoporosis; bone; hip fracture surgery; fragility fracture

Special Issue Information

Dear Colleagues,

Advancements in imaging modalities, surgical procedures, and fixators have driven significant progress in fracture treatment over the past few decades. These innovations have enabled more precise surgical interventions and improved patient outcomes. The principles of modern fracture treatment, including the preservation of fracture biology, have been firmly established, providing a solid foundation for optimizing healing and restoring function. As a result, most fractures now achieve favorable outcomes with satisfactory functional recovery.

However, despite these advancements, certain fracture types continue to pose significant challenges for orthopedic surgeons. The aging population and changing demographics have led to a rise in fragility fractures, such as atypical femoral fractures, femoral neck fractures, and periprosthetic fractures, which are often linked to bone fragility and comorbid conditions. These fractures are complex in nature, requiring tailored approaches to achieve optimal healing and functional recovery. Furthermore, the management of these fractures often highlights gaps in our current understanding, presenting opportunities for innovation and research.

This Special Issue aims to explore recent advancements in fracture healing techniques, encompassing both diagnostic and therapeutic strategies. We encourage submissions that address cutting-edge approaches, including minimally invasive techniques, clinical applications of novel biomaterials, and individualized treatment, to further enhance the care of patients with challenging fractures.

Dr. Seong-Eun Byun
Guest Editor

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Keywords

fracture
fracture surgery
fracture healing
diagnosis
treatment

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Published Papers (7 papers)

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10 pages, 930 KB

Open AccessArticle

Compression Osteosynthesis Without Iliac Crest Osteotomy Through the Anterior Iliac Approach for Incomplete High Anterior Column Fractures of the Acetabulum: A Case Series and Surgical Technique

by Young-Ho Cho, Young-Soo Byun and Seong-Eun Byun

J. Clin. Med. 2026, 15(7), 2739; https://doi.org/10.3390/jcm15072739 - 4 Apr 2026

Viewed by 463

Abstract

Introduction: An incomplete high anterior column fracture of the acetabulum is commonly considered to require completion of the fracture. However, reduction may become more difficult after completing the incomplete fracture due to plastic deformation. This study describes a surgical technique of compression osteosynthesis without completing the incomplete fracture and evaluates the clinical and radiographic outcomes. Materials and Methods: In this retrospective study, 25 patients with incomplete high anterior column fractures met the inclusion criteria. The fracture was reduced and stabilized by compression osteosynthesis through the anterior iliac approach without completing the incomplete fracture in the iliac wing. Patient demographics, the mechanism of injury, associated injuries, time to surgical reconstruction, operation time, and postoperative complications were analyzed. The quality of reduction and outcome were evaluated according to Matta’s criteria. Results: The mean operation time was 110 ± 23 min (range, 75–160). All fractures achieved bone union at a mean of 10.2 ± 1.4 weeks (range, 8–14). The quality of fracture reduction was graded as anatomical in 22 hips, imperfect in one and poor in two. Clinical results were excellent in 19 patients and good in six, and radiographic results were excellent in 22 patients and good in three. No statistically significant differences were observed between patients with and without quadrilateral plate fractures. Lateral femoral cutaneous nerve injury occurred in 13 patients (52%), mostly without significant symptoms. One patient experienced vascular injury. Conclusions: Incomplete high anterior column fractures can be effectively reduced and stabilized by compression osteosynthesis through the anterior iliac approach without completing the incomplete fracture in the iliac wing. This case series demonstrated favorable clinical and radiographic outcomes using this surgical technique. However, because this study was a retrospective case series with a small sample size and no comparative control group, further studies are required to confirm these findings. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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22 pages, 1645 KB

Open AccessArticle

Stability-Driven Osteoporosis Screening: Multi-View Consensus Feature Selection with External Validation and Sensitivity Analysis

by Waragunt Waratamrongpatai, Watcharaporn Cholamjiak, Nontawat Eiamniran and Phatcharapon Udomluck

J. Clin. Med. 2026, 15(2), 677; https://doi.org/10.3390/jcm15020677 - 14 Jan 2026

Viewed by 613

Abstract

Background/Objectives: Osteoporosis is a major global health concern, and early risk assessment plays a crucial role in fracture prevention. Although demographic, clinical, and lifestyle factors are commonly incorporated into screening tools, their relative importance within data-driven prediction frameworks can vary substantially across datasets. Rather than aiming to identify novel predictors, this study evaluates the stability and behavior of established osteoporosis risk factors using statistical inference and machine learning-based feature selection methods across heterogeneous data sources. We further examine whether simplified and near-minimal models can achieve predictive performances comparable to that of full-feature configurations. Methods: An open-access Kaggle dataset (n = 1958) and a retrospective clinical dataset from the University of Phayao Hospital (n = 176) were analyzed. Feature relevance was assessed using logistic regression, likelihood ratio testing, MRMR, ReliefF, and unified importance scoring. Multiple predictor configurations, ranging from full-feature to minimal and near-minimal models, were evaluated using decision tree, support vector machine, k-nearest neighbor, naïve Bayes, and efficient linear classifiers. External validation was performed using hospital-based records. Results: Across all analyses, age consistently emerged as the dominant predictor, followed by corticosteroid use, while other variables showed limited incremental predictive contributions. Simplified models based on age alone or age combined with medication-related variables achieved performances comparable to full-feature models (accuracy ≈91% and AUC ≈ 0.95). In addition, near-minimal models incorporating gender alongside age and medications demonstrated a favorable balance between discrimination and computational efficiency under external validation. Although overall performance declined under distributional shift, naïve Bayes and efficient linear classifiers showed the most stable external behavior (AUC = 0.728–0.787). Conclusions: These findings indicate that stability-driven feature selection primarily reproduces well-established epidemiological risk patterns rather than identifying novel predictors. Minimal and near-minimal models—including those incorporating gender—retain acceptable performances under external validation and are methodologically efficient. Given the limited size and single-center nature of the external cohort, the results should be interpreted as preliminary methodological evidence rather than definitive support for clinical screening deployment. Further multi-center studies are required to assess generalizability and clinical relevance. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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12 pages, 2619 KB

Open AccessArticle

Decortication in the Surgical Management of Complete Atypical Femoral Fractures: A Strategy to Accelerate Fracture Healing

by Young-Ho Cho, Changhun Lim and Dongha Kim

J. Clin. Med. 2026, 15(2), 436; https://doi.org/10.3390/jcm15020436 - 6 Jan 2026

Cited by 1 | Viewed by 1002

Abstract

Background/Objectives: Surgical management of atypical femoral fractures (AFFs) stabilized with intramedullary (IM) nailing is frequently challenged by delayed union or nonunion due to the severely suppressed bone turnover characteristic of bisphosphonate-related bone pathology, often leading to a hypertrophic nonunion-like state at the fracture site. This consecutive case series aimed to evaluate the effectiveness of intraoperative percutaneous decortication at the hypertrophic cortex in promoting rapid bone healing in complete AFFs. Methods: This was a single-center consecutive case series of patients with complete atypical femoral fractures (AFFs) treated with intramedullary nailing and adjunctive percutaneous decortication since February 2021. The standardized surgical protocol—including percutaneous decortication performed through a small anterolateral incision using an osteotome to create bone chips and stimulate the sclerotic cortex—was applied prospectively to all consecutive patients from February 2021. Of the 20 patients who underwent surgery during this period, 14 with sufficient radiographic follow-up were included in the final retrospective analysis. Data collected included patient demographics, duration of bisphosphonate use, fracture location (diaphyseal vs. subtrochanteric), operative details (including iatrogenic fracture), and radiographic bone union time. Bone union was assessed on serial radiographs by two independent observers. Results: All 14 patients were female, with a median age of 75 years (IQR 67–79 years). Thirteen patients (92.9%) had prior bisphosphonate exposure for a median of 4.5 years (IQR 3–10 years). Six fractures were subtrochanteric fractures, and six were complicated by iatrogenic fracture during nail insertion. Postoperative teriparatide was administered to six patients. Radiographic bone union was achieved in all 14 patients at a median of 19 weeks (IQR 16–22 weeks; range 16–24 weeks). No major complications (infection, implant failure, nonunion, or neurovascular injury) occurred during follow-up. Conclusions: Percutaneous decortication is a simple, safe, and biologically plausible adjunct to intramedullary nailing. In this series of 14 elderly women with long-term bisphosphonate exposure (median 4.5 years), the technique was associated with 100% radiographic union at a median of 19 weeks without major complications, suggesting a promising strategy that warrants validation in larger, controlled trials. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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33 pages, 5235 KB

Open AccessArticle

Long-Term and Heavy Smoking as a Risk Factor for Lumbar Spinal Stenosis: Evidence from a Large-Scale, Nationwide Population-Based Cohort

by Ji-Hyun Ryu, Ki-Won Kim and Ju-Yeong Kim

J. Clin. Med. 2025, 14(21), 7691; https://doi.org/10.3390/jcm14217691 - 29 Oct 2025

Cited by 1 | Viewed by 2174

Abstract

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of disability in older adults, but the role of cigarette smoking in its development remains unclear. This study aimed to clarify the association between smoking and the incidence of LSS, with a focus on dose–response relationships and subgroup variations by age and sex. Methods: We conducted a nationwide, population-based cohort study using the Korean National Health Insurance Service database. A total of 2,123,268 adults aged ≥ 40 years who underwent health screening in 2009 were followed until LSS diagnosis, death, or 2020. Smoking status, duration, daily consumption, and pack-years were assessed. Cox proportional hazards models with progressive adjustment for demographic, lifestyle, and clinical factors were applied. Results: Over a mean follow-up of 8.2 years (17.5 million person-years), 721,909 new cases of LSS were identified. Fully adjusted models showed higher risk in former (HR 1.047; 95% CI, 1.039–1.056) and current smokers (HR 1.052; 95% CI, 1.044–1.060) compared with never smokers. A clear dose–response pattern was observed, with the greatest risk in heavy smokers (≥40 pack-years; HR 1.207; 95% CI, 1.191–1.222). Subgroup analyses indicated stronger associations among adults aged ≥ 65 years and in women. Conclusions: Cigarette smoking was independently associated with an increased risk of LSS, with risk increasing according to lifetime exposure. The findings underscore the importance of smoking cessation strategies to reduce the burden of spinal degeneration, especially in older adults and women. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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10 pages, 1803 KB

Open AccessArticle

Innovating Pelvic Fracture Surgery: Development and Evaluation of a New Surgical Table for Enhanced C-Arm Imaging and Operational Efficiency

by Yong-Cheol Yoon, Min Jun Kim, Ji Sub Lim and Hyung Keun Song

J. Clin. Med. 2025, 14(9), 3169; https://doi.org/10.3390/jcm14093169 - 3 May 2025

Viewed by 1395

Abstract

Background: Pelvic fractures require precise reduction and stabilization, necessitating high-quality C-arm imaging and accurate patient positioning. Standard operating tables often obstruct optimal C-arm maneuverability. To address this, we developed a new auxiliary surgical table that integrates with existing tables and evaluated its clinical utility compared to a specialized carbon surgical table. Methods: Between March 2018 and June 2023, we conducted a retrospective study involving 162 patients (97 men and 65 women; average age 45.7 years) who underwent percutaneous sacroiliac screw fixation for pelvic fractures. Ninety patients were treated using the newly developed table, and seventy-two patients were treated using the carbon table. The new table, measuring 200 cm in length, 50 cm in width, and 2 cm in thickness, was constructed from waterproof plywood and designed to be securely attached to existing operating tables. We compared surgical preparation times, economic costs, and intraoperative imaging feasibility between the two groups. Results: Use of the new table significantly reduced the surgical preparation time by an average of 21 min and saved approximately $43,000 in cost compared to the carbon table. Subjective assessments indicated no notable difference in intraoperative C-arm image quality between the two groups. The new table allowed free C-arm rotation by overcoming the mechanical limitations of conventional tables. Conclusions: The new auxiliary table demonstrated clinical feasibility and economic advantages without compromising intraoperative imaging quality, offering a practical and cost-effective alternative for pelvic fracture surgeries. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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11 pages, 1028 KB

Open AccessArticle

Comparative Analysis of Anterolateral and Posterior Approaches for Distal Humerus Shaft Fractures: A Multicenter Retrospective Study

by Yong-Cheol Yoon, Hyoung-Keun Oh, Hyung-Suh Kim and Joon-Woo Kim

J. Clin. Med. 2025, 14(9), 2890; https://doi.org/10.3390/jcm14092890 - 22 Apr 2025

Cited by 2 | Viewed by 2499

Abstract

Background: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. Methods: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Results: Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (p = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, p = 0.03). However, intraoperative blood loss (p = 0.36), Mayo Elbow Performance Score (p = 0.71), range of motion (p = 0.36), and complication rates (p = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (p = 0.17), and four cases required implant removal due to discomfort (p = 0.18) in the anterolateral group. Conclusions: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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14 pages, 5246 KB

Open AccessSystematic Review

Risk Factors for Readmission Within 30 Days After Discharge Following Hip Fracture Surgery: A Systematic Review and Meta-Analysis

by Kyung-Joo Lee, Ji Wan Kim and Chul-Ho Kim

J. Clin. Med. 2025, 14(8), 2779; https://doi.org/10.3390/jcm14082779 - 17 Apr 2025

Cited by 6 | Viewed by 2437

Abstract

Background/Objectives: Hip fractures in older patients frequently lead to early readmissions, which negatively impact patient outcomes and significantly increase healthcare costs. Identifying and understanding risk factors for 30-day readmission following hip fracture surgery is essential for improving patient management and optimizing healthcare resource utilization. Methods: A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library databases up to 30 December 2024. Studies investigating potential risk factors for 30-day readmission following hip fracture surgery were included. The risk factors were meta-analytically pooled, and odds ratios (ORs) were calculated using a random-effects model. Results: Twelve studies comprising 128,053 patients were included. Pooled analyses revealed significant associations between higher readmission rates and factors such as male sex (OR = 1.45; 95% CI, 1.27–1.65), hip arthroplasty surgery (OR = 1.36; 95% CI, 1.03–1.80), advanced age (OR, 1.22; 95% CI 1.00–1.49), high American Society of Anesthesiologists (ASA) Physical Status Classification System class (OR, 2.22; 95% CI, 1.28–3.85), and high Charlson comorbidity index (OR, 1.67; 95% CI, 1.36–2.05). Additionally, the most frequently reported comorbidities associated with higher readmission risks were diabetes mellitus and congestive heart failure, with ORs of 1.63 and 1.57, respectively. Conclusions: Male sex, advanced age, higher ASA scores, and greater preoperative comorbidity burdens significantly increase the risk of 30-day readmission following hip fracture surgery. Effective risk stratification and targeted perioperative management strategies addressing these identified factors may reduce early readmission rates and enhance postoperative patient outcomes. Full article

(This article belongs to the Special Issue Accelerating Fracture Healing: Clinical Diagnosis and Treatment)

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