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Orthopedic Trauma and Fracture Care: Patient Expectations and Fulfillment in Clinical Practice

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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 (25 February 2025) | Viewed by 2109

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Dr. Tim Saier

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Guest Editor

Department for Orthopedic Sports Medicine, Technical University Munich, Munich, Germany
Interests: sports injuries; knee surgery; knee injuries; fracture; trauma surgery; bone; arthroplasty; hip

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine aims to add more insights on the important topic of patient-reported outcomes in trauma surgery care. To date, it has already been highlighted that measuring patients´ expectations and fulfillment is a powerful tool to compare preoperative expectations and perceived improvement postoperatively. Understanding expectations and fulfillment in trauma surgery helps to highlight areas for improvement in guiding patients towards realistic expectations and establishing better care. With such information, surgeons can assist in setting realistic patient expectations and goals. This has the potential to provide valuable additional support for patients whose expectations may not have been fully met. To achieve these objectives, it is of high relevance to add data to the existing literature that directly assesses patients' expectations and fulfillment in trauma surgery. With this Special Issue, we aim to fill a gap in the exisiting literature on this topic. We encourage you to share your valuable data with us.

Dr. Tim Saier
Guest Editor

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Keywords

fracture
trauma surgery
patient-reported outcome
expectation
fulfillment

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Published Papers (3 papers)

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Research

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11 pages, 588 KiB

Open AccessArticle

Routine Removal of Syndesmotic Screws After Tibiofibular Syndesmosis Fixation Does Not Affect Patient Function and Is Associated with a Higher Risk of Postoperative Complications

by Błażej Grzegorz Wójtowicz, Katarzyna Chawrylak, Jędrzej Lesman, Hubert Makowski, Kacper Kuczyński, Michał Maciejowski, Antoni Raciborski-Król and Marcin Domżalski

J. Clin. Med. 2025, 14(10), 3276; https://doi.org/10.3390/jcm14103276 - 8 May 2025

Abstract

Background: Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its clinical relevance. Methods: This retrospective observational study included 330 patients treated surgically for tibiofibular syndesmosis injuries at a single institution from 2016 to 2024. Patients were categorized into three groups: no removal, routine removal, and removal for clinical indications. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS), and complications, including infections and prolonged pain, were recorded. Statistical analyses evaluated differences between groups. Results: Of the 170 patients who completed follow-up, no significant differences in OMASs were found between the groups (p = 0.646). Complications were more frequent in reoperated patients (9% vs. 2% for non-reoperated), but routine removal did not improve functional outcomes. Younger patients showed better OMASs, highlighting age as a key factor in recovery. Fixation and fracture types had no significant impact on outcomes. Conclusions: Routine syndesmosis screw removal offers no significant functional benefits, as demonstrated by comparable OMASs across groups (median OMAS: 85 for non-reoperated, 80 for routinely reoperated, and 80 for indication-based reoperated patients). However, routine removal is associated with a higher complication rate. A selective approach focusing on clinical indications is recommended to minimize unnecessary surgeries and optimize patient outcomes. Future research should focus on redefining evidence-based management strategies for syndesmotic fixation. Full article

(This article belongs to the Special Issue Orthopedic Trauma and Fracture Care: Patient Expectations and Fulfillment in Clinical Practice)

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10 pages, 805 KiB

Open AccessArticle

Return to Skiing After Proximal Tibial Fracture: Postoperative Reality and Initial Expectations

by Lena Keppler, Fanny Navarre, Alexander Martin Keppler, Fabian Maria Stuby, Wolfgang Böcker and Tim Saier

J. Clin. Med. 2024, 13(23), 7352; https://doi.org/10.3390/jcm13237352 - 2 Dec 2024

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Abstract

Background/Objectives: The aim of this study was to investigate patient-reported outcomes of patient expectations and fulfillment of expectations in alpine skiers who had a skiing accident and suffered a complex proximal tibial fracture (AO/OTA—Type B or C) which was treated surgically with open reduction and internal fixation. Methods: In this prospective study, 38 consecutive patients who suffered a complex tibial fracture (AO/OTA—Type B and C) caused by a skiing accident were evaluated. Before surgical treatment with open reduction and internal fixation, patient expectations were evaluated regarding outcomes on knee functionality (e.g., pain) and the return to skiing. At follow-up ≥ 1 year after surgery, an individualized questionnaire was used to evaluate whether their preoperatively formulated expectations had been fulfilled (rated 0–2). In addition, the Knee injury and Osteoarthritis Outcome Score (KOOS), and SF-12 was used. Results: Preoperatively, 76% (n = 29) of patients stated that it was “not so important” to be able to return to their initial skiing level, 50% (n = 19) of patients did not expect to be able to ski again, 34% (n = 13) expected to return to skiing at a significantly lower level, and 16% (n = 6) expected to return to skiing with minor restrictions at most. Postoperatively, the return to skiing rate on initial level was 32% (n = 12); 50% (n = 19) stated that their initial skiing level was not reached again but they were able to ski with moderate restrictions, 10% (n = 4) patients stated that no return to skiing was possible, 50% (n = 19) stated that their expectations were fully met, and n = 7 (18%) stated that their preoperative expectations were not met at all. The mean SF-12 physical component score (PCS) was 52, and the mean mental component score (MCS) was 49.9. The mean Numeric Rating Scale (NRS) was 2.3. The mean KOOS for pain was 86.1 (SD 17.1), for symptoms 62.2 (SD 12.9), for ADL 90.7 (SD 14.4), for sports 74.2 (SD 25.7), and for quality of life (QOL) 66.6 (21.0). Conclusions: After suffering from a complex proximal tibial fracture (AO/OTA—Type B or C) in a skiing accident, preoperative patient expectations to return to skiing is limited. This patient-reported outcome of patient expectations was confirmed by the findings of the patient-reported fulfillment of expectations at least one year after surgery as only 32% of patients returned to their initial skiing level, 50% returned to skiing with limitations, and 50% of patients did not meet their preoperative expectations to return to alpine skiing. The results of this study emphasize the importance of directing patients towards realistic expectations by managing the patients’ understanding of the severity of their injury and realistic outcomes, and providing realistic forecasts of postoperative outcomes. Full article

(This article belongs to the Special Issue Orthopedic Trauma and Fracture Care: Patient Expectations and Fulfillment in Clinical Practice)

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Review

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17 pages, 9437 KiB

Open AccessReview

Minimally Invasive and Navigation-Assisted Fracture Stabilization Following Traumatic Spinopelvic Dissociation

by Mina Y. Girgis, Alex Tang, Michael S. Pheasant, Kenneth L. Koury, Michael T. Jung and Tan Chen

J. Clin. Med. 2025, 14(4), 1289; https://doi.org/10.3390/jcm14041289 - 15 Feb 2025

Viewed by 585

Abstract

Spinopelvic dissociation is a highly unstable orthopedic injury with a growing incidence worldwide. Operative treatment classically involves an open lumbopelvic fusion and sacroiliac stabilization, which carries high perioperative morbidity and mortality in a frail patient population. Advancements in spinal navigation, robotics, and minimally invasive surgery (MIS) techniques now allow these fracture patterns to be treated entirely percutaneously through small incisions. These incisions are just large enough to accommodate pedicle screw guides and enable the placement of lumbopelvic instrumentation, with rods being passed subfascially across pedicle screws and extending caudally to iliac fixation. This contrasts with the open midline approach, which requires more extensive soft tissue dissection and results in increased blood loss compared to percutaneous techniques. Modern imaging techniques, including CT navigation and robotics, facilitate the precise placement of sacral S2AI screw instrumentation in both open and percutaneous methods, all while safely avoiding previously placed trans-sacral fixation and other existing hardware, such as acetabular screws. Trans-sacral screws are typically percutaneously inserted first by the orthopedic trauma service, utilizing inlet, outlet, and lateral sacral fluoroscopic guidance to navigate the limited available corridor. With the advent of MIS techniques, trauma patients can now benefit from faster postoperative rehabilitation, minimal blood loss, decreased pain, and quicker mobilization. This article will review current concepts on spinopelvic anatomy, fracture patterns, indications for treatment, and current concepts for minimally invasive percutaneous lumbopelvic fixation, and it will present illustrative examples. Full article

(This article belongs to the Special Issue Orthopedic Trauma and Fracture Care: Patient Expectations and Fulfillment in Clinical Practice)

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