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Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation
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Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation

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

Deadline for manuscript submissions: 20 August 2026 | Viewed by 3183

Special Issue Editor

Prof. Dr. Emmanouil Liodakis

E-Mail Website
Guest Editor
Department of Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, 66421 Homburg, Germany
Interests: orthopedic trauma; fragility fractures; biomechanics; hip surgery; bone defect; nonunions; pelvic ring; acetabular fractures

Special Issue Information

Dear Colleagues,

Orthopaedic trauma care has undergone major advances in recent years, particularly in the management of fragility fractures, complex pelvic and acetabular injuries, postraumatic bone defects, and amputations. Meanwhile, deeper understanding of biomechanics, biology, and implant charachteristics has led to more individualized treatment approaches.

Emerging technologies such as 3D printing, smart implants, artificial intelligence, and computer-assisted planning are further transforming trauma care by enabling personalized solutions for complex injuries. These innovations, combined with progress in bone regeneration and rehabilitation, hold great potential to improve outcomes across the full spectrum of orthopaedic trauma.

This Special Issue of the Journal of Clinical Medicine welcomes original research articles and reviews addressing recent developments in orthopaedic trauma care. Submissions may focus on clinical aspects of fracture treatment, bone defect reconstruction, pelvic and acetabular trauma, amputation management, and rehabilitation. Contributions exploring the role of new technologies in surgical decision-making, implant design, and regenerative strategies are of particular interest.

We look forward to receiving your submissions.

Prof. Dr. Emmanouil Liodakis
Guest Editor

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

  • orthopedic trauma
  • fragility fractures
  • biomechanics
  • bone defect
  • pelvic ring
  • acetabular fractures
  • amputation
  • re-habilitation

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Published Papers (4 papers)

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Research

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10 pages, 1946 KB  
Article
Open Book on the Water Slide: A Case Series of APC2 Pelvic Ring Injuries from High-Energy Aquatic Accidents
by Adeeb Algaith, Kapil Soni, Attila Mácsai, Lilla Sándor, Ákos Csonka, Endre Varga and Petra Hartmann
J. Clin. Med. 2026, 15(5), 1729; https://doi.org/10.3390/jcm15051729 - 25 Feb 2026
Viewed by 278
Abstract
Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity [...] Read more.
Background and Objectives: Pelvic ring injuries with symphyseal disruption are classically associated with high-energy mechanisms such as motor vehicle collisions. Recently, waterslides have emerged as an underrecognized but distinct source of severe pelvic trauma. Waterslide-related pelvic trauma represents a distinct biomechanical entity characterized by a supine or semi-supine body position at splashdown, extreme forced hip abduction, asymmetric lower-limb positioning, and abrupt hydrodynamic deceleration. The high descent velocity, abrupt hydrodynamic deceleration, and forced hip abduction at water entry may combine to generate open-book-type pelvic injuries. Evidence guiding diagnosis and surgical management in this setting remains scarce. Materials and Methods: We retrospectively analyzed a consecutive series of adult patients sustaining waterslide-related anterior–posterior compression type II (APC2) pelvic ring injuries. Demographic data and the body mass index (BMI), fracture classification, surgical strategy, complications, and functional outcomes were reviewed. Only patients with complete imaging, operative records, and follow-up were included. Results: Four patients (38–72 years) met the inclusion criteria. All sustained rotationally unstable open-book pelvic injuries and were classified as APC2; three were AO/OTA 61B2.3 and one 61B3.3. All patients were overweight or obese (BMI 27.2–31.2). Pelvic binders provided an effective acute reduction in symphyseal diastasis; however, in one bilateral injury, CT imaging obtained with the binder in situ masked posterior ligamentous instability. Definitive surgical fixation was performed in all cases. Early mechanical failure occurred in two patients treated with short anterior symphyseal plate constructs. In the bilateral injury, isolated anterior fixation failed repeatedly until posterior sacroiliac stabilization was added. No deep infections or thromboembolic events occurred. Although two patients required short observational ICU stays, none were admitted for hemodynamic instability or pelvic bleeding. Conclusions: At 12-month follow-up, three patients achieved pain-free ambulation without assistive devices, while one patient required intermittent use of a single crutch; all patients regained independence in daily activities. Waterslide accidents represent a high-energy injury mechanism capable of producing severe APC2 pelvic disruptions, particularly in patients with an elevated BMI. Awareness of this mechanism and meticulous assessment of posterior stability are essential to avoid under-treatment and mechanical failure. Full article
(This article belongs to the Special Issue Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation)
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17 pages, 1389 KB  
Article
Risk-Stratified Predictive Analysis of Docking Site Outcomes in Lower Extremity Bone Transport: Identifying High-Risk and Low-Risk Zones for Large Segmental Defect Management
by Gökmen Aktas, Jorge Mayor, Jan Clausen, Ricardo Ramon, Tilman Graulich, Schayan Tabrizi, Maximilian Koblenzer, Hür Özbek, Emmanouil Liodakis, Phillipp Mommsen, Stephan Sehmisch and Tarek Omar Pacha
J. Clin. Med. 2026, 15(2), 487; https://doi.org/10.3390/jcm15020487 - 8 Jan 2026
Viewed by 293
Abstract
Background: Reconstruction of limbs with extensive bone loss often requires complex surgical procedures, which can be technically demanding, time-consuming, and physically and psychologically burdensome for patients. Historically, the lack of alternatives for large bone defects often led to primary amputation. Modern musculoskeletal [...] Read more.
Background: Reconstruction of limbs with extensive bone loss often requires complex surgical procedures, which can be technically demanding, time-consuming, and physically and psychologically burdensome for patients. Historically, the lack of alternatives for large bone defects often led to primary amputation. Modern musculoskeletal practice allows for reconstruction using autologous or allogeneic bone grafts, or through more complex procedures such as the Masquelet technique or distraction osteogenesis. However, these methods share a common challenge: the need for a docking site procedure in cases of insufficient bony fusion of the transport segment. The aim of this study was to identify predictive factors for the need for a docking site procedure. Methods: A retrospective analysis was conducted on 93 patients treated for lower extremity bone defects between January 2013 and June 2023. Of these, 39 patients (41.9%) underwent segmental bone transport and formed the study cohort for the predictive model analysis. Patients of all ages and both genders were included, regardless of the etiology and size of the defect. The need for a docking site procedure was analyzed using logistic regression, ROC analysis, and ANOVA. Results: The study included 93 patients (73 male, 19 female) aged 7 to 83 years. The mean defect size was 76.46 mm (range: 12.1 to 225.1 mm). The mean transport duration was 149.97 days, with a mean transport speed of 0.61 mm/day. Among the 39 segmental transport patients, a docking site procedure was performed in 64.1% (n = 25). Logistic regression and ROC analysis were performed on this subgroup (n = 39, with 25 events). Significant predictors for the need for a docking site procedure were age (p = 0.024), vascular injury (p = 0.009), transport duration (p = 0.001), and transport speed (p < 0.001). ROC analysis demonstrated that transport speed (AUC = 0.931) and transport duration (AUC = 0.911) showed strong discriminative ability for predicting docking site procedure necessity, suggesting potential utility as clinical decision-support parameters. Conclusions: The study identified transport duration and speed as potentially valuable predictive factors in this retrospective cohort for the need of a docking site procedure, though prospective validation is required. A transport duration exceeding 290.5 days significantly increased the likelihood of requiring a docking site procedure. These findings can help optimize treatment planning and improve long-term limb preservation. Full article
(This article belongs to the Special Issue Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation)
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15 pages, 904 KB  
Article
Treatment Strategies for Isolated LC-1 Pelvic Injuries: A Comparative Cohort Study of Percutaneous Posterior-Only vs. Combined Anterior–Posterior Fixation
by Mohammed Rashed Aly Abdelrahman, Frank Hildebrand, Eftychios Bolierakis, Till Berk and Hatem Alabdulrahman
J. Clin. Med. 2025, 14(21), 7507; https://doi.org/10.3390/jcm14217507 - 23 Oct 2025
Viewed by 1525
Abstract
Background: The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior–posterior fixation remains scarce. This study evaluated whether [...] Read more.
Background: The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior–posterior fixation remains scarce. This study evaluated whether institutional criteria reliably identify patients who benefit from additional percutaneous anterior fixation. Methods: A retrospective cohort study was conducted at a level I trauma center and included adults with LC-1 fractures treated exclusively by percutaneous fixation. Combined anterior–posterior fixation was performed when predominant anterior pain and radiographic compromise indicated instability. Primary outcomes were pain trajectory (Numeric Rating Scale), inpatient opioid use, physiotherapy clearance, and ward mobility. Results: Thirty-seven patients were analyzed (combined = 14; posterior-only = 23). Preoperative pain was higher in the combined group (median 7 vs. 6; median difference 1 [95% CI 0 to 2]; p = 0.0036). Postoperatively, pain scores were lower in the combined group at 1–6 weeks (median difference −1 [95% CI −2 to 0]; p < 0.05). Opioid consumption was reduced (193 mg vs. 312 mg; median difference −200 mg [95% CI −280 to −120]; p < 0.001), and physiotherapy clearance occurred earlier (4 vs. 7 days; median difference −3 [95% CI −5 to −1]; p = 0.020). Conclusion: Our current indications to perform combined fixation were associated with favorable early outcomes in pain control and physiotherapy clearance among patients with LC-1 fractures showing anterior compromise. These results support a selective combined approach, though interpretation must remain cautious given the small retrospective cohort. Further prospective studies are warranted to validate these findings and refine patient selection. Full article
(This article belongs to the Special Issue Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation)
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Review

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22 pages, 931 KB  
Review
Central Sensitisation After Orthopaedic Trauma: An Overlooked Contributor to Chronic Pain and Functional Disability—A Scoping Review
by Arfaz Shaik, Arjun Chakrapani, Aaron Alexander, Abdullah Al Jumaili and Umar Hayat
J. Clin. Med. 2026, 15(3), 1035; https://doi.org/10.3390/jcm15031035 - 28 Jan 2026
Viewed by 509
Abstract
Background: Persistent pain following orthopaedic trauma is common, often disproportionate to structural healing, and increasingly interpreted as reflecting centrally mediated pain mechanisms. However, the mechanisms, clinical features, diagnostic approaches, prognostic indicators, and management strategies relevant to trauma-related central sensitisation (CS) remain poorly understood. [...] Read more.
Background: Persistent pain following orthopaedic trauma is common, often disproportionate to structural healing, and increasingly interpreted as reflecting centrally mediated pain mechanisms. However, the mechanisms, clinical features, diagnostic approaches, prognostic indicators, and management strategies relevant to trauma-related central sensitisation (CS) remain poorly understood. Objective: To map and synthesise existing evidence on CS following orthopaedic trauma, addressing mechanistic pathways, clinical manifestations, epidemiology, assessment methods, management approaches, and health system implications. Methods: A scoping review was conducted in accordance with PRISMA-ScR. Twenty-one studies met the eligibility criteria, comprising nine primary trauma cohorts and 12 contextual mechanistic or review studies relevant to trauma-associated CS. Data were charted across six prespecified domains of mechanistic processes, clinical presentation and diagnostic features, epidemiology and prognosis, assessment tools and outcome measures, interventions, and health system and care delivery considerations. Results: Mechanistic studies demonstrated trauma-induced neuroimmune activation, altered cortical and spinal excitability, and molecular pathways consistent with sensitisation. Clinical studies have identified neuropathic features, widespread pain, and heightened sensory responsiveness following fractures and other injuries. Neurophysiological evidence has indicated early cortical disinhibition following upper limb trauma, whereas epidemiological cohorts have reported persistent pain and disability years after major trauma. Measurement studies have highlighted the limited reliability and specificity of current tools in trauma populations, including quantitative sensory testing and self-report instruments. Early predictors of adverse trajectories include severe acute pain, neuropathic descriptors, psychological distress, and opioid-dominant analgesia. Evidence regarding early intervention, rehabilitation strategies, and system-level screening pathways remains limited. Conclusions: Central sensitisation (CS)–consistent mechanisms after orthopaedic trauma are suggested by convergent mechanistic, neurophysiological, and clinical findings. However, trauma-specific diagnostic criteria, prognostic models, and management frameworks remain underdeveloped. High-quality longitudinal research is needed to clarify early trajectories, refine assessment methods, and establish targeted interventions to reduce long-term pain and disability. Full article
(This article belongs to the Special Issue Orthopedic Trauma: Diagnosis, Treatment and Rehabilitation)
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