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Recent Advances in the Management of Fractures
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Recent Advances in the Management of Fractures

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

Deadline for manuscript submissions: 15 December 2025 | Viewed by 7373

Special Issue Editors

Prof. Dr. Giulio Maccauro

E-Mail Website
Guest Editor
Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
Interests: pathological fractures; bone tumors; metastases; infection; prosthesis; hip; sarcoma; biomaterial
Special Issues, Collections and Topics in MDPI journals
Dr. Raffaele Vitiello

E-Mail Website
Guest Editor
Orthopaedics and Traumatology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
Interests: infections; bone and soft tissue tumor; traumatology; foot and ankle surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue aims to provide an in-depth exploration of the latest advancements in fracture management. It will cover innovative surgical techniques, advanced diagnostic imaging methods, and the application of novel biomaterials for bone repair. Our objective is to offer a comprehensive overview of state-of-the-art approaches that are revolutionizing outcomes for orthopedic patients. We invite submissions of manuscripts that present cutting-edge research and clinical trials offering fresh perspectives on fracture treatment and rehabilitation.

Prof. Dr. Giulio Maccauro
Dr. Raffaele Vitiello
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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • trauma
  • fractures
  • prosthesis
  • megaprosthesis
  • modular prosthesis
  • plate
  • nail
  • combo
  • screw
  • rehabilitation
  • radiology

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Published Papers (6 papers)

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Research

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12 pages, 5341 KB  
Article
Whole Span Plating Prevents Subsequent Ipsilateral Femoral Fractures After Peri-Implant Fixation: A Preliminary Report
by Shunsuke Sato, Satoshi Hatashita, Michiyuki Hakozaki, Takuya Kameda, Yoichi Kaneuchi, Masayuki Ito and Yoshihiro Matsumoto
J. Clin. Med. 2025, 14(10), 3473; https://doi.org/10.3390/jcm14103473 - 15 May 2025
Viewed by 1048
Abstract
Background: Peri-implant femoral fractures are increasingly prevalent among the elderly, often leading to re-fractures due to osteoporosis and implant stress. Whole span plating (WSP) has been proposed as a surgical approach to mitigate this risk. Methods: A retrospective study was conducted on 10 [...] Read more.
Background: Peri-implant femoral fractures are increasingly prevalent among the elderly, often leading to re-fractures due to osteoporosis and implant stress. Whole span plating (WSP) has been proposed as a surgical approach to mitigate this risk. Methods: A retrospective study was conducted on 10 patients (mean age: 79.5 years) who underwent WSP for peri-implant femoral fractures between April 2020 and March 2023. Fractures were classified using the Vancouver, NPPIF, and Lewis and Rorabeck systems. Surgical indication required meeting at least two of the following criteria: age ≥ 70 years, history of fragility fracture(s), high fall risk, severe osteoporosis, extensive fracture pattern, or no implant loosening. Results: No re-fractures were observed during a mean follow-up period of 14.5 months. Although 90% of patients required red blood cell transfusions (mean volume: 3.8 units), early weight-bearing was achieved in most cases. Four patients had received osteoporosis treatment, highlighting the need for integrated bone health management. Conclusions: WSP appears to be a feasible and safe surgical option for high-risk patients with peri-implant femoral fractures, potentially reducing the incidence of subsequent fractures. Further studies with larger cohorts and longer follow-up are warranted. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
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15 pages, 4970 KB  
Article
ARTT Approach to Total Elbow Arthroplasty Devised for Post-Trauma Patients: Preliminary Results
by Biagio Abate, Martina Coppola, Giuseppe Bardellini, Federico Martinelli, Andrea Celli and Luigi Celli
J. Clin. Med. 2025, 14(9), 2901; https://doi.org/10.3390/jcm14092901 - 23 Apr 2025
Viewed by 744
Abstract
Background: An increasing number of total elbow arthroplasty (TEA) procedures are performed in trauma patients every year through a variety of approaches. We have devised the Anconeus-reflected Triceps tongue (ARTT) approach for TEA, which optimizes soft tissue management and implant placement, particularly in [...] Read more.
Background: An increasing number of total elbow arthroplasty (TEA) procedures are performed in trauma patients every year through a variety of approaches. We have devised the Anconeus-reflected Triceps tongue (ARTT) approach for TEA, which optimizes soft tissue management and implant placement, particularly in post-trauma patients, where extensive scar tissue and/or marked bone deformity hamper joint exposure and carry a risk of component malposition. We describe the ARTT surgical technique, discuss its advantages, and report its preliminary results. Methods: Six consecutive patients with malunion of the articular elbow surfaces with severe soft tissue retraction and multiple previous surgeries underwent TEA using the ARTT approach, which spares the triceps tendon insertion on the olecranon and reflects the anconeus and triceps muscles as one. Results: At a mean follow-up of 29 months, the Mayo Elbow Performance Score had increased from 39 to 95 points, whereas the visual analog score for pain had fallen from 7.5 to 1. None of the patients had insufficiency or secondary detachment of the triceps tendon and all achieved grade 4 or 5 on the Medical Research Council scale. Discussion: The ARTT approach provides enhanced joint exposure, resulting in the preservation of the triceps tendon insertion on the olecranon and enabling earlier active rehabilitation. Our preliminary results indicate that it is a viable alternative to traditional techniques, particularly in post-trauma patients with severe elbow dysfunction, who often suffer from extensive scarring, soft tissue damage, and bone deformity. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
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Review

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10 pages, 236 KB  
Review
A Comprehensive Review of 3D Imaging and Printing in Proximal Humerus Fractures and Sequelae
by Roberto de Giovanni, Martina Coppola, Valentina Rossi, Massimo Mariconda and Andrea Cozzolino
J. Clin. Med. 2025, 14(21), 7711; https://doi.org/10.3390/jcm14217711 - 30 Oct 2025
Viewed by 182
Abstract
Proximal humerus fractures are common and complex; despite advances, malunion, nonunion, and osteonecrosis remain concerns. Three-dimensional (3D) imaging/printing has emerged to improve classification, planning, and execution, especially in displaced patterns. Methods: Multiple databases have been searched using predefined terms (“proximal humerus fractures/sequelae”, “three-dimensional”, [...] Read more.
Proximal humerus fractures are common and complex; despite advances, malunion, nonunion, and osteonecrosis remain concerns. Three-dimensional (3D) imaging/printing has emerged to improve classification, planning, and execution, especially in displaced patterns. Methods: Multiple databases have been searched using predefined terms (“proximal humerus fractures/sequelae”, “three-dimensional”, and “3D printing”). Inclusion criteria targeted human longitudinal studies (retrospective/prospective) on 3D-assisted fracture or sequela management; expert opinion, prior reviews, and letters to editors were excluded. Data extracted included the design, the level of evidence (LoE), the sample size, 3D application (diagnostic, planning, intraoperative, and combined), outcomes, follow-up, and complications. Results: Nineteen studies were included (fourteen fractures and five sequelae; 636 and 28 patients, respectively). In fractures, 3D imaging was used chiefly for preoperative planning (57.1%) and diagnostic support (35.7%); no intraoperative PSI was reported. In sequelae, intraoperative/PSI dominated (100%), with planning in 80% and combined uses in 80%. Fracture studies were mostly retrospective (50.0%; LoE III 78.6%), while all sequelae were LoE IV–V (60% of case reports). Standardized outcomes were reported in 42.1% of studies; follow-up was available in 42.1% (means ≈ 18 months). Complications occurred in 14.3% of fracture studies and in none of the sequelae. Conclusions: Three-dimensional printing is primarily applied for planning in fractures and intraoperative guidance in sequelae. While feasibility and potential perioperative benefits are evident, small heterogeneous cohorts and limited outcome reporting warrant larger prospective studies with standardized endpoints. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
13 pages, 558 KB  
Review
Megaprosthetic Reconstruction for Pathological Proximal Humerus Fractures: Infection Rates, Prevention Strategies, and Functional Outcomes—A Narrative Review
by Federica Messina, Cesare Meschini, Maria Serena Oliva, Matteo Caredda, Antonio Bove, Giuseppe Rovere and Antonio Ziranu
J. Clin. Med. 2025, 14(21), 7672; https://doi.org/10.3390/jcm14217672 - 29 Oct 2025
Viewed by 270
Abstract
Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. [...] Read more.
Background: Megaprosthetic replacement is widely used following tumour resection but remains challenged by periprosthetic joint infection (PJI) and variable functional outcomes. This narrative review aims to summarise current evidence on infection rates, prevention strategies, and functional outcomes following proximal humerus megaprosthetic reconstruction. We hypothesise that antibacterial coatings and improved soft-tissue techniques reduce infection rates and enhance functional recovery. Methods: A comprehensive narrative review of PubMed, Web of Science, and the Cochrane Library was performed using the terms proximal humerus, shoulder, bone tumor, sarcoma, neoplasm, infection, megaprosthesis, and endoprosthetic replacement. Reference lists were screened manually. Case reports and series with fewer than five patients were excluded. Twenty-seven clinical studies (more than 1100 patients; mainly osteosarcoma, chondrosarcoma, and metastatic lesions) were included and qualitatively analyzed. Results: The reported infection rates ranged from 4% to 20%, with higher risk in patients receiving adjuvant therapy. Silver-coated implants reduced PJI compared with uncoated designs (e.g., 11.2% → 9.2% in primary implants; 29.2% → 13.7% in revisions) without systemic toxicity. Alternative antibacterial coatings (e.g., silver- or copper-enriched hydroxyapatite) showed promising early results but remain supported by limited clinical data. Soft-tissue stabilization with Trevira tube or synthetic mesh improved joint stability and did not increase infection risk. Functional outcomes, usually assessed by MSTS or TESS, were moderate to good (≈60–80%) overall, with better scores when the deltoid and axillary nerve were preserved or when reverse total shoulder arthroplasty was possible. Conclusions: Proximal humerus megaprosthetic reconstruction benefits from meticulous soft-tissue handling, selective use of antibacterial technologies, and multidisciplinary management. The current literature is mainly retrospective, heterogeneous, and non-comparative. Prospective multicenter studies are needed to clarify the long-term effectiveness of silver or alternative coatings, soft-tissue reconstruction techniques, and emerging custom-made 3D-printed prostheses. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
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23 pages, 1348 KB  
Review
Opportunities Offered by Telemedicine in the Care of Patients Affected by Fractures and Critical Issues: A Narrative Review
by Giulia Vita, Valerio Massimo Magro, Andrea Sorbino, Concetta Ljoka, Nicola Manocchio and Calogero Foti
J. Clin. Med. 2025, 14(20), 7135; https://doi.org/10.3390/jcm14207135 - 10 Oct 2025
Viewed by 693
Abstract
Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction [...] Read more.
Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
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Other

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20 pages, 1668 KB  
Systematic Review
Conservative Treatment with Teriparatide Versus Vertebroplasty for Acute Osteoporotic Vertebral Compression Fractures: A Meta-Analysis
by Subum Lee, Junseok W. Hur, Younggyu Oh, Sungjae An, Yeongu Chung, Danbi Park and Jin Hoon Park
J. Clin. Med. 2025, 14(11), 3967; https://doi.org/10.3390/jcm14113967 - 4 Jun 2025
Viewed by 3674
Abstract
Background/Objectives: The debate continues, despite numerous studies, on whether vertebroplasty (VP) or conservative treatment is more suitable for osteoporotic vertebral compression fractures (OVCFs). Meanwhile, teriparatide (TP) has shown promise in accelerating bone healing in OVCFs. This analysis aims to clarify the potential benefits [...] Read more.
Background/Objectives: The debate continues, despite numerous studies, on whether vertebroplasty (VP) or conservative treatment is more suitable for osteoporotic vertebral compression fractures (OVCFs). Meanwhile, teriparatide (TP) has shown promise in accelerating bone healing in OVCFs. This analysis aims to clarify the potential benefits of conservative treatment using TP over VP from several clinical studies on acute OVCFs. Methods: A literature search was performed, using the MEDLINE, Embase, Cochrane Review, Web of Science, and Google Scholar databases, for studies published up until September 2023. Five studies [one randomized controlled study (RCT) and four non-RCTs] were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random-effects model to obtain the effect size. Results: Five studies with a total of 326 (TP = 147, VP = 179) patients were included. Within the first week of treatment, the VP group showed a significantly greater decrease in their visual analog scale (VAS) scores. There was no significant difference in VAS score reduction between the two groups from one to three months. However, after 6 months, the TP group exhibited significant superiority in VAS scores and bone mineral density (BMD). Furthermore, TP was associated with a reduced number of new-onset OVCFs, with a statistically significant estimated odds ratio of 0.15 (95% CI, 0.04–0.51, p < 0.01). Conclusions: Conservative treatment using TP for acute OVCF has been found to reduce subsequent fractures, provide equivalent or superior pain control, and increase BMD compared to VP. Nonetheless, the meta-analysis results are weak, due to the low level of evidence. Full article
(This article belongs to the Special Issue Recent Advances in the Management of Fractures)
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