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Advances in Trauma and Orthopedic Surgery: 2nd Edition

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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: 20 May 2025 | Viewed by 7687

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Prof. Dr. Christian von Rüden

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Department of Trauma Surgery, Orthopaedics and Hand Surgery, Weiden Medical Center, 92637 Weiden, Germany
Interests: major trauma; long bone fractures; complex joint fractures; pelvic trauma; nonunion treatment; pediatric trauma
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Special Issue Information

Dear Colleagues,

This Special Issue is dedicated to showcasing innovations in the treatment of traumatized patients. These include modern developments in implants and osteosynthesis materials, new approaches and the application of the latest intraoperative technology. Many of these innovations are based on the findings of translational research, for example, in the field of biomechanics. This is a new volume, which follows the publication of 16 papers in the first volume. You can find more details by following the link below:
https://www.mdpi.com/journal/jcm/special_issues/EF6ECZ130F

In recent decades, significant progress has been made in the field of orthopedics and traumatology as a result of scientific research findings, although the context has continued to change. Road safety has led to a decrease in high-energy trauma following major trauma, while the number of elderly patients with low-energy trauma continues to increase. It is the task of the surgeon to treat this broad spectrum of complex patients in the best possible way using all appropriate resources.

Therefore, this Special Issue of the Journal of Clinical Medicine targets multifactorial improvements in trauma and orthopedic surgery with the goal of improving daily clinical practice through scientific recommendations for the benefit of our patients. In addition to the latest clinical care approaches, translational topics will also be considered.

Prof. Dr. Christian von Rüden
Guest Editor

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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.

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Keywords

trauma
fracture
fracture fixation
osteosynthesis
biomechanics
bone
approach
nonunion
joint replacement
outcome

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Advances in Trauma and Orthopedic Surgery in Journal of Clinical Medicine (17 articles)

Published Papers (8 papers)

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15 pages, 3014 KiB

Open AccessArticle

Biomechanical Performance and Handling of Mineral–Organic Adhesive Bone Cements Based on Magnesium Under Clinical Test Conditions

by Stefanie Hoelscher-Doht, Alexandra Fabian, Lasse Bögelein, Eva Kupczyk, Rainer H. Meffert, Uwe Gbureck and Tobias Renner

J. Clin. Med. 2025, 14(9), 3081; https://doi.org/10.3390/jcm14093081 - 29 Apr 2025

Abstract

Background/Objectives: Biomineral adhesive bone adhesives composed of phosphoserine combined with magnesium oxides or phosphates exhibit exceptional adhesive properties. This study evaluates two experimental mineral–organic cementitious adhesives in a clinical test setup, investigating their potential for fracture reduction and simultaneous defect filling. Methods: The two experimental adhesives (Groups B and C) and a standard hydroxyapatite cement (Group A, reference) underwent compressive strength testing, shear strength testing, and screw pullout tests as part of a first biomechanical characterization. Furthermore, all materials were tested in a porcine tibial split depression fracture model, where they served both for fracture reduction and for filling the metaphyseal bone defect, supplementary to plate osteosynthesis. Fracture stability was assessed under cyclic loading in a materials testing machine. Results: The OPLS (O-phospho-L-serine) containing adhesive (Group B) demonstrated the highest compressive strength as well as the highest shear strength. All three materials showed comparable maximum pullout forces. Both experimental adhesives (Groups B and C) exhibited higher pullout stiffness compared to the standard cement (Group A). In the fracture model, no significant differences in displacement under cyclic loading were observed between groups. Conclusions: The biomineral adhesive bone adhesives (Groups B and C) demonstrated biomechanical advantages in axial compression, adhesive (shear) strength, and screw fixation compared to the standard hydroxyapatite cement (Group A). Furthermore, they achieved comparable stabilization of metaphyseal fractures under clinically relevant dynamic loading conditions. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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18 pages, 6733 KiB

Open AccessArticle

Optimizing Stem Length in Conversion Total Hip Arthroplasty: An Expanded Finite Element Analysis

by Koshiro Shimasaki, Tomofumi Nishino, Tomohiro Yoshizawa, Ryunosuke Watanabe, Fumi Hirose, Shota Yasunaga and Hajime Mishima

J. Clin. Med. 2025, 14(4), 1141; https://doi.org/10.3390/jcm14041141 - 10 Feb 2025

Viewed by 628

Abstract

Background/Objectives: Stress concentration around distal screw-removal holes confers a major risk for periprosthetic fractures following conversion total hip arthroplasty (cTHA) for intertrochanteric femoral fractures. Optimal stem-selection criteria and guidelines for cTHA can improve clinical outcomes. We determined the influence of the cementless stem length on the stress distribution around distal screw-removal holes. Methods: For the finite element analysis, institutional data from preoperative CT scans of contralateral femurs of patients who underwent THA were used. To replicate the post-nail-removal state, we used 3D registration of standard triangulated language data of the intramedullary nail as an unused material to simulate distal screw-removal holes, located 135 mm from the proximal end of the intramedullary nail. Cementless stems of 130, 140, 150, and 160 mm were individually registered using STL data, and cTHA models were constructed accordingly. Using simulations under load conditions representing normal walking and stair climbing, the mean and maximum equivalent stress values around the distal screw-removal holes were calculated. For multiple comparisons, repeated-measures ANOVA with Bonferroni correction was employed. Results: Compared to the 130 mm stem, the 150 mm and 160 mm stems similarly reduced the maximum equivalent stress around the distal screw-removal holes, although the 140 mm stem showed no significant difference with other stems. Conclusions: A ≥150 mm stem length reliably mitigated stress concentration around distal screw-removal holes post-cTHA; it is the optimal choice for balancing effectiveness and risk of complications and may contribute to improved long-term clinical outcomes. This study provides practical evidence for stem selection in cTHA and offers valuable insights for future treatment guidelines. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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21 pages, 5629 KiB

Open AccessArticle

Early Surgery and Screw-Only Osteosyntheses in Minimally Invasive Treatment of Calcaneal Fractures—Risk or Benefit for Our Patients?

by Christian Rodemund, Moritz Katzensteiner, Maximilian Vogel and Georg Mattiassich

J. Clin. Med. 2025, 14(2), 344; https://doi.org/10.3390/jcm14020344 - 8 Jan 2025

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Abstract

Background: This study aims to analyze the outcomes following the minimally invasive surgery of calcaneal fractures using screw-only osteosynthesis, as well as the impact of surgical timing. Methods: Between 2015 and 2020, 155 patients with 168 fractures were included. According to the Sanders classification, 48.21% of fractures were classified as Sanders 2, 33.33% as Sanders 3, and 10.11% as Sanders 4 fractures, with the remaining fractures unclassified. A total of 117 cases were treated on the day of admission or the following day. The surgeries followed a standardized protocol for fracture analysis, positioning, and X-ray techniques, primarily using a percutaneous approach with stab incisions. Osteosynthesis was mainly performed using screws, with five cases treated with K-wires for open fractures. Results: The mean Boehler’s angle improved from 8.52° preoperatively to 25.00° postoperatively. Three superficial infections were observed. Deep infections occurred in three cases, all following open fractures. Secondary dislocation was noted in five patients—one due to a deep infection, and four attributed to clear technical failures. One case involved a questionable indication for a screw change (7.3 mm screw) after two weeks due to perforation of the medial wall. A total of 79 fractures were followed up for an average of 4 years and 3 months. The mean AOFAS score was 91.3, and the mean FAOS score was 88.7. Surgery within 7 days after admission showed no significant impact on the outcomes. Conclusions: Minimally invasive screw-only osteosynthesis with early surgical intervention offers favorable outcomes with minimal risk. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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12 pages, 4982 KiB

Open AccessArticle

Positive Results Using Variable Fixation in Medial Opening Wedge High Tibial Osteotomies in Patients with Unilateral Knee Osteoarthritis: An Observational Clinical Investigation

by Christian Colcuc, Thomas Vordemvenne, Georg Beyer, Philipp Leimkühler and Dirk Wähnert

J. Clin. Med. 2024, 13(24), 7707; https://doi.org/10.3390/jcm13247707 - 17 Dec 2024

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Abstract

Background: Medial opening wedge high tibial osteotomy (HTO) treats medial knee osteoarthritis by realigning the knee joint, though it still carries quite a high risk of complications. A new Variable Fixation Locking Screw technology, designed to gradually reduce construct stiffness and promote bone healing, aims to address these issues. This observational study evaluates the safety and effectiveness of this innovative approach in improving clinical outcomes. Methods: Data were prospectively collected on a cohort of the first ten consecutive patients (over 18 years of age) who underwent corrective medial opening wedge high tibial osteotomy using Variable Fixation Locking Screws (VFLSs). The procedure followed the standard surgical technique, with osteotomies stabilized using a Tomofix plate and a combination of standard locking screws and VFLSs. This study aimed to evaluate outcomes such as fracture healing, patient safety, and procedural success at 6 and 12 weeks and at 6 months. Results: No complications, side effects, or need for implant removal were observed. By six months, 70% of patients showed radiographic and clinical healing, and 100% of patients achieved full functional recovery without any issues like length discrepancy, instability, pain, or joint stiffness. Conclusions: This first clinical observation study indicates that Variable Fixation Locking Screws are safe and effective for medial opening wedge high tibial osteotomies, showing promising results in reducing the risk of delayed closure or non-closure of the wedge. Further studies with a larger patient population are needed to confirm their effectiveness. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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13 pages, 1977 KiB

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Lumbar Magnetic Resonance Imaging Shows Sex-Specific Alterations During Musculoskeletal Aging—A Radio-Anatomic Investigation Involving 202 Individuals

by Horst Balling, Boris Michael Holzapfel, Wolfgang Böcker, Dominic Simon, Paul Reidler and Joerg Arnholdt

J. Clin. Med. 2024, 13(23), 7233; https://doi.org/10.3390/jcm13237233 - 28 Nov 2024

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Background/Objectives: Musculoskeletal aging can clinically hardly be distinguished from degenerative disease, especially if symptoms are nonspecific, like lower back pain and reduced physical resilience. However, age-related changes are considered to be physiological until they cause osteoporotic fractures or sarcopenia-related restrictions. This radio-anatomic investigation examines whether findings in lumbar magnetic resonance imaging (MRI) mirror age- and sex-related musculoskeletal differences that help to identify the onset of sarcopenia. Methods: Lumbar MRI investigations from 101 women and 101 men were retrospectively evaluated for vertebral and muscular cross-sectional diameter sizes and T2-signal intensities (“T2-brightness”) in axial sections in the L5-level. The results were correlated with the individual’s age to find specific alterations that were indicative of sarcopenia or attributable to the aging process. Results: In women (average age 62.6 (34–85) years), musculoskeletal cross-sectional area sizes and diameters were significantly smaller (p < 0.00001) compared to those in men (average age 57.0 (21–90) years). The most pronounced structural age-related change was the increasing mean posterior paravertebral muscle brightness (MPPVB), which exceeded the mean vertebral brightness (MVB) earlier and to a greater extent in women than in men (p < 0.00001). The brightness difference (∆MVB − MPPVB) was found to indicate (pre-)sarcopenia at values below 25. Conclusions: Significant age-related deterioration in muscle quantity and quality was more obvious in women, correlated with the onset of menopause, and progressed to lower levels during aging. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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17 pages, 3478 KiB

Open AccessArticle

Effect on Syndecan-1 and Hyaluronan Levels Depending on Multiple Organ Failure, Coagulopathy and Survival: An Observational Study in Major Trauma Patients

by Mareen Braunstein, Thorsten Annecke, Kathrin Frey, Thomas Kusmenkov, Markus Wörnle, Ludwig Ney, Wolfgang Böcker and Viktoria Bogner-Flatz

J. Clin. Med. 2024, 13(22), 6768; https://doi.org/10.3390/jcm13226768 - 10 Nov 2024

Cited by 1 | Viewed by 1051

Abstract

Background: Major trauma, as well as traumatic hemorrhagic shock go along with early damage to the endothelial glycocalyx (EG). Shed glycocalyx constituents can activate the innate immune system and aggravate secondary injury. Subsequently, we investigated the relationship between glycocalyx shedding and the occurrence of coagulopathy, multiple organ failure (MOF) and outcome in our cohort after severe trauma. Methods: We included multiple trauma patients, as defined by Injury Severity Score (ISS). Polytraumatized patients must have arrived in our level 1 trauma center within 60 min after trauma. Retrospectively, patients were assigned to predefined clinical conditions, based on injury severity (ISS ≥ 16 points), multiple organ failure (MOF score ≥ 6 points), need for massive transfusion (≥10 RBC units/first 24 h), coagulopathy (prothrombin time < 70% at 0 h) and survival (90-day survival). Syndecan-1 (Sdc-1) and hyaluronan (HA) plasma concentrations were evaluated immediately (0 h), 6 h and 12 h after trauma. Results: 49 patients (mean ISS 35.7 ± 12.1 SD, mean age 45.78 ± 15.6 SD) were included in this study. A total of 37 patients (75.5%) survived, while 12 patients died within the observation period of 90 days after trauma (24.5%). A total of 77% of all patients suffered multiple organ failure (MOF score ≥ 6, n = 30). Initial prothrombin time at 0 h was <70% in 31 patients. Plasma concentrations of circulating both glycocalyx constituents showed a significant increase over the first 12 h after trauma (p = 0.001; p = 0.008). Patients with multiple organ failure showed significantly increased hyaluronan concentrations at all three time points (p = 0.007/0.006/<0.001), and the syndecan-1 levels were significantly elevated 12 h after trauma in the MOF group (p = 0.01). Patients with coagulopathy on admission exhibited significantly higher hyaluronan levels at 12 h (p = 0.042). Non-survivors showed significantly increased syndecan-1 levels at 12 h after trauma (p = 0.024). Conclusions: Glycocalyx shedding occurs immediately after major trauma. Coagulopathy is associated with significantly increased plasma hyaluronan. Further, significant changes in plasma concentrations within the first 12 h help to identify subgroups at risk for developing MOF and death. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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14 pages, 3729 KiB

Open AccessArticle

Functional and Radiological Results Following Revision Blade Plating and Cephalomedullary Nailing in Aseptic Trochanteric and Subtrochanteric Nonunion

by Julia Rehme-Röhrl, Andreas Brand, Annika Dolt, Dag Grünewald, Reinhard Hoffmann, Fabian Stuby, Uwe Schweigkofler and Christian von Rüden

J. Clin. Med. 2024, 13(12), 3591; https://doi.org/10.3390/jcm13123591 - 19 Jun 2024

Cited by 1 | Viewed by 1141

Abstract

Background: Trochanteric and subtrochanteric fractures result in nonunion in more than 20% of cases. The aim of this study was to assess the functional and radiological results following revision cephalomedullary nailing and 95-degree angled blade plating in aseptic trochanteric and subtrochanteric nonunion. Methods: In a retrospective multi-center study between January 2010 and December 2020, a total of 68 consecutive patients (21 women and 47 men) from two European level I trauma centers with the diagnosis of aseptic nonunion were recruited. Follow-up assessment and the patients’ convenience were assessed using the Harris Hip Score, Visual Analog Scale for pain at rest and on stress/exertion and Short Form-12. Results: The patients’ mean age was 57 (range 26–85) years. After a follow-up period of 12 months, one case of persistent nonunion in the cephalomedullary nail group and 10 cases in the blade plate group were identified. The mean duration of surgery was 137 ± 47 min in the cephalomedullary nail group and 202 ± 59 min in the blade plate group (<0.0001). Short-term postoperative complications included wound dehiscence, bleeding, mismatched screw and hematoma. The mid-term results 12 months after surgical revision demonstrated significantly different osseous union rates (p = 0.018). The long-term functional outcome according to the Harris Hip Score 6 years (range 2–10) after revision surgery demonstrated 81 ± 21 points in the cephalomedullary nail group and 64 ± 23 points in the plate group (p = 0.026). Conclusions: This study demonstrated that the revision treatment of trochanteric and subtrochanteric nonunion using a 95-degree blade plate or cephalomedullary nail resulted in a high percentage of osseous union, with a low incidence of complications and good functional results for both methods. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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9 pages, 618 KiB

Open AccessSystematic Review

Systematic Review of Acute Isolated Distal Radioulnar Joint Dislocation: Treatment Options

by Konstantinos Zampetakis, Ioannis M. Stavrakakis, Kalliopi Alpantaki, Grigorios Kastanis, Ioannis Ktistakis, Alexandros Tsioupros, Nikolaos Ritzakis and Constantinos Chaniotakis

J. Clin. Med. 2024, 13(24), 7817; https://doi.org/10.3390/jcm13247817 - 21 Dec 2024

Viewed by 1212

Abstract

Background/Objectives: Acute isolated distal radioulnar joint (DRUJ) dislocations are rare and often misdiagnosed during initial evaluation due to subtle clinical presentation, low index of suspicion, and imaging barriers. Prompt diagnosis and treatment are critical to avoid chronic instability, limited wrist mobility, and osteoarthritis. This systematic review evaluates the functional outcomes of conservative and surgical treatment protocols for acute isolated DRUJ dislocations. Methods: A systematic search of PubMed, Scopus, and Mendeley databases (2000–2024) was conducted following PRISMA guidelines. Inclusion criteria involved adult patients with isolated DRUJ dislocations diagnosed and managed within one week of injury. Studies reporting on underage patients, associated fractures, delayed management, and open injuries were excluded. Data on demographics, injury mechanism, diagnostic methods, treatment protocols, and functional outcomes were extracted and analyzed. Results: In total, 22 cases across 20 studies were included. The majority (90.9%) were males, with a mean age of 37.9 years (range: 20–70 years). Falls and sports injuries were the major causes, with volar dislocations predominating (18/22). The misdiagnosis rate was equal to 18%. Most cases were treated conservatively with closed reduction and immobilization for an average of 4.9 weeks. Operative treatment was performed in 6 cases, mainly following failed closed reductions. Functional outcomes were generally favorable, although the same parameters were not consistently studied in all patients. Overall, 82% (14 of 17 patients) achieved a full range of motion; 88% (14 of 16 patients) reported no pain, and all assessed cases had stable DRUJs at follow-up. Conclusions: This review highlights the rarity and diagnostic challenges of this injury. The functional outcomes of both conservative and operative treatment are generally satisfactory. Conservative treatment should be the first-line approach, with surgery reserved for irreducible or unstable cases. Future research using standardized outcome measures is needed to provide guidance for clinicians. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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