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Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition

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

Deadline for manuscript submissions: 25 September 2026 | Viewed by 8483

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Dr. Matthias Fröhlich

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Department of Traumatology, Orthopedic Surgery and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, 51109 Cologne, Germany
Interests: orthopedics; trauma surgery; sports traumatology; polytrauma care; hip and knee, preclinical trauma care
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Dr. Michael Caspers

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1. Department of Traumatology, Orthopedic Surgery and Sports Traumatology, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, 51109 Cologne, Germany
2. Institute for Research in Operative Medicine (IFOM), Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstr. 200, 51109 Cologne, Germany
Interests: trauma surgery; polytrauma care; coagulation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to the Special Issue entitled “Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition”. This is one new volume; we published 11 papers in the first volume. For more details, please visit:

https://www.mdpi.com/journal/jcm/special_issues/R41L31JMEX

This Special Issue focuses on the immediate management and treatment of traumatic injuries, as well as the subsequent surgical outcomes, resulting from accidents, falls, violence, or other forms of physical trauma. The field of acute care for traumatic injuries involves providing timely and specialized medical interventions to stabilize patients, prevent further damage, and optimize outcomes, which may include emergency resuscitation, diagnostic imaging, surgical interventions, pain management, and rehabilitation. Since the average life expectancy of global populations has been increasing in recent decades, doctors now often have to provide care for patients who suffer from several comorbidities, which may require specialized treatment algorithms for older patients.

By continually improving acute care protocols and surgical techniques, healthcare professionals aim to enhance patient outcomes, minimize complications, and improve the overall quality of life of individuals who have experienced traumatic injuries. With this purpose in mind, we cordially invite all authors to submit original or review articles to the Special Issue.

Dr. Matthias Fröhlich
Dr. Michael Caspers
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 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

trauma injuries
orthopedics
polytrauma
emergency care
coagulation disorders
fractures
surgical outcomes
acute care
diagnostic imaging

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Related Special Issue

Acute Care for Traumatic Injuries and Surgical Outcomes in Journal of Clinical Medicine (12 articles)

Published Papers (6 papers)

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Research

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13 pages, 740 KB

Open AccessArticle

Early Anti-Rhabdomyolysis Infusion Therapy Before Tourniquet Release Is Associated with Reduced Acute Kidney Injury, Limb Amputation, and Mortality in Combat-Related Lower Extremity Injuries: A Retrospective Cohort Study

by Vitalii A. Lukiianchuk, Wojciech Barg, Oleksandr V. Oliynyk, Svitlana M. Yaroslavska, Arsen A. Gudyma and Tomasz Jurek

J. Clin. Med. 2026, 15(6), 2123; https://doi.org/10.3390/jcm15062123 - 11 Mar 2026

Viewed by 1011

Abstract

Background: Combat-related lower extremity injuries frequently require prolonged tourniquet application to control life-threatening hemorrhage. Although effective for hemorrhage control, prolonged ischemia followed by reperfusion substantially increases the risk of rhabdomyolysis, acute kidney injury (AKI), limb loss, and mortality. The optimal timing of anti-rhabdomyolysis infusion therapy in relation to tourniquet release remains uncertain. Methods: This retrospective single-center cohort study analyzed 120 Ukrainian military casualties with combat-related lower extremity injuries requiring prolonged tourniquet application and subsequent surgical management, including fasciotomy and tourniquet release. Patients were divided into two groups based on infusion strategy: standard therapy initiated after tourniquet release and early anti-rhabdomyolysis infusion therapy initiated before tourniquet removal during the ischemic phase. Primary outcomes included dialysis-requiring AKI, limb amputation, and death. Multivariable logistic regression models were adjusted for baseline physiological severity, including shock index at admission and baseline acid–base status. Model performance was evaluated using the Akaike Information Criterion (AIC) and receiver operating characteristic (ROC) analysis. Propensity score–based inverse probability of treatment weighting (IPTW) was applied as a sensitivity analysis. Results: After adjustment, early infusion therapy was independently associated with lower rates of dialysis-requiring AKI (adjusted odds ratio [OR] 0.33; 95% confidence interval [CI] 0.13–0.84; p = 0.020), limb amputation (OR 0.32; 95% CI 0.11–0.95; p = 0.040), and mortality (OR 0.23; 95% CI 0.07–0.77; p = 0.017). Adjusted models demonstrated good discriminative ability, with areas under the ROC curve of 0.813 for AKI, 0.838 for amputation, and 0.823 for mortality. Sensitivity analyses using IPTW yielded consistent results. Conclusions: In combat-related lower extremity injuries requiring prolonged tourniquet application, early initiation of anti-rhabdomyolysis infusion therapy prior to reperfusion is associated with significantly reduced risks of severe AKI, limb loss, and death. These findings suggest that preventive renal-protective strategies initiated before tourniquet release may improve outcomes in high-risk military trauma settings and warrant further prospective investigation. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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12 pages, 2238 KB

Open AccessFeature PaperArticle

Ultrasound-Guided Supraclavicular Nerves Block for Acute Pain Management in Clavicular Fractures—A Pragmatic Randomized Trial

by Eckehart Schöll, Mark Ulrich Gerbershagen, Werner Vach, Maria Rösli and Rainer Jürgen Litz

J. Clin. Med. 2025, 14(22), 8249; https://doi.org/10.3390/jcm14228249 - 20 Nov 2025

Cited by 2 | Viewed by 1073

Abstract

Background/Objectives: This pragmatic randomized controlled trial evaluated the efficacy of ultrasound-guided supraclavicular nerve (SCLN) block compared to standard pain management in patients with acute displaced clavicle fractures (CFs) in an emergency department (ED) setting. Secondary outcomes included time to first request for analgesics, opioid consumption, and patient satisfaction. Methods: Forty-one patients with acute displaced CFs were randomized to receive either an SCLN block (n = 19) or routine pain management (n = 22). Pain intensity was recorded at admission and at 1, 2, 4, 6, 12, and 24 h. Patient satisfaction was assessed after 24 h. Analgesic use, adverse reactions, and adverse events were documented for 24 h. Results: Pain intensity, measured by the numeric rating scale (NRS), was significantly lower in the SCLN group at all time points within the first 12 h (p < 0.001). After one hour, 68% of patients in the SCLN group reported an NRS of 0–2, compared to 19% in the control group. The time to first request for analgesics was markedly longer in the SCLN group (9.1 h vs. 0.7 h). In two patients, SCLN visualization was insufficient, and a cervical plexus block was performed instead. Four patients in the SCLN block group reported adverse reactions. Patient satisfaction after 24 h was significantly higher in the SCLN group (p < 0.001), with 85% indicating they would choose the block again. Conclusions: Ultrasound-guided selective SCLN block appears to be an effective and well-tolerated method for acute analgesia in patients with displaced CFs, with the most pronounced benefit observed during the first 12 h. Patient acceptance of the procedure was high. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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9 pages, 207 KB

Open AccessArticle

Utility of the Shock Index as a Prognostic Predictor in Patients Undergoing Emergency Surgery for Trauma: A Single Center, Retrospective Study

by Byungchul Yu, Chun Gon Park, Kunhee Lee and Youn Yi Jo

J. Clin. Med. 2025, 14(19), 6783; https://doi.org/10.3390/jcm14196783 - 25 Sep 2025

Viewed by 3296

Abstract

Background: Shock index (SI) is calculated by dividing heart rate (HR) by systolic blood pressure (sBP) and is a useful tool for predicting the prognosis of trauma patients. This study aimed to determine whether SI is useful in predicting mortality in patients undergoing emergency surgery for trauma. Methods: We analyzed 1657 patients who underwent emergency surgery for trauma. Patients were divided into SI < 1 and SI ≥ 1 groups and the Glasgow Coma Scale (GCS), Injury Severity Score (ISS), revised trauma score (RTS), Korean Triage and Acuity Scale (KTAS), transfusion amount, and mortality were compared. Binary logistic regression analysis was performed to identify factors associated with mortality. Results: There were significant differences in GCS, ISS, RTS, and KTAS in the SI ≥ 1 group compared to the SI < 1 group (all p-values < 0.001). In the SI < 1 cohort, the mortality rate was 11% (144/1283), and in the SI ≥ 1 group the mortality rate was 33% (125/374) (p < 0.001). Age, GCS, ISS, SI ≥ 1, and KTAS were determined to be predictors of mortality by logistic regression analysis. In particular, SI ≥ 1 group members exhibited a high association with elevated mortality (OR, 2.498; 95% CI, 1.708–3.652; p < 0.01). Conclusions: Although SI alone has limitations in predicting the patient’s prognosis, patients with SI ≥ 1 upon arrival at the emergency room are associated with mortality of patients undergoing emergency surgery for trauma, along with already known trauma assessment systems such as GCS, ISS, and KTAS. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

14 pages, 486 KB

Open AccessArticle

Clinical Indicators and Imaging Characteristics of Blunt Traumatic Diaphragmatic Injury: A Retrospective Single-Center Study

by Hoon Ryu, Chun Sung Byun, Sungyup Kim, Keum Seok Bae, Il Hwan Park, Jin Rok Oh, Chan Young Kang, Jun Gi Kim and Young Un Choi

J. Clin. Med. 2025, 14(18), 6562; https://doi.org/10.3390/jcm14186562 - 18 Sep 2025

Cited by 1 | Viewed by 1045

Abstract

Background/Objectives: Blunt trauma injury of the diaphragm is uncommon. Even after imaging examination, accurate diagnosis remains difficult. We sought to identify clinical factors that raise suspicion of such injuries, which can be applied during the initial evaluation of trauma patients. Methods: We retrospectively analyzed patients with blunt trauma who were diagnosed with diaphragmatic injury between January 2015 and July 2025. Demographic variables, clinical findings, operative records, and imaging findings were reviewed. Results: The most common mechanism of injury in patients with diaphragmatic injury was traffic accidents (64.2%), and 77.4% were identified as severe injuries with an Injury Severity Score (ISS) ≥ 16. Computed tomography (CT) scans of these patients frequently showed hemothorax, hemoperitoneum, and pneumothorax, but 49.1% of cases did not show diaphragmatic injury on preoperative imaging. In these patients, pneumothorax, lower rib fractures, and liver injury were more common. Notably, pneumothorax strongly suggested the possibility of diaphragmatic injury in patients where intrathoracic herniation was not clear. Conclusions: In patients with polytrauma and unstable vital signs, CT evaluation of torso injuries and careful interpretation are essential. Even when CT does not reveal diaphragmatic injury, suspicion should be elevated in cases with high ISS accompanied by pneumothorax, hemoperitoneum, hemothorax, lower rib fractures, or extremity injuries. If the injury mechanism further raises clinical suspicion, repeated physical examinations and imaging studies should be performed. When suspicion remains high, surgical intervention should be considered to confirm the diagnosis. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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13 pages, 491 KB

Open AccessArticle

Transsacral Bar Fixation for Osteoporotic H-Type Sacral Fractures: A Viable Alternative to Spinopelvic Fixation

by Martin Naisan, Felix Schmitz, Yazan Noufal, Yama Afghanyar, Matthias Fröhlich, Marcus Richter, Philipp Drees and Philipp Hartung

J. Clin. Med. 2025, 14(18), 6503; https://doi.org/10.3390/jcm14186503 - 16 Sep 2025

Cited by 1 | Viewed by 1480

Abstract

Background: Fragility fractures of the pelvis (FFP) are an increasing challenge in aging societies. Among these, FFP type 4B (“H-shaped” sacral fractures) represent the most unstable subtype, characterized by bilateral sacral ala fractures with transverse dissociation. Optimal fixation strategies remain debated, as spinopelvic fixation provides maximal stability but is invasive, while iliosacral screws often fail in osteoporotic bone. Trans-sacral bar (TSB) fixation has been proposed as a less invasive alternative, though evidence for its use in FFP 4B remains limited. Methods: We conducted a retrospective single-center study of 31 elderly patients (mean age 77.9 years; 87.1% female) with CT-confirmed FFP type 4B fractures treated between 2015 and 2022 using navigation-guided TSB constructs. Surgical configurations included hybrid fixation (TSB + bilateral iliosacral screws, n = 25) and dual-bar fixation (n = 6). Outcomes included perioperative complications, implant survival, radiographic healing, pain, and mobility at 3 and 12 months. Opportunistic CT-derived Hounsfield units (HU) were used to assess bone quality. Results: All patients had severe osteoporosis (mean HU 75.8 ± 30.1). Mean operative time was 71 min, and mean hospitalization was 9.1 days. No intraoperative or postoperative complications occurred, and no implant loosening, migration, or revision surgeries were required. At 3 months, mean pain score was 1.9, further decreasing to 1.1 at 12 months; 60.9% of patients reported complete pain resolution. Mobility improved in most cases, with 80.6% discharged with a walker or crutches. Radiographic follow-up confirmed stable healing in all patients. Conclusions: Navigation-guided TSB-based fixation provided stable osteosynthesis with excellent implant survival, significant pain relief, and early mobilization in elderly patients with FFP type 4B fractures. Hybrid and dual-bar constructs both achieved reliable outcomes. TSB fixation thus represents a safe and effective alternative to spinopelvic fixation in this fragile population. Larger multicenter prospective studies are warranted to confirm these findings and refine fixation strategies. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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29 pages, 425 KB

Open AccessReview

Rare and Unusual Consequences of Blunt Abdominal Trauma—The Significance of Anatomical Anomalies

by Maciej Rybicki, Bartłomiej Białas, Wiktoria Jachymczak, Igor Karolczak, Julia Kot, Klaudia Dobrowolska, Bartosz Marek Czyżewski, Joanna Czyżewska, Kamil Paszowski and Karol Kamil Kłosińki

J. Clin. Med. 2026, 15(8), 2842; https://doi.org/10.3390/jcm15082842 - 9 Apr 2026

Viewed by 194

Abstract

Background/Objectives: Blunt abdominal trauma is a frequent challenge in emergency medicine, but its diagnosis and treatment become significantly more complex when rare anatomical anomalies are present. Atypical anatomy may mask symptoms or mimic other acute abdominal conditions, causing delays in treatment. The aim of this paper is to review the literature on six rare anatomical anomalies and their impact on the consequences of blunt abdominal trauma. Methods: A Narrative literature review was undertaken, covering PubMed, Scopus, Web of Science and Google Scholar databases, analysing publications from 1960 to 2025. Case reports and case series (91 patients in total) with confirmed organ damage following blunt trauma in the course of: duodenal diverticulum, Meckel’s diverticulum, splenic torsion, rupture or torsion of the accessory spleen, visceral inversion (situs inversus) and horseshoe kidney. Results: Demographic analysis revealed a predominance of perforations of the duodenal diverticulum in older women (mean age 62 years), while younger men predominated in all other groups. The clinical picture was often non-specific or misleading, especially in situs inversus, where the location of pain did not correlate with the typical topography of organs. Contrast-enhanced computed tomography (CECT) has proved to be a key diagnostic tool, surpassing ultrasound/FAST scans due to its ability to provide precise anatomical imaging. Surgical treatment was predominant (100% in Meckel’s diverticulum, 95% in duodenal diverticulum), while conservative treatment was effective in horseshoe kidney injuries (94.8%). Mortality was highest in situs inversus (29%) and duodenal diverticulum perforation (20%). The vast majority of these fatal cases occurred in the era of modern computed tomography, suggesting that the therapeutic challenges stem directly from the specific nature of these anomalies, rather than from past diagnostic limitations. Conclusions: Anatomical anomalies significantly modulate the clinical manifestations of blunt abdominal trauma, increasing the risk of diagnostic errors. Early contrast-enhanced computed tomography and awareness of these rare pathologies are crucial for appropriate management and improved prognosis. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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