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Medicina
Special Issues
Recent Advances and Future Challenges in Orthopaedic Trauma Surgery
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Recent Advances and Future Challenges in Orthopaedic Trauma Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 September 2026 | Viewed by 4262

Editors

Dr. Zinon Kokkalis

E-Mail Website
Guest Editor
Department of Orthopaedics, School of Medicine of Patras University, 26504 Rio-Patras, Greece
Interests: shoulder surgery; arthroscopic rotator cuff repair; shoulder instability; shoulder arthroplasty; elbow surgery; elbow arthroscopy; complex elbow trauma; minimally invasive surgery of the wrist and hand; compression neuropathies; surgery of peripheral nerve and brachial plexus injuries in adults; surgery of brachial plexus birth palsies (obstetrical paralysis); treatment of femoral head osteonecrosis; orthopaedic trauma, bone fractures and ligament injuries
Dr. Dimitrios Ntourantonis

E-Mail Website
Guest Editor Assistant
Orthopaedic & Trauma Surgeon, University Hospital of Patras-Greece, 26504 Patras, Greece
Interests: orthopaedic trauma; foot feformities; arthroplasty

Special Issue Information

Dear Colleagues,

Background & history of this topic: Ancient civilizations were aware of the severity and disability caused by orthopaedic trauma and the consequent impact on their daily lives; they began to develop techniques to deal with it. Typical examples are the ancient Egyptians, with their pioneering fracture splinting techniques for that time, and then the ancient Greeks who, with the Hippocratic school, first applied traction techniques to the treatment of fractures and spoke 2500 years ago about the need for early mobilization of these patients. The Middle Ages and subsequently the Napoleonic Wars and even more recently the two world wars were essentially the source for the development of surgical orthopaedic traumatology, and most of the techniques used in these conflict zones have subsequently become daily practice in general orthopaedics and modern reconstructive orthopaedic surgery.

Aim and scope of the special issue: These innovations have led to advances, not only in newer and safer prosthetic materials, but also in technological achievements and the advancement of surgical education, allowing surgeons to push the boundaries of health care to offer the trauma patient the best possible treatment, regardless of their age. Despite this progress, significant challenges remain. Fragility fractures are now a global epidemic, and the treatment of multi-trauma patients in critical condition with multiple comorbidities is one of the challenges in daily clinical practice. However, the most important challenge for the modern surgical treatment of orthopaedic trauma is at the same time what makes it so exciting: the acute need for rapid decisions that are individualized and patient-centred, yet rooted in evidence-based practice.

Cutting-edge research: The purpose of this Special Issue is to gather high-quality research and expert perspectives on recent advances and emerging challenges in orthopaedic trauma surgery. We welcome original research articles, clinical studies, and reviews that shed light on contemporary topics in fracture management, surgical innovation, perioperative protocols, and post-traumatic rehabilitation.

What kind of papers we are soliciting: Submissions exploring the following topics are encouraged and of particular interest: “advances in fixations techniques and implant design”, “geriatric and osteoporotic fracture management”, “management of open, complex, or high-energy injuries”, “decision-making in polytrauma care”, “biological approaches to fracture healing and non-unions”, “global disparities and system-level challenges in trauma care”, and “integrating technology (e.g., navigation, 3D planning, and AI) into daily surgical practice”.

Dr. Zinon Kokkalis
Guest Editor

Dr. Dimitrios Ntourantonis
Guest Editor Assistant

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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly 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 2200 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

  • orthopaedic trauma
  • fracture fixation
  • polytrauma
  • non-union
  • geriatric fractures
  • implant design
  • surgical innovation
  • perioperative care
  • postoperative rehabilitation

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Published Papers (4 papers)

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Research

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20 pages, 3222 KB  
Article
Biomechanical Study of the Preventive Effect of Different Cephalomedullary Fixation Methods on the Occurrence of Femoral Neck Fractures in Osteoporotic Femurs
by Incheol Kook, Ki-Chul Park, Hyoung Keun Oh, Je-Hyun Yoo, Chang-Nam Kang and Kyu Tae Hwang
Medicina 2026, 62(8), 1560; https://doi.org/10.3390/medicina62081560 - 14 Aug 2026
Viewed by 154
Abstract
Background and Objectives: This study aimed to investigate the biomechanical properties of different cephalomedullary fixation methods for osteoporotic femurs using a synthetic bone model. Materials and Methods: Lateral impact tests and axial cyclic loading tests were performed, and each test was divided into [...] Read more.
Background and Objectives: This study aimed to investigate the biomechanical properties of different cephalomedullary fixation methods for osteoporotic femurs using a synthetic bone model. Materials and Methods: Lateral impact tests and axial cyclic loading tests were performed, and each test was divided into three groups: group 1 with one reconstruction screw, group 2 with two reconstruction screws, and group 3 without cephalomedullary fixation. To simulate a healed femoral shaft fracture, no osteotomy was performed on the specimens. Results: Groups 1 and 2 had significantly higher mean stiffness, ultimate failure load, and energy to failure in the lateral impact test compared to the native synthetic femur (p < 0.001 for all), while group 3 had significantly lower values in all outcomes (p < 0.05 for all). Groups 1 and 2 showed significantly higher average number of cycles, total load to failure, and initial axial stiffness in the axial cyclic incremental loading test compared to the native synthetic femur (p < 0.001 for all), whereas group 3 showed a significantly lower mean number of cycles and total load to failure (p < 0.001 for all). Conclusions: Under the specific test conditions of this intact synthetic bone model, cephalomedullary fixation with one or two reconstruction screws demonstrated superior relative mechanical stability compared to standard interlocking nails. Using two reconstruction screws provided the greatest biomechanical resistance to failure. In cases where inserting two reconstruction screws is technically challenging or infeasible, a single reconstruction screw may offer an acceptable biomechanical alternative to help prevent peri-implant fractures in healed or prophylactic settings. Intramedullary nailing without cephalomedullary fixation exhibited the lowest mechanical performance, suggesting a potential biomechanical vulnerability to peri-implant fractures under these test conditions. Full article
(This article belongs to the Special Issue Recent Advances and Future Challenges in Orthopaedic Trauma Surgery)
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11 pages, 3002 KB  
Article
Acute Total Hip Arthroplasty with or Without Internal Fixation for Acetabular Fractures in the Elderly: A Case Series
by Vasileios Athanasiou and Vasileios Giannatos
Medicina 2026, 62(2), 350; https://doi.org/10.3390/medicina62020350 - 10 Feb 2026
Viewed by 1272
Abstract
Background and Objectives: Acetabular fractures in elderly patients are increasing in incidence and are frequently associated with osteoporotic bone, fracture comminution, marginal impaction, and pre-existing joint degeneration. Open reduction and internal fixation (ORIF) alone in this population is associated with high rates [...] Read more.
Background and Objectives: Acetabular fractures in elderly patients are increasing in incidence and are frequently associated with osteoporotic bone, fracture comminution, marginal impaction, and pre-existing joint degeneration. Open reduction and internal fixation (ORIF) alone in this population is associated with high rates of fixation failure, post-traumatic osteoarthritis, and secondary conversion to total hip arthroplasty (THA). Acute THA, with or without concomitant internal fixation, has emerged as an alternative strategy aimed at enabling early mobilization and reducing reoperation rates. Materials and Methods: We retrospectively reviewed a series of elderly patients who sustained an acetabular fracture and were treated with acute THA, either as a standalone procedure or combined with internal fixation. Demographic data, fracture patterns, surgical technique, implant choice, complications, and short-term clinical and radiographic outcomes were analyzed. Results: Acute THA allowed immediate or early weight bearing in all patients. Implant stability was achieved using a highly porous, multi-hole acetabular component with supplemental screw fixation and selective use of internal fixation to restore columnar stability when required. Complications were comparable to those reported in the contemporary literature for acute THA in acetabular fractures. Conclusions: In carefully selected elderly patients with acetabular fractures at high risk of failure after ORIF, acute THA with or without internal fixation represents a viable definitive treatment strategy, enabling early mobilization and avoiding the morbidity associated with delayed salvage arthroplasty. Full article
(This article belongs to the Special Issue Recent Advances and Future Challenges in Orthopaedic Trauma Surgery)
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Review

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10 pages, 738 KB  
Review
Thromboprophylaxis After ACL Reconstruction: Controversies and Future Challenges
by Theodoros Bouras, Panagiotis Antzoulas, Vasileios Giannatos, Ioanna Lianou, Alexandros Voutsinas Kandilioros, Dimitrios Ntourantonis and Vasileios Chouliaras
Medicina 2026, 62(7), 1315; https://doi.org/10.3390/medicina62071315 - 8 Jul 2026
Viewed by 510
Abstract
Background and Objectives: Anterior cruciate ligament reconstruction (ACLR) is a very common procedure in young, active individuals. One of the rarest, but potentially life-threatening complications is symptomatic venous thromboembolism (VTE). Despite that, international guidelines offer conflicting advice on routine thromboprophylaxis. This review [...] Read more.
Background and Objectives: Anterior cruciate ligament reconstruction (ACLR) is a very common procedure in young, active individuals. One of the rarest, but potentially life-threatening complications is symptomatic venous thromboembolism (VTE). Despite that, international guidelines offer conflicting advice on routine thromboprophylaxis. This review aims to summarize key international recommendations to support clinical decision-making. Materials and Methods: The role of thromboprophylaxis after ACL reconstruction remains controversial. Rather than performing a systematic review, relevant documents were identified from official publications, consensus statements, and registry-based recommendations issued by recognized orthopaedic and thrombosis-related organizations. Documents were included if they represented formal guidelines, consensus statements, or national/registry-based recommendations with direct clinical relevance to ACLR and thromboprophylaxis, and if they reflected contemporary practice across different healthcare systems. Recommendations from CHEST, NICE, BOA/BASK/BOSTAA, AAOS, ICM-VTE, ICS, SFAR, HAOST, and the Swedish Knee Ligament Registry were included. These were analyzed with respect to indications for pharmacological and mechanical prophylaxis, as well as risk stratification strategies. Results: This narrative review identified nine major international guidelines addressing thromboprophylaxis in ACLR. Most guidelines, including CHEST and NICE, advise against routine anticoagulation for low-risk patients, reserving it for those with specific risk factors. BOA recommends prophylaxis only when multiple comorbidities are present. The Swedish registry indicates that anticoagulation is primarily used in patients with prior VTE or oral contraceptive use. While ICM-VTE supports the use of aspirin or LMWH in high-risk cases, SFAR stands out by recommending routine LMWH for all patients. HAOST emphasizes early mobilization and selective prophylaxis, including aspirin for low-risk groups. Conclusions: Current evidence does not support universal thromboprophylaxis following ACLR. A risk-stratified approach is recommended, with mechanical measures or aspirin for low-to-moderate-risk patients and LMWH or DOACs for high-risk individuals. Future research may focus on genetic and patient-specific factors to better explain existing heterogeneity. Full article
(This article belongs to the Special Issue Recent Advances and Future Challenges in Orthopaedic Trauma Surgery)
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11 pages, 766 KB  
Review
Additive Manufacturing in Orthopaedic Trauma: Current Evidence and Applications
by Nikolaos A. Stavropoulos, Fotios Kantas, Dimitrios V. Papadopoulos, Vasileios S. Nikolaou and George C. Babis
Medicina 2026, 62(3), 599; https://doi.org/10.3390/medicina62030599 - 21 Mar 2026
Viewed by 654
Abstract
Additive manufacturing also known as three-dimensional printing (3D printing), provided the ability to produce precise three-dimensional structures, representing a rapidly growing field in Orthopaedics. Its clinical value has been attributed to the ability to create complex three dimensional objects with relative ease and [...] Read more.
Additive manufacturing also known as three-dimensional printing (3D printing), provided the ability to produce precise three-dimensional structures, representing a rapidly growing field in Orthopaedics. Its clinical value has been attributed to the ability to create complex three dimensional objects with relative ease and at low cost. However, the available evidence regarding its applications in trauma was heterogeneous. This narrative review aimed to analyze the clinical applications of 3D printing in traumatology. Additionally, the research gaps that emerged in our literature search were underscored. Four application domains were selected based on their prevalence in the screened literature and relative level of clinical implementation within orthopaedic traumatology, including (1) 3D-printed anatomical models, (2) patient-specific surgical guides (PSSGs), (3) 3D-printed implants, and (4) temporary 3D-printed external fixation devices. 3D-printed anatomical models were found to help in reducing operative time, estimated blood loss, and the intraoperative radiation exposure. The use of PSSGs was shown to improve intraoperative accuracy and to provide a basis for consistent, accurate, and reproducible outcomes. However, their implementation was hindered by preparation time, the need for stable anatomical landmarks, and reduced accuracy due to potential soft-tissue injury and swelling. In contrast, 3D-printed implants and external fixation devices constituted promising but less extensively studied applications of 3D printing in trauma. The production of customized implants and external fixators, as suggested by the studies available, was deemed feasible, with comparable mechanical properties and significantly lower cost. Larger multicenter studies are required to support and validate these findings. Overall, based on the available evidence, 3D-printed anatomical models and patient-specific surgical guides demonstrate the highest level of clinical applicability, primarily in preoperative planning and intraoperative guidance. Full article
(This article belongs to the Special Issue Recent Advances and Future Challenges in Orthopaedic Trauma Surgery)
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