Orthopedic Trauma and Fractures: From Pathophysiology to Novel Therapeutic Approaches

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 2154

Special Issue Editors


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Guest Editor
Orthopaedic and Traumatology Unit, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
Interests: knee; knee surgery; arthroplasty; fracture; trauma surgery; anterior cruciate ligament; knee injuries; sports injuries; cartilage; osteoporosis
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Orthopaedic and Traumatology Unit, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
Interests: flatfoot; ankle arthroscopy; diabetic foot; calcaneus; talus; ankle biomechanics; orthopedic surgery; sports medicine; sports injuries; arthroplasty
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Bone and joint traumatology is a continuously growing sector of orthopedics, evolving both from a diagnostic and treatment point of view. Correctly understanding the traumatic mechanism and diagnosis made in a short time frame is of essential importance to manage these conditions as best as possible. It is also very important to understand the availability and applicability of diagnostic imaging tools, which can be decisive in avoiding diagnostic errors and, consequently, incorrect treatments. Over the years, we have moved from a predominantly conservative treatment of fractures to the tendency to treat the majority of them with surgery, always after a correct evaluation of the indication for such treatment. This has led to improvements in surgical techniques, which should possibly be mini-invasive, thanks to dedicated fixation devices produced by the industry, without neglecting the anatomical reduction in the fracture. The considerable attention paid nowadays to all methods of preventing trauma and its recurrences should not be underestimated. This Special Issue aims to collect original articles that can help understand this complex field of interest.

Dr. Giuseppe Rinonapoli
Dr. Paolo Ceccarini
Guest Editors

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Keywords

  • fracture
  • osteoporosis
  • osteosynthesis
  • surgery
  • bone
  • diagnosis

Published Papers (3 papers)

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Research

7 pages, 218 KiB  
Article
Comparison of Three Antibiotic Prophylaxis Protocols for Preventing Postoperative Infection in Tibial Plateau Fractures
by Carolina Montoya-delaTorre, Ernesto Muñoz-Mahamud, Jose Alonso Zumbado, Laura Morata, Judit Martínez-Peñas and Oscar Ares
Appl. Sci. 2024, 14(10), 4192; https://doi.org/10.3390/app14104192 - 15 May 2024
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Abstract
Background: The aim of this study was to compare the impact of three different types of intraoperative antibiotic prophylaxis on the risk of postoperative surgical site infection (SSI). Material and Methods: Single-center retrospective cohort study. Patients who underwent surgery for osteosynthesis of a [...] Read more.
Background: The aim of this study was to compare the impact of three different types of intraoperative antibiotic prophylaxis on the risk of postoperative surgical site infection (SSI). Material and Methods: Single-center retrospective cohort study. Patients who underwent surgery for osteosynthesis of a tibial plateau fracture (January 2009–November 2018) in Hospital Clinic i Provincial de Barcelona were included. Three types of prophylaxis during the study period were used: group A (cefuroxime single-dose treatment), group B (meropenem + teicoplanin), and group C (ceftriaxone + teicoplanin). Demographics, co-morbidity, type of fracture, need for external fixation, microbiology data, surgical time, and outcome were recorded. Failure was defined as the need for reintervention due to postoperative surgical site infection. Results: From a total of 148 patients included, 20 cases developed SSI, 8 from group A, 8 from group B, and 4 from group C. Higher ASA scores, Schatzker II classification, need for external fixation, and a prolonged surgical time were associated with a significantly (p < 0.005) increased incidence of SSI. Group C showed the overall highest survival and lowest cumulative risk, but differences were not statistically significant. Conclusions: Group C showed the lowest incidence of infection in this sample. It is necessary to confirm these findings with larger studies. Full article
14 pages, 1412 KiB  
Article
An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms
by Antonio Mazzotti, Alberto Arceri, Pejman Abdi, Elena Artioli, Simone Ottavio Zielli, Laura Langone, Laura Ramponi, Arianna Ridolfi, Cesare Faldini and Lorenzo Brognara
Appl. Sci. 2024, 14(5), 1964; https://doi.org/10.3390/app14051964 - 28 Feb 2024
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Abstract
Background: Total ankle arthroplasty (TAA) has grown in popularity and indications, with encouraging results over time. Today, preoperative and postoperative evaluations are mainly performed using clinical test and diagnostic imaging, but there is a deficiency in objectively evaluating the biomechanics of the foot [...] Read more.
Background: Total ankle arthroplasty (TAA) has grown in popularity and indications, with encouraging results over time. Today, preoperative and postoperative evaluations are mainly performed using clinical test and diagnostic imaging, but there is a deficiency in objectively evaluating the biomechanics of the foot and ankle, which serve as the functional markers for monitoring the effectiveness and outcomes of surgery. Inertial measurement units associated with plantar pressure measurements may provide an accurate and reliable method of evaluating function through the analysis of gait and ankle joint mobility. The aim of this study was to introduce an innovative technology, to assess its accuracy and feasibility compared to standard clinical assessment methods and to objectify kinematic outcomes in patients with end-stage ankle OA before and after TAA surgery. Methods: A consecutive series of eight patients with symptomatic end-stage osteoarthritis and treated with TAA was prospectively evaluated using clinical scores (AOFAS, MOxFQ, VAS, SF-36, 17-IFFI), physical tests (FPI, ALT), plantar pressure measurements with FLEX EPS/R2 Letsense® baropodometric platform, gait analysis and wearable sensors-based ankle motion and kinematic outcomes using Wiva Science inertial sensors by Letsense®. Data were collected preoperatively and 4 months after surgery. Results: All PROMs exhibited statistical significance in improvement from pre- to postoperative periods, except for one. Physical examinations showed no significant changes of the foot shape and alignment. Plantar pressure analyses revealed no significant changes in static and dynamic evaluations, but a more uniform distribution of plantar pressure was observed between the two periods. Inertial sensor parameters demonstrated no significant differences, except for a significant reduction in stride length and step length for the operated foot after surgery. Conclusions: Gait analysis using inertial sensors and plantar pressure measurements offer ease of handling, cost effectiveness, portability and swift data reading, making them highly appealing for widespread clinical use. Integrating these tools into the routine assessments of patients with TAA holds promise for advancing precision of treating this condition and our depth of its understanding, contributing to more comprehensive and insightful patient care. Full article
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12 pages, 4853 KiB  
Article
Fixation of Posterior Malleolus in Trimalleolar Ankle Fractures: Anteroposterior Screw or Posterolateral Plate?
by Paolo Ceccarini, Marco Donantoni, Federico Milazzo, Vito Prezioso, Rosario Petruccelli, Elena Manuela Samaila, Daniele Marcolli, Massimiliano Leigheb, Giuseppe Rinonapoli and Auro Caraffa
Appl. Sci. 2024, 14(2), 802; https://doi.org/10.3390/app14020802 - 17 Jan 2024
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Abstract
Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based [...] Read more.
Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based on the intervention type (screw or plate). Instrumental assessments comprised pre- and post-operative X-rays and pre-operative CT scans to evaluate joint step-off. The mean follow-up duration was 1 year and 9 months. Results: Radiographic control revealed no loss of reduction or mobilization of the synthesis devices, and all patients achieved fracture healing. Articular step-off > 2 mm was observed in 21 patients (38.9%), including 4 in the plate group and 17 in the screw group, with a statistically significant likelihood of step-off presence in the latter. The mean AOFAS score was 90 points, negatively correlated with age, and lower in patients with joint step-off and a 15° reduction in ROM. Conclusions: The management of posterior malleolus fractures has changed with anatomical studies and an understanding of ankle stability through CT scans. ORIF with a posterior plate is advantageous for anatomical reduction of the tibial plafond but is disadvantageous in terms of surgical invasiveness and technical difficulty. Full article
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