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Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome
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Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome

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

Deadline for manuscript submissions: 20 September 2024 | Viewed by 5442

Special Issue Editors

Prof. Dr. Markus Kuster

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
Interests: orthopaedic trauma; fracture management; adult reconstruction; hip and knee arthroplasty; osteotomies
Special Issues, Collections and Topics in MDPI journals
Dr. William G. Blakeney

E-Mail Website
Guest Editor
1. Associate Professor, Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA, Australia
2. Department of Surgery, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
Interests: orthopaedic trauma; shoulder, hip and knee surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Fracture treatment remains a cornerstone of all orthopaedic surgeons in training. Many surgeons remain involved in fracture management throughout their working life. Even for the most experienced surgeon, some fractures are challenging to treat and innovative solutions are necessary for a satisfactory outcome. Fracture treatment has made immense improvements over the years, from conservative treatment and traction of almost all fractures to open reduction and internal fixation (ORIF). In the early adoption of ORIF, surgeons tried to achieve absolute stability and primary bone healing without callus formation. This often led to non-unions and implant failures. A more biological and dynamic fixation emerged, and bridging the callus of a fracture is now considered ideal.

Despite the advancements of locking plates, precontoured anatomical plates, intramedullary nails and minimally invasive insertion, some challenges remain such as open fractures, infections, non-union, and malunions. Geriatric fractures in osteoporotic bones and aged patients with multiple comorbidities are also on the increase and need novel solutions. Advances in fracture management (diagnosis, treatment, outcome and rehabilitation) including new innovative techniques to solve the current challenges as well as the management of multi-trauma patients will be the focus of this Special Issue on orthopaedic trauma surgery.

Prof. Dr. Markus Kuster
Dr. William G. Blakeney
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

  • fracture
  • malunion
  • nonunion
  • locking plate
  • intramedullary nail
  • osteoporotic fracture
  • polytrauma

Published Papers (7 papers)

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Research

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16 pages, 1313 KiB  
Article
Bisphosphonate-Related Atypical Femoral Fractures in Patients with Autoimmune Disease Treated with Glucocorticoids: Surgical Results for 20 Limbs
by Tomofumi Nishino, Kojiro Hyodo, Yukei Matsumoto, Yohei Yanagisawa and Masashi Yamazaki
J. Clin. Med. 2024, 13(4), 1027; https://doi.org/10.3390/jcm13041027 - 10 Feb 2024
Viewed by 690
Abstract
Background: Glucocorticoids induce osteoporosis, while bisphosphonates treat it, yet both can lead to atypical femoral fractures. Patients on both agents may face challenges in healing from such fractures due to their pathophysiology and pharmacological effects. Methods: Intramedullary nail surgery was performed on 20 [...] Read more.
Background: Glucocorticoids induce osteoporosis, while bisphosphonates treat it, yet both can lead to atypical femoral fractures. Patients on both agents may face challenges in healing from such fractures due to their pathophysiology and pharmacological effects. Methods: Intramedullary nail surgery was performed on 20 limbs in 19 patients with atypical femoral fractures and autoimmune diseases, who had received bisphosphonates for GC-induced osteoporosis. The average durations of glucocorticoid and bisphosphonate use were 17 and 9 years (standard deviation: 7.59 and 4.35), respectively, and the mean follow-up period was 66 months. Fifteen and five limbs were fractured at the subtrochanter and diaphysis, respectively. The surgical techniques (type of nail) and additional procedures performed in these cases were examined. The post-operative alignment and reduction status on radiographs were examined to determine their relationship with post-operative outcomes. Results: Cephalomedullary long nails were inserted in nine limbs and antegrade intramedullary nails in 11 limbs. As an additional surgical procedure, open reduction, bone grafting and drilling were carried out on six, two, and five limbs, respectively. Regarding malalignment on radiographs, AP images showed varus in four limbs, and lateral images showed extension in two limbs. Regarding the cortical discontinuity, the distal fragment of the 11th limb shifted posteriorly in the lateral view. Gaps at the fracture sites were observed in 11 limbs. As a result, bone union was confirmed in 13 limbs. Five of the seven nonunion limbs required additional surgery. When comparing union and nonunion, open reduction and drilling were involved in nonunion limbs. Conclusion: The surgical outcomes of atypical femoral fractures in patients with autoimmune disease and on long-term glucocorticoids and bisphosphonates were poor. Although it is not possible to affirm for sure based on these results alone, management with prophylactic surgery before complete fracture is considered to be required to improve outcomes. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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9 pages, 926 KiB  
Article
Does Far Cortical Locking Improve Fracture Healing in Distal Femur Fractures: A Randomised, Controlled, Prospective Multicentre Study
by Thomas England, Humza Khan, Sheldon Moniz, David Mitchell and Markus S. Kuster
J. Clin. Med. 2023, 12(24), 7554; https://doi.org/10.3390/jcm12247554 - 07 Dec 2023
Viewed by 599
Abstract
(1) Background: Bone healing is influenced by various mechanical factors, such as stability, interfragmentary motion, strain rate, and direction of loading. Far cortical locking (FCL) is a novel screw design that promotes bone healing through controlled fracture motion. (2) Methods: This study compared [...] Read more.
(1) Background: Bone healing is influenced by various mechanical factors, such as stability, interfragmentary motion, strain rate, and direction of loading. Far cortical locking (FCL) is a novel screw design that promotes bone healing through controlled fracture motion. (2) Methods: This study compared the outcome of distal femur fractures treated with FCL or SL (standard locking) screws and an NCB plate in a randomised controlled prospective multicentre trial. The radiographic union scale (RUST) and healing time was used to quantify bone healing on follow-up imaging. (3) Results: The study included 21 patients with distal femur fractures, 7 treated with SL and 14 treated with FCL screws. The mean working length for patients with SL screws was 6.1, whereas for FCL screws, it was 3.9. The mean RUST score at 6 months post fracture was 8.0 for patients with SL plates and 7.3 for patients with FCL plates (p value > 0.05). The mean healing time was 6.5 months for patients with SL plates and 9.9 months for patients with FCL plates (p value < 0.05). (4) Conclusions: Fractures fixed with SL plates had longer working lengths and faster healing times when compared to FCL constructs, suggesting that an adequate working length is important for fracture healing regardless of screw choice. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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10 pages, 1217 KiB  
Article
Glenohumeral Pathologies following Primary Anterior Traumatic Shoulder Dislocation—Comparison of Magnetic Resonance Arthrography and Arthroscopy
by Oliver Holub, Jakob E. Schanda, Sandra Boesmueller, Marion Tödtling, Alexander Talaska, Rudolf M. Kinsky, Rainer Mittermayr and Christian Fialka
J. Clin. Med. 2023, 12(21), 6707; https://doi.org/10.3390/jcm12216707 - 24 Oct 2023
Cited by 1 | Viewed by 780
Abstract
Background: We assessed intraarticular injuries in patients after primary anterior traumatic shoulder dislocation by comparing magnetic resonance arthrography (MRA) results with concomitant arthroscopic findings. Methods: All patients with primary traumatic shoulder dislocation who underwent arthroscopic surgery between 2001 and 2020 with preoperative MRA [...] Read more.
Background: We assessed intraarticular injuries in patients after primary anterior traumatic shoulder dislocation by comparing magnetic resonance arthrography (MRA) results with concomitant arthroscopic findings. Methods: All patients with primary traumatic shoulder dislocation who underwent arthroscopic surgery between 2001 and 2020 with preoperative MRA were included in this study. MRA was retrospectively compared with arthroscopic findings. Postoperative shoulder function was prospectively assessed using the Disabilities of Arm, Shoulder and Hand score (quick DASH), the Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), as well as the rate of return to sports. Results: A total of 74 patients were included in this study. A Hill–Sachs lesion was consistently found in the corresponding shoulders on MRA and arthroscopy in 35 cases (p = 0.007), a Bankart lesion in 37 shoulders (p = 0.004), and a superior labrum from anterior to posterior (SLAP) lesion in 55 cases (p = 0.581). Of all cases, 32 patients were available for a clinical and functional follow-up evaluation. A positive correlation was found between the level of sport practiced and the Oxford Shoulder Score (redislocation subset) (p = 0.032) and between the age at the time of surgery and the follow-up SSV (p = 0.036). Conversely, a negative correlation was observed between the age at the time of surgery and the Oxford Instability Score (redislocation subset) (p = 0.038). Conclusions: The results of this study show a good correlation between MRA and arthroscopy. Therefore, MRA is a valid tool for the detection of soft tissue pathologies after primary anterior traumatic shoulder dislocation and can aid in presurgical planning. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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12 pages, 1977 KiB  
Article
Incidence, Management, and Hospital Costs of Orthopaedic Injuries of E-Scooter Riders in Western Australia
by Kyle Raubenheimer, Katherine Szeliga, Jonathan R. Manara, Daniel M. Fatovich, James G. A. Plant and William G. Blakeney
J. Clin. Med. 2023, 12(20), 6591; https://doi.org/10.3390/jcm12206591 - 18 Oct 2023
Viewed by 963
Abstract
The use of electric scooters (e-scooters) is increasing in Australia and internationally. The increasing availability of e-scooters has led to a rise in the number of injuries, with most patients sustaining orthopaedic injuries. This retrospective case series describes the incidence, management, and hospital [...] Read more.
The use of electric scooters (e-scooters) is increasing in Australia and internationally. The increasing availability of e-scooters has led to a rise in the number of injuries, with most patients sustaining orthopaedic injuries. This retrospective case series describes the incidence, management, and hospital costs of the orthopaedic injuries, which presented to the emergency department (ED) of the major trauma center in Western Australia. Data on demographics, ED dispatch destination, management, follow-up clinics, and hospital costs were collected between 2017 and 2022. Since June 2020, there have been 61 e-scooter crashes, which resulted in orthopaedic injuries, with more than half of the crashes occurring after the introduction of regional e-scooter sharing schemes. Thirty-two patients (52%) were admitted to the hospital. The most common orthopaedic fracture was to the upper limb (44%), followed by the lower limb (41%) and the axial skeleton (15%). Fourteen (23%) patients sustained more than one fracture. Twenty-two patients (36%) required operative management. The median number of outpatient clinic attendances per patient was 3 (interquartile range (IQR): 1–5), with inpatients requiring twice the number of clinics as compared to those discharged from the ED. The median cost per presentation was AU$5880.60 (IQR: AU$1283.10–AU$21,150.90) with inpatient costs exceeding those discharged from the ED. The range of the total costs was AU$413.80 to AU$100,239.80. The rise in the accessibility of e-scooters in Western Australia has led to a rise in ED presentations with orthopaedic injuries. Considering the recent implementation of e-scooter sharing schemes in metropolitan areas, ongoing surveillance of e-scooter injuries by clinicians and policy makers is warranted to inform harm minimization strategies. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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9 pages, 5915 KiB  
Article
Risk Factors of Proximal Screw Breakage of Locking Plate (ZPLP®) after MIPO for Distal Femur Fractures -Analysis of Patients with Plate Removal after Bony Union-
by Jehyun Yoo, Daekyung Kwak, Joongil Kim, Seungcheol Kwon, Junhyuk Kwon and Jihyo Hwang
J. Clin. Med. 2023, 12(19), 6345; https://doi.org/10.3390/jcm12196345 - 03 Oct 2023
Cited by 1 | Viewed by 787
Abstract
Background: Locking a compression plate is a more favorable surgical technique than intramedullary nailing in the treatment of distal femur fractures. This study analyzed the risk factors of proximal screw breakage retrospectively, which was confirmed in the patients with plate removal after bony [...] Read more.
Background: Locking a compression plate is a more favorable surgical technique than intramedullary nailing in the treatment of distal femur fractures. This study analyzed the risk factors of proximal screw breakage retrospectively, which was confirmed in the patients with plate removal after bony union. Methods: A total of 140 patients who were fixed by MIPO using ZPLP from 2009 to 2019 were identified. A total of 42 patients met the inclusion criteria and were included. The screw breakage group (12 patients) and the non-breakage group (30 patients) were compared. Results: Approximately 12 (28.6%) of 42 plate-removal patients showed proximal screw breakage. The breakage of proximal screws developed at the junction of the screw head and neck. The number of broken proximal screws averaged 1.4 (1~4). The breakage of the proximal screw even after the bony union is more frequent in older patients (p = 0.023), the dominant side (p = 0.025), the use of the cortical screw as the proximal uppermost screw (p = 0.039), and the higher plate-screw density (p = 0.048). Conclusions: Advanced age, dominant side, use of the cortical screw as the uppermost screw, and higher plate-screw density were related to proximal screw breakage. When the plate is removed after bony union or delayed union is shown in these situations, the possibility of proximal screw breakage should be kept in mind. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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Review

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12 pages, 1750 KiB  
Review
Evolution in the Management of Patella Fractures
by Mahak Baid, Sid Narula, Jonathan R. Manara and William Blakeney
J. Clin. Med. 2024, 13(5), 1426; https://doi.org/10.3390/jcm13051426 - 29 Feb 2024
Viewed by 883
Abstract
Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of [...] Read more.
Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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Other

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16 pages, 878 KiB  
Systematic Review
Association between Bone Turnover Markers and Fracture Healing in Long Bone Non-Union: A Systematic Review
by Francesca Perut, Laura Roncuzzi, Enrique Gómez-Barrena and Nicola Baldini
J. Clin. Med. 2024, 13(8), 2333; https://doi.org/10.3390/jcm13082333 - 17 Apr 2024
Viewed by 282
Abstract
Background: Fracture healing is a very complex and well-orchestrated regenerative process involving many cell types and molecular pathways. Despite the high efficiency of this process, unsatisfying healing outcomes, such as non-union, occur for approximately 5–10% of long bone fractures. Although there is [...] Read more.
Background: Fracture healing is a very complex and well-orchestrated regenerative process involving many cell types and molecular pathways. Despite the high efficiency of this process, unsatisfying healing outcomes, such as non-union, occur for approximately 5–10% of long bone fractures. Although there is an obvious need to identify markers to monitor the healing process and to predict a potential failure in callus formation to heal the fracture, circulating bone turnover markers’ (BTMs) utility as biomarkers in association with radiographic and clinical examination still lacks evidence so far. Methods: A systematic review on the association between BTMs changes and fracture healing in long bone non-union was performed following PRISMA guidelines. The research papers were identified via the PubMed, Cochrane, Cinahl, Web of Science, Scopus, and Embase databases. Studies in which the failure of fracture healing was associated with osteoporosis or genetic disorders were not included. Results: A total of 172 studies were collected and, given the inclusion criteria, 14 manuscripts were included in this review. Changes in circulating BTMs levels were detected during the healing process and across groups (healed vs. non-union patients and healthy vs. patients with non-union). However, we found high heterogeneity in patients’ characteristics (fracture site, gender, and age) and in sample scheduling, which made it impossible to perform a meta-analysis. Conclusions: Clinical findings and radiographic features remain the two important components of non-union diagnosis so far. We suggest improving blood sample standardization and clinical data collection in future research to lay the foundations for the effective use of BTMs as tools for diagnosing non-union. Full article
(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Damage Control Stabilization of the pelvis in patients “in extremis”

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