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Clinical Treatment and Management of Orthopedic Trauma

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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: closed (25 October 2024) | Viewed by 9774

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Prof. Dr. René R.H. Hartensuer

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Guest Editor

Surgical Clinic II, Aschaffenburg-Alzenau Hospital, 63739 Aschaffenburg, Germany
Interests: pelvic and spine surgery; traumatology; trauma network; seriously injured care; telemedicine; augmented reality
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Dr. Elmar Herbst

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Guest Editor

Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, 48149 Muenster, Germany
Interests: knee; ACL; rotatory instability; osteotomy; ligament; meniscus; biomechanics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine titled ‘Clinical Treatment and Management of Orthopedic Trauma’ will be a comprehensive collection of research and articles focusing on advancements in the field of orthopedic trauma. It aims to bring together expert perspectives and cutting-edge studies to provide valuable insights into the diagnosis, treatment, and management of various musculoskeletal injuries. The included research will cover a wide range of topics, including fracture management, clinical surgeries, and rehabilitation strategies. Novel approaches such as minimally invasive surgeries, advanced imaging technologies, and regenerative therapies will be discussed, highlighting their potential in improving patient outcomes and enhancing recovery.

We invite researchers in the field of musculoskeletal injuries to submit their original research work to this Special Issue which will provide a comprehensive understanding of orthopedic trauma from a wide spectrum of perspectives.

Prof. Dr. René R.H. Hartensuer
Dr. Elmar Herbst
Guest Editors

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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.

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

musculoskeletal
orthopedics
rehabilitation
pain
trauma
osteoporosis
fractures

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Published Papers (9 papers)

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8 pages, 906 KiB

Open AccessArticle

The Effectiveness of the Modified Side-Locking Loop Suture Technique with Early Accelerated Rehabilitation for Acute Achilles Tendon Rupture in Athletes

by Yuta Matsumae, Shota Morimoto, Masashi Nakamura, Futoshi Morio, Tomoya Iseki and Toshiya Tachibana

J. Clin. Med. 2024, 13(19), 5818; https://doi.org/10.3390/jcm13195818 - 29 Sep 2024

Viewed by 648

Abstract

Background/Objectives: An early accelerated rehabilitation is generally recommended after surgery for acute Achilles tendon ruptures (ATRs). The modified side-locking loop suture (MSLLS) is a surgical technique that provides high tensile strength to the repaired Achilles tendon and allows for a safe, early accelerated rehabilitation protocol without requiring postoperative immobilization. However, there are no reports investigating the clinical outcomes of the MSLLS technique with early accelerated rehabilitation for ATRs. To clarify the effectiveness of the MSLLS technique with an early accelerated rehabilitation protocol for ATR in athletes. Methods: We retrospectively analyzed 27 athletes (Tegner activity score ≥ 6) who underwent surgical treatment using the MSLLS technique for ATR between April 2017 and August 2022. All patients underwent an early accelerated rehabilitation protocol without immobilization. Outcome measures included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score taken preoperatively and one year postoperatively, the time required to perform 20 continuous double-leg heel raises (DHR) and single-leg heel raises (SHR), the time to return to the original sport, and the presence of any complications. Results: The mean AOFAS score significantly improved from 37.2 ± 9.7 preoperatively to 96.3 ± 5.3 one year postoperatively. The mean time to be able to perform 20 continuous DHR and SHR was 7.7 ± 1.2 weeks and 11.3 ± 1.6 weeks, respectively. All patients were able to return to their original sport at their pre-injury level in an average of 22.7 ± 3.7 weeks without complication. Conclusions: The MSLLS technique in conjunction with an early accelerated rehabilitation protocol for ATR in athletes produced satisfactory results, with all patients able to return to their original sport at their preinjury level without complication. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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10 pages, 3000 KiB

Open AccessArticle

Clavicle Shaft Non-Unions–Do We Even Need Bone Grafts?

by Nils Mühlenfeld, Ferdinand C. Wagner, Andreas Hupperich, Lukas Heykendorf, Andreas Frodl, Peter Obid, Jan Kühle, Hagen Schmal, Benjamin Erdle and Martin Jaeger

J. Clin. Med. 2024, 13(16), 4850; https://doi.org/10.3390/jcm13164850 - 16 Aug 2024

Viewed by 757

Abstract

Background: The surgical treatment of bony non-unions is traditionally performed with additional bone grafts when atrophic and/or stronger implants when hypertrophic. In the case of the clavicle shaft, however, in our experience, a more controversial method where no additional bone graft is needed leads to equally good consolidation rates, independent of the non-union morphology. This method requires the meticulous anatomical reconstruction of the initial fracture and fixation according to the AO principle of relative stability. Methods: A retrospective review following the STROBE guidelines was performed on a consecutive cohort of all patients who received surgical treatment of a midshaft clavicle non-union at the Medical Center of the University of Freiburg between January 2003 and December 2023. Patients were identified using a retrospective systematical query in the Hospital Information System (HIS) using the International Statistical Classification of Diseases and Related Health Problems Version 10 (ICD-10) codes of the German Diagnosis Related Groups (G-DRG). Two groups were formed to compare the consolidation rates of patients who received additional bone grafting from the iliac crest with those of patients who did not. A 3.5 mm reconstruction LCP plate was used in all patients. Consolidation rates were evaluated using follow-up radiographs and outcomes after material removal with a mean follow-up of 31.5 ± 44.3 months (range 0–196). Results: Final data included 50 patients, predominantly male (29:21); age: 46.0 ± 13.0 years, BMI 26.1 ± 3.7. Autologous bone grafts from the iliac crest were used in 38.0% (n = 19), while no bone addition was used in 62.0% (n = 30). Six patients were lost to follow-up. Radiological consolidation was documented after a mean of 15.1 ± 8.0 months for the remaining 44 patients. Consolidation rates were 94.4% (n = 17) in patients for whom additional bone grafting was used and 96.2% (n = 25) in patients for whom no graft was used. There was no relevant difference in the percentage of atrophic or hypertrophic non-unions between both groups (p = 0.2425). Differences between groups in the rate of consolidation were not significant (p = 0.7890). The complication rate was low, with 4.5% (n = 2). Conclusions: Independent of the non-union morphology, non-unions of the clavicle midshaft can be treated successfully with 3.5 mm locking reconstruction plates without the use of additional bone grafting in most cases. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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11 pages, 1924 KiB

Open AccessArticle

From Detection to Decision: How STIR Sequence MRI Influences Treatment Strategies for Osteoporotic Vertebral Fractures

by Réka Viola, Siran Aslan, Mohammad Walid Al-Smadi, Dávid Süvegh and Árpád Viola

J. Clin. Med. 2024, 13(11), 3347; https://doi.org/10.3390/jcm13113347 - 6 Jun 2024

Cited by 1 | Viewed by 1110

Abstract

Background/Objectives: Osteoporotic vertebral fractures (OVFs) significantly impair quality of life. This study evaluates the impact of STIR sequence MR imaging on clinical decision-making for treating OVFs, mainly focusing on how MRI findings influence treatment modifications compared to those based solely on CT scans. Methods: This retrospective analysis reviewed cases from the Manninger Jenő National Traumatology Institute over ten years, where patients with suspected OVFs underwent CT and STIR sequence MR imaging. The study examined changes in treatment plans initiated by MRI findings. The diagnostic effectiveness of MRI was compared against CT in terms of sensitivity, specificity, and the ability to influence clinical treatment paths. Results: MRI detected 1.65 times more fractures than CT scans. MRI influenced treatment adjustments in 67% of cases, leading to significant changes from conservative–conservative, conservative–surgery, and surgery–surgery based on fracture characterizations provided by MRI. Conclusions: This study demonstrates that integrating STIR sequence MR imaging into the diagnostic pathway for OVFs significantly enhances the accuracy of fracture detection and profoundly impacts treatment decisions. The ability of MRI to reveal specific fracture features that are not detectable by CT scans supports its importance in the clinical evaluation of OVFs, suggesting that MRI should be incorporated more into diagnostic protocols to improve patient management and outcomes. The findings advocate for further research to establish STIR MRI as a standard osteoporosis management tool and explore its long-term benefits in preventing secondary fractures. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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12 pages, 1623 KiB

Open AccessArticle

Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level

by Claas Neidlein, Julius Watrinet, Robert Pätzold, Daniel P. Berthold, Wolf Christian Prall, Wolfgang Böcker, Boris Michael Holzapfel, Julian Fürmetz and Markus Bormann

J. Clin. Med. 2024, 13(8), 2327; https://doi.org/10.3390/jcm13082327 - 17 Apr 2024

Cited by 1 | Viewed by 1340

Abstract

Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I–III) and complex (Schatzker IV–VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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10 pages, 529 KiB

Open AccessArticle

Long-Term Follow-Up after Iliosacral Screw Fixation of Unstable Pelvic Ring Fractures

by Josef Stolberg-Stolberg, Moritz F. Lodde, Dominik Seiß, Jeanette Köppe, René Hartensuer, Michael J. Raschke and Oliver Riesenbeck

J. Clin. Med. 2024, 13(4), 1070; https://doi.org/10.3390/jcm13041070 - 14 Feb 2024

Viewed by 965

Abstract

(1) Background: High-energy injuries of the pelvic ring are rare. The wide application of iliosacral screw fixation of the posterior pelvic ring is relatively new. The aim of the present study was to evaluate the long-term quality of life. (2) Methods: All patients treated with an iliosacral screw for a posterior pelvic ring stabilization after high-energy trauma at a level 1 trauma center between 2005 and 2015 were included. Pelvic ring injuries were classified according to the Tile classification adapted by AO/ASIF. The clinical evaluation included the patient-oriented questionnaires surveys of the Majeed Score, Iowa Pelvic Score (IPS), Work Ability Index (WAI), SF-36, EQ5D-5L. (3) Results: A total of 84 patients were included with a median follow-up of 130.1 months (IQR 95.0–162.0 months). The median ISS was 22.5 (IQR 16.0–29.0), mean Majeed Score 83.32 (SD ± 19.26), IPS 77.88 (SD ± 13.96), WAI 32.71 (SD ± 11.31), SF-36 PF 71.25 (SD ± 29.61) and EQ5D-5L 0.83 (SD ± 0.21). There was a notably difference between uni- and bilateral pelvic fractures (p = 0.033) as well as a correlation with the ISS (p = 0.043) with inferior functional outcome measured by IPS. (4) Conclusions: Long-term follow-up of iliosacral screw fixation of unstable pelvic ring fractures showed a good quality of life and functional outcome with equal EQ5D-5L results and inferior SF-36 physical functioning compared to the German population. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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9 pages, 9187 KiB

Open AccessCase Report

Humeral Head Preservation after Neglected Glenohumeral Dislocation by Latarjet and Infraspinatus Remplissage—A Case Report

by Pieter van Gerven, Nikki Buijs, Leanne Blaas, J. Zhang Yuan, Jacobus A. de Priester and Robert Jan Derksen

J. Clin. Med. 2024, 13(16), 4862; https://doi.org/10.3390/jcm13164862 - 17 Aug 2024

Viewed by 968

Abstract

Background: Neglected anterior glenohumeral dislocations provide a challenging problem for physicians. For many patients with these injuries, reverse shoulder arthroplasty has been the treatment of choice, although the preservation of the patient’s own humeral head might have significant advantages. Methods: We present a case of a 66-year-old male with a neglected anterior glenohumeral dislocation that he sustained 6 weeks prior when he was hit by a car as a pedestrian. Radiographic imaging revealed a large off-track Hill-Sachs deformity and a fracture of the greater tuberosity in addition to the persisting glenohumeral dislocation. We performed open reduction and to aid stability, an infraspinatus tendon remplissage and a Latarjet procedure were performed. Results: Apart from minor and self-limiting neuropraxia, recovery was without complications. At 24 month follow-up, the patient had no impairment in general activities, had no residual pain, and had a good active range of motion. Conclusions: The authors, therefore, believe that a combination of infraspinatus tendon remplissage and the Latarjet procedure seems a feasible alternative for reverse shoulder arthroplasty and can preserve the patient’s own humeral head. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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12 pages, 2981 KiB

Open AccessSystematic Review

Does Combined Reconstruction of the Medial Collateral and Anterior Cruciate Ligaments Provide Better Knee Function? A Systematic Review and Meta-Analysis

by Károly Csete, Bálint Baráth, Lilla Sándor, Helga Holovic, Péter Mátrai, László Török and Petra Hartmann

J. Clin. Med. 2024, 13(13), 3882; https://doi.org/10.3390/jcm13133882 - 1 Jul 2024

Viewed by 885

Abstract

Objective: This study aimed to determine if medial collateral ligament reconstruction (MCLR) alongside anterior cruciate ligament reconstruction (ACLR) preserves knee functionality better than isolated ACLR in combined ACL and MCL tears. Methods: MEDLINE, EMBASE, Scopus, CENTRAL, and Web of Science were searched systematically on 31 March 2023. Studies reporting post-operative function after ACLR and ACLR + MCLR in combined injuries were included. Outcomes included International Knee Documentation Committee (IKDC) score, side-to-side difference (SSD), Lysholm, and Tegner scale values. Results: Out of 2362 papers, 8 studies met the criteria. The analysis found no significant difference in outcomes (MD = 3.63, 95% CI: [−5.05, 12.3] for IKDC; MD = −0.64, 95% CI: [−3.24, 1.96] for SSD at 0° extension; MD = −1.79, 95% CI: [−4.61, 1.04] for SSD at 30° extension; MD = −1.48, 95% CI: [−16.35, 13.39] for Lysholm scale; MD = −0.21, 95% CI: [−4.29, 3.87] for Tegner scale) between treatments. Conclusions: This meta-analysis found no significant difference in outcomes between ACLR and ACLR + MCLR, suggesting that adding MCLR does not provide additional benefits. Due to the heterogeneity and quality of the included studies, further high-quality randomized controlled trials are needed to determine the optimal treatment for combined severe MCL–ACL injuries. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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8 pages, 1328 KiB

Open AccessCase Report

Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

by Takashi Higuchi, Atsushi Taninaka, Rikuto Yoshimizu, Katsuhiro Hayashi, Shinji Miwa, Norio Yamamoto, Hiroyuki Tsuchiya and Satoru Demura

J. Clin. Med. 2024, 13(8), 2393; https://doi.org/10.3390/jcm13082393 - 19 Apr 2024

Viewed by 1110

Abstract

Background: Recently, the T2 alpha nailing system (Stryker, Inc.), which has advanced locking screws that can attach a screw to a rod, has been used worldwide and is expected to improve fracture fixation. We analyzed two cases of supracondylar femoral fractures in older adult patients, in which intraoperative fractures occurred during the insertion of advanced locking screws of the T2 alpha femur retrograde intramedullary nail. Case presentation: A 93-year-old and an 82-year-old woman each underwent T2 alpha femur retrograde nail fixation for supracondylar femur fractures at separate hospitals, and advanced locking screws were used as the proximal transverse locking screws. In both patients, a fracture line was observed at the proximal screw postoperatively, and the fractures were refixed with distal cable wiring and/or femoral distal plates. The patients were subsequently discharged from the same facility with no remarkable pain. Conclusions: When inserting advanced locking screws, it is necessary to enlarge the screw hole in the near-bone cortex with a counterbore drill, which might add torque to the bone cortex that could result in fractures. If the sleeve is distant from the bone, the counterbore drill will not reach the bone, the screw hole will not expand, and the insertion of advanced locking screws will apply a strong torque to the bone cortex and may result in fracture. Moreover, it is important to confirm that the counterbore drill is securely inserted under fluoroscopy and to carefully enlarge the bony foramen manually to prevent fractures during screw insertion. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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9 pages, 657 KiB

Open AccessCase Report

Clinical Utility of Robot-Assisted Gait Training in Patients with Spinal Cord Injury Caused by Electrical Burns: A Case Report

by Seung-Yeol Lee, Cheong-Hoon Seo, Yoon-Soo Cho and So-Young Joo

J. Clin. Med. 2023, 12(23), 7220; https://doi.org/10.3390/jcm12237220 - 21 Nov 2023

Cited by 1 | Viewed by 1236

Abstract

Robot-assisted gait training (RAGT) has been proven effective in improving gait function in not only patients with central nervous system damage, but also in patients who have undergone musculoskeletal surgery. Nevertheless, evidence supporting the efficacy of such training in burn patients remains insufficient. This report aimed to evaluate the effect of RAGT in burn patients with spinal cord injuries (SCI) caused by electrical trauma. We reported a case of two patients. The total duration of each session was about 1 h 30 min. This included 10 min to put on the exoskeleton, 30 min of robot-assisted training using SUBAR^®, 10 min to remove the exoskeleton, 10 min to observe whether complications such as skin abrasion, ulcer, or pain occur in the scar area after RAGT, and 30 min of conventional physiotherapy, at a rate of 5 days a week for 12 weeks. All measurements were assessed before training (0 week) and after training (12 weeks). The American Spinal Cord Injury Association (ASIA) lower extremity motor score (LEMS), passive range of motions (ROMs) of different joints (hip, knee, and ankle), ambulatory motor index (AMI), functional ambulation categories (FAC), and 6 min walking (6 MWT) distances were evaluated to measure the degree of gait function through training. In both patients, manual muscle test measurement and joint ROM in the lower extremities improved after 12 weeks training. The first patient scored 0 in the FAC before training. After 12 weeks of training, he could walk independently indoors, improving to an FAC score of 4. He also reached 92.16 m in the 6 MWT. LEMS improved from 22 before training to 30 after training, and AMI score improved from 12 before training to 16 after training. In the second patient, an independent walking function was not acquired. LEMS improved from 10 before training to 26 after training. AMI scores were the same at 10 points before and after training. The results suggested the possibility of achieving clinical effects in terms of improving lower extremity muscle strength, joint ROMs, and gait performance in patients with SCI caused by electrical trauma. Full article

(This article belongs to the Special Issue Clinical Treatment and Management of Orthopedic Trauma)

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