Background The 30-day mortality rate after surgical treatment of proximal femur fractures (PF) is reported in the literature to be up to 10%. Clinical studies in German-speaking countries on the suspected causes or underlying diagnoses have not yet been available, which is the reason for this study. Materials and methods The retrospective single-center cohort study is based on a database that records PF. Patients who died within 30 days postoperatively between 2006 and 2025 were included. The primary study endpoint was the causes of death, as documented in the final discharge summary. The secondary study endpoint was a descriptive analysis of deaths occurring within 24 h (day 0) postoperatively, as well as an assessment of variables associated with mortality between postoperative days 1-15 and days 16-30. Results The overall cohort comprised 5431 patients with PF. Of these, 369 patients (6.8%) died within 30 days. The mean age was 85.2 years (53-101 years). Compared with the preceding 5-year periods, the mortality rate decreased significantly in the last period (2021-2025; p = 0.007). The causes of death were respiratory (n = 105) and cardiovascular events (n = 54), multiorgan failure (n = 44), palliative condition (n = 32), renal events (n = 23), acute gastrointestinal diseases (n = 24), cerebral events (n = 15), periprosthetic infection including sepsis (n = 2), and other causes (n = 3). In 67 individuals, the cause of death was unclear. Within 24 h (day 0), 29 patients died, of whom n = 11 died from bone cement embolism or fat embolism syndrome. Five patients died in the operating room. More patients died between days 1 and 15 compared with the second half of the observation period (n = 216 vs. n = 124; p = 0.001), particularly during the first week (n = 145). In the first half, more women (p = 0.016) and patients treated with joint arthroplasty (p = 0.002) also died. All other variables were not statistically significant. With regard to the causes of death, both groups showed a similar distribution (p = 0.056).Conclusion In our cohort of patients with PF, the first postoperative week was the most vulnerable period for death. The causes of death provide an approximation to this previously largely overlooked topic, but they are consistent with registry or autopsy data. Over the 20-year analysis, mortality most recently declined significantly. Evidence: III; retrospective cohort study. Conclusion In our cohort of patients with PF, the first postoperative week was the most vulnerable period for death. The causes of death provide an approximation to this previously largely overlooked topic, but they are consistent with registry or autopsy data. Over the 20-year analysis, mortality most recently declined significantly. Evidence: III; retrospective cohort study.
Orthoplastic surgery combines the expertise of trauma and orthopedic surgery with plastic and reconstructive surgery for the management of complex musculoskeletal injuries associated with extensive soft tissue defects. Its primary aim is to provide early, coordinated interdisciplinary care to restore skeletal stability, achieve durable soft tissue coverage, and maximize long-term function. An acute orthoplastic patient is defined as an individual with complex musculoskeletal and soft tissue injuries requiring close interdisciplinary collaboration between trauma, plastic, and, where appropriate, additional surgical specialties. Furthermore, associated factors such as vascular injuries, infection, or relevant comorbidities may necessitate an orthoplastic treatment approach. The following recommendations were agreed upon: Patients who are hemodynamically stable and without an acutely threatened limb should be transferred to an orthoplastic competence center as early as possible, ideally within 24 h after injury. If immediate transfer is not feasible, early structured telemedical consultation with standardized transmission of clinical information, imaging, and photographic documentation of the soft tissue injury is recommended. Management should follow a standardized treatment pathway including prompt initiation of empirical antibiotic therapy, interdisciplinary radical debridement, restoration of bone stability, early vascular assessment, and timely definitive reconstruction. Whenever feasible, definitive fracture fixation and soft tissue reconstruction should be performed simultaneously or within a short time interval. These consensus recommendations provide the first structured framework for defining, triaging, and managing acute orthoplastic patients and aim to promote standardized orthoplastic care in specialized centers.
Background The December 2025 DGUV (Deutsche Gesetzliche Unfallversicherung) consensus paper provides reference values for selected musculoskeletal injury outcomes in pensions granted for an indefinite period. These values are comparators, not a formula. Each assessment must therefore identify the reference condition that most closely reflects the documented functional impairment. Objective To provide a concise and accessible guide that leads less experienced or occasional medical experts from clarification of the mandate to a transparent estimate of the reduction in earning capacity (MdE). Materials and methods The 2025 DGUV consensus paper was the starting point. Statutory provisions, case law, and supplementary medicolegal literature were reviewed narratively to structure the case-specific reference comparison into three steps. The reference values were adopted without modification. Three case examples illustrate their application. Results The guide follows three steps: clarify the mandate, assessment date, and accepted consequences; describe the documented impairment and its impact on general work demands; and identify the closest reference condition. Six guiding questions make the comparison and estimate explicit. Conclusion The approach supports clear and verifiable reasoning, especially for beginners, and may aid training and quality control. It does not replace individual expert judgement and has not yet been evaluated empirically.
The challenging transformation of medicine in the twenty-first century, involving robotics, artificial intelligence (AI) and the digitalization of daily work routines, is hampered by bureaucratic hurdles, a shortage of skilled workers and socioeconomic pressures within an aging healthcare system. This article provides an overview of current possibilities and applications of AI in the (peri)operative care of trauma patients. Even before surgeons enter the operating room, preoperative AI planning tools could increase efficiency in the future. Intraoperatively, navigation and robotics are already well-established and improve precision. In the future, ambient AI and digital twins can be expected to also link perioperative data as well as optimizing workflows and making decisions. The AI-supported surgical documentation increasingly relieves the workload for physicians but it still poses risks and interoperability issues. Key hurdles for AI in the operating room remain data heterogeneity, a lack of standardization and costs. It is also important, especially in the operating room, that the ethical responsibility for controlling (semi)autonomous systems remains with humans.
