Introduction:Osteoporotic medication (oTh) is essential for secondary prevention but is often not prescribed after vertebral fractures. Research question:The aim of this analysis was to assess the status of oTh in inpatients with osteoporotic thoracolumbar fractures and to analyze possible supply gaps. Materials and methods:Data were collected as part of the multicenter, prospective EOFTT (Evaluation of the Osteoporotic Fracture Classification, Treatment Score and Therapy Recommendations) study. A total of 518 patients with osteoporotic thoracolumbar fractures in 17 clinics were included. The presence, type, and changes over time of oTh were recorded and evaluated using the Cochrane Q test. Results:Hospitalisation increased oTh with 36% at admission significantly in women to 83%, and in men to 71% (p < 0.001). At admission women received more frequently oTh than men (p = 0.017). At the follow-up after 7 ± 5 months, there was no significant differences between the sexes (p = 0.330). However, the proportion in both groups decreased significantly to 41% (women) and 34% (men), respectively (p < 0.001). In-hospital treatment led to a significant increase in the initiation of anti-osteoporotic medication, with calcium and vitamin D supplementation rising from 13% at admission to 35% at discharge (p < 0.001). However, a substantial and significant decline was observed during follow-up (18%, p < 0.001). Discussion and conclusion:In the inpatient setting, there is a clear improvement in oTh, which is particularly pronounced in female patients. However, the significant decline in therapy rates at follow-up highlights deficits in long-term care. Despite existing recommendations, evidence-based agents such as bisphosphonates or osteoanabolic are still rarely used. This indicates a relevant gap in care in secondary prevention and underscores the need for structured, post-hospitalisation concepts for sustainable osteoporosis therapy.

PURPOSE:Severe trauma and polytrauma are major public health concerns due to their long-term impact on survivors' quality of life (QoL). While advances in trauma care have improved survival rates, long-term functional, psychological, and social outcomes remain inadequately understood. This study evaluates the health-related quality of life (HRQoL), functional deficits, and mortality of trauma patients ten years post-injury, comparing severely injured (SI) and polytrauma (PT) patients. METHODS:Patients admitted to the shock trauma unit at a Level 1 trauma center between 2010 and 2013 with an Injury Severity Score (ISS) ≥ 9 were identified. Survivors were categorized into SI (ISS ≥ 9 and <16 or isolated injury in one body region) and PT (ISS ≥ 16 and injuries in multiple body regions). HRQoL was assessed using the Polytrauma Outcome (POLO) Chart, including the EuroQol 5D-3L, SF-36, and Trauma Outcome Profile (TOP). RESULTS:Ninety-one patients (42 SI, 49 PT) completed follow-up, with an additional 80 confirmed deceased patients. Polytrauma patients had significantly longer hospital and ICU stays, higher rates of mechanical ventilation, and worse functional outcomes (p < 0.001). While PT patients reported more physical impairments and pain (SF-36 Physical Functioning, Physical Role, and Pain dimensions; p < 0.05), no significant differences were observed in psychological or social dimensions. Overall, 60.4% of the cohort reported reduced QoL (EuroQol Index ≤0.8), with no significant difference between SI and PT groups. Long-term mortality did not differ between groups (p = 0.6). CONCLUSION:Ten years post-trauma, both SI and PT patients experience substantial reductions in QoL, with physical impairments more pronounced in PT patients. However, psychological and social outcomes appear independent of injury severity, suggesting that factors beyond trauma severity influence long-term recovery. These findings highlight important associations relevant to long-term outcomes and underscore the need for further research to better define how persistent pain, functional limitations, and psychosocial factors interact in long-term recovery after severe injury and polytrauma.

The number of osteoporotic thoracolumbar vertebral fractures (OVCF) is steadily increasing. Incomplete burst type fractures of type OF3 represent a significant proportion of OVCF. The aim of this study is therefore to evaluate the different treatment modalities of OF3 fractures. A prospective multicenter evaluation of the osteoporotic fracture classification, treatment score and therapy recommendations (EOFTT) was conducted from 2017 to 2020. Patients with OF3 fractures and a minimum follow-up of 6 weeks were included. The exclusion criteria were dementia, malignancies and a history of surgical stabilization or fusion in the fracture region. Before treatment (TD, day of treatment decision) and at last follow-up (FU), the OF score and the following parameters were collected: VAS, Timed Up Go test (TuG), ODI, Eq. 5D 5 L and complications. A total of 218 patients with OF3 fractures and mean age of 75 ± 10 years (range 41–96, female 73

Osteoporotic pelvic ring fractures (OPRFs) are common in ageing populations and challenging due to multimorbidity and immobility-related complications. The OF-Pelvis classification and score support therapeutic decision-making, yet their relationship with in-hospital complications remains unclear. We conducted a prospective multicentre study of 390 patients treated at 14 German centres. Fractures were classified using the OF-Pelvis system; treatment recommendations were derived from the OF-Pelvis Score and compared with the therapy performed. Complications during hospitalisation were recorded, and predictors were assessed by logistic regression. Functional outcomes between treatment decision and discharge were analysed with repeated-measures general linear models. Overall, 258 patients (66%) underwent surgery and 132 (34%) received conservative care. Complications occurred in 26%, most commonly urinary tract infections and wound-related events. The OF-Pelvis Score showed high concordance with real-world treatment decisions, while age was the only independent predictor of complications; neither treatment modality nor the score independently predicted adverse events. Functional outcomes improved significantly across groups despite complications when managed within structured multidisciplinary care. These findings support the score’s utility for decision-making but indicate that complication risk is driven primarily by patient-related factors, emphasising the need for targeted geriatric co-management and prevention strategies.

The evidence for operative treatment (OP) versus conservative management (CM) in patients with vertebral fractures (VFs) remains controversial. The aim of this study was to evaluate the impact of treatment on clinical outcomes. All patients aged ≥ 85 years presenting with a symptomatic thoracolumbar VF (either acute or exacerbated chronic) at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were all-cause mortality and its associated factors one year after hospital admission, as well as disability and quality of life (QoL), measured by the Oswestry Disability Index (ODI). For statistical analysis, the Kaplan-Meier method and Cox proportional hazards modeling were performed. A total of 153 patients (mean age 88.5, range 85 to 99; 68.6

Abstract Purpose To evaluate the feasibility of using the recently developed OF-Pelvis-Score (OFP-Score) for treatment decisions in patients with osteoporotic fractures of the pelvis (OFP) based on standard clinical diagnostics. Methods A multicenter prospective cohort study was conducted at 14 trauma centers including 375 consecutive patients who were treated for an OFP over a period of 19 months. All fractures were classified according to the OF-Pelvis-Classification (OFP-Classification). The decision for either conservative or surgical therapy was made independently of the OFP-Score recommendation. Final decisions were compared to the recommendations given by the OFP-Score. Results 375 patients with an average age of 81.0 years (± 7.6) were included, mainly female (85.6%). According to the OFP-Score, surgery was recommended in 60.5%, and conservative treatment was recommended in 21.9%. In 66 patients (17.6%) the score was undetermined with no treatment recommendation. In daily practice, 33.6% of the patients were treated conservatively and the remaining 66.4% operatively. Overall, the agreement between the OFP-Score and the performed treatment was 91%. The score was obtained in a mean of 3.1 min (± 2.9). All patients improved significantly with respect of VAS (p < 0.001) and ODI (p < 0.001) during their hospital stay. Conclusion Patients with osteoporotic sacral fractures improved clinically both after surgical and conservative treatment. The OFP-Score-based therapy recommendations showed a promisingly high rate of agreement with the therapy of daily practice. The scoring method provides a structured framework that supports clinical decision-making, complementing clinical judgment and other evidence-based tools in guiding treatment choices.

Study Design Multicenter study with prospective collected data. Objectives This study investigates the relationship between individual score components and treatment success, defined by achieving Minimal Clinically Important Difference (MCID) thresholds in functional outcomes, using multicenter prospectively collected data. This work aimed to optimize the OF-Score while maintaining its original structure. By using outcome-oriented data, we refined this established decision-support tool to improve its predictive accuracy for successful clinical outcomes. Methods Data from 518 patients from the EOFTT study with osteoporotic vertebral fractures were analyzed. Only patients with clinically successful outcomes, defined by improvement beyond MCID thresholds in functional scores after conservative or surgical treatment, were selected from this cohort. Optimization was performed using a data-driven reweighting approach combined with structured clinical expert evaluation, adjusting variable weights within predefined limits to improve alignment with successful therapies. Results The subset data of 374 successfully treated patients were analyzed. Before optimization, the OF-Score showed an accuracy of 73%, with pain and mobilization being the most important parameters. After optimization, the OF-Score showed an accuracy of 80.7% (sensitivity 85.2%, specificity 71.2%). The number of nonapplicable (indifferent) therapy recommendations dropped from 144 (37%) to 72 (19%). A threshold of 5 points provided optimal discrimination between conservative treatment (≤5) and surgical treatment (>5). Discussion The optimized OF-Score, targeted weight adjustments, improves the alignment between clinical recommendations and treatment success. This refinement enhances the score’s predictive accuracy for treatment responders while maintaining the simple, practical structure.

Osteoporotic vertebral fractures (OVF) present varying treatment challenges depending on fracture severity, stability, and patient characteristics. While the OF classification system guides treatment decisions, gender differences in OVF management and outcomes remain underexplored. How do treatment strategies and clinical outcomes differ between genders? This secondary analysis utilized prospective data from the German multicenter EOFTT study, including 518 patients (390 females, 128 males) treated for thoracolumbar OVF. Outcomes assessed included adherence to OF score recommendations, pain levels, functional performance (Timed Up Go test, Barthel Index, Oswestry Disability Index), and rates of anti-osteoporotic therapy (aoTh). Statistical analyses included generalized linear mixed models and repeated-measures general linear models, with therapy type as a covariate. Gender did not influence overall treatment choice; however, men more frequently underwent instrumentation, while women received augmentation procedures. AoTh administration was significantly lower in men at discharge (72

BACKGROUND:Artificial intelligence (AI)-driven discharge-letter tools aim to reduce documentation burden for clinicians. OBJECTIVE:Map the German-speaking market, compare feature sets and assess real-world feasibility, data security and costs. METHODS:Structured market scan (Jan-Mar 2025); 14 vendors contacted, 4 questionnaires, and 4 live demos analysed. A 26-item feature matrix and directed qualitative content analysis were applied. RESULTS:Response rate 28%. Full-stack systems (Atacama, Fraunhofer) covered 65% and 38% of features, producing almost complete letters yet requiring manual approval. Basic transcription tools (Grundig) generated raw text only. No product offered automatic ICD/OPS coding or therapy suggestions. Pricing ranged from € 49 per user/month to six-figure enterprise packages. CONCLUSION:AI-generated letters are technically viable but limited by interoperability gaps, missing reimbursement and strict EU-AI-Act requirements. Hospitals should launch KPI-driven pilots with privacy-by-design to build evidence.

Introduction Acetabular fractures in geriatric patients are increasing in frequency and present unique challenges due to poor bone quality and pre-existing osteoarthritis. High rates of secondary conversion to Total Hip Arthroplasty (THA) have led to the increased use of a "Fix and Replace" strategy (Trauma Arthroplasty). This systematic review and meta-analysis compares clinical outcomes and complications of ORIF with primary THA/Combined Hip Procedure (CHP) based on fracture-based treatment strategies in the elderly. Methods A systematic literature search was conducted (PubMed, Embase, Cochrane, and Web of Science) for studies published between 1997 and 2025 involving patients aged ≥55 years with acetabular fractures. We compared ORIF (n = 2,034) versus Arthroplasty (CHP/THA, n = 417) [Synthesized from updated dataset]. Primary outcomes were functional scores (Harris Hip Score and Oxford Hip Score), 90-day and 1-year mortality rates, and reoperation/conversion rates. Absolute numbers and pooled odds ratios (OR) were calculated using a random-effects model Results Out of 2,163 screened articles, 20 (0.9%) were included in this study, encompassing a total cohort of 2,703 patients. The mean age of the study population was 74.14 years (SD 6.97), with a mean ASA score of 2.8. The primary THA/CHP group achieved a significantly higher postoperative Harris Hip Score with a mean of 73.6 compared to 66.3 in the ORIF group at three months (p < 0.05). Surgical intensity was higher in the "Fix and Replace" cohort in several series, which demonstrated a significantly longer median operative time (185 vs. 125minutes, p < 0.001) and an increased intraoperative blood loss (median 1,000ml vs. 500ml, p = 0.006) compared to isolated ORIF. The 90-day mortality rate was 11% for ORIF and 15% for THA/CHP, showing no statistically significant difference (OR 1.08; 95% CI 0.58–2.02; p = 0.82). Patients initially treated with ORIF had a significantly higher risk of failure requiring secondary surgery, with a 14% to 45% conversion rate to THA due to post-traumatic osteoarthritis or hardware failure. The primary THA/CHP group had a significantly lower reoperation rate of 4.4% to 7.7%, yielding a pooled odds ratio of 2.34 (95% CI 1.31–5.67; p < 0.001) in favor of primary arthroplasty Conclusion Primary Trauma Arthroplasty (Fix and Replace) provides superior functional outcomes and lower reoperation rates compared to ORIF alone in geriatric patients with comminuted acetabular fractures or joint impaction. While surgical intensity is higher, the avoidance of "failed" osteosynthesis and subsequent complex revision surgery suggests that primary THA is a viable first-line treatment for selected elderly patients.

BackgroundPolytrauma management demands rapid, high-stakes decisions under severe time pressure, increasing the risk of error and deviation from evidence-based protocols. Computer-assisted decision support systems (CDSS) may counter these risks by improving adherence to guidelines and reducing cognitive strain. We developed TraumaFlow, a CDSS integrating the German S3 guideline and ATLS® principles, and evaluated its impact in real-world trauma care.MethodsIn a prospective study at a level 1 trauma center, 30 shock room cases were managed with TraumaFlow alongside the standard paper protocol and compared both with the corresponding paper documentation and with 30 conventionally documented cases from a historical cohort. System-generated recommendations were tracked for implementation. Usability was assessed by questionnaire, and workload measured with the NASA Raw Task Load Index (NASA-RTLX).ResultsEighteen residents (mean age 31 ± 4 years, 56% female) participated in 30 polytrauma cases. Documentation completeness was significantly higher with TraumaFlow compared to paper (20.5/25 items (82%) vs. 18.4/25 items (74%), p = 0.002). Of 74 clinical prompts, 37% triggered clinically relevant actions that might otherwise have been missed. Workload did not differ significantly between TraumaFlow-supported and conventional cases (35.0 ± 12.4 vs. 34.7 ± 15.3). Participants rated usability positively and reported improved confidence.ConclusionTraumaFlow enhanced documentation quality and supported guideline-based management in acute polytrauma care. Although no measurable reduction in workload was observed, the system improved structure, reduced risk of omission, and was well accepted by clinicians. These findings highlight the potential of CDSS to strengthen trauma team performance and standardize complex emergency care.Clinical Trial Registrationhttps://drks.de/register/de/trial/DRKS00034201, Registration No. DRKS00034201.

Introduction:Osteoporotic vertebral compression fractures (OVCF) represent a growing clinical challenge and the effect of bisegmental Cobb angles in treatment decision and outcome prediction for remains unclear. Material and methods:This prospective multicenter study analyzed 350 patients with thoracolumbar OVCF (OF2-OF4). Bisegmental Cobb angles (CA) were measured at the day of treatment decision, discharge, and follow-up. Associations with treatment, OF classification, pain, and functional outcomes were analyzed. Results:Patients treated with instrumentation showed more pronounced kyphotic alignment than conservatively treated patients at baseline (-11 ± 12° vs. -7 ± 14°, p = 0.042). CA correlated weakly with OF-Score (r = -0.167, p = 0.002) and OF classification (r = -0.195, p < 0.001), but not with pain (p = 0.789). ROC analyses demonstrated poor discriminatory power of CA for treatment (AUC = 0.557, p = 0.078); the predefined kyphosis threshold of -15° was not predictive. Multinomial logistic regression confirmed that OF classification (p < 0.001) and pain intensity (p < 0.001), but not CA (p = 0.310), independently predicted the performed treatment. Over time, surgically treated patients achieved significant fracture reduction (-6 ± 7° during hospitalization, p < 0.001) with partial loss at follow-up, whereas conservatively treated patients showed progressive increased kyphosis. CA were not consistently associated with functional outcomes. Discussion and conclusion:The CA alone has limited value for guiding treatment decisions in thoracolumbar OVCF, and fixed angular thresholds are not clinically useful. However, restoration of the segmental sagittal profile appears to be associated with clinical outcome after surgical treatment. For this reason, the bisegmental Cobb angle certainly does not play the main role in the decision on treatment, but it should be included as a secondary parameter.

Die aktuelle Richtlinie des Gemeinsamen Bundesausschusses fordert eine frühestmögliche operative Versorgung hüftgelenknaher Femurfrakturen innerhalb von 24 h nach Aufnahme zur Senkung der Komplikationsrate und Mortalität. Ziel war es, Krankenhaussterblichkeit sowie Komplikationsrate und -arten in Bezug auf die präoperative Wartezeit zu analysieren. Zwischen 2010 und 2020 wurden 575 Patienten mit Duokopfprothese nach Schenkelhalsfraktur retrospektiv hinsichtlich Krankenhausmortalität und Komplikationen untersucht. Ausgeschlossen wurden pathologische Frakturen, Frakturen älter als 4 Wochen sowie osteosynthetisch versorgte Patienten. Erfasst wurden patientenspezifische Daten, Krankenhaussterblichkeit sowie Komplikationsrate und -arten. Die präoperative Wartezeit sank im Median von 38 h (2010) auf 19 h (2020). Patienten, die innerhalb von 24 h operiert wurden, erhielten die OP im Median nach 14,2 h, im Vergleich zu 40,2 h bei späterer OP. Der ASA-Mittelwert lag bei 2,76; die > 24 h-Gruppe wies signifikant höhere ASA-Werte auf (p = 0,024). 12 (4,2

BackgroundSocial media (SM) is increasingly used in the healthcare system and offers various benefits for patients such as accessible health information and communication with other patients and healthcare professionals. However, SM also poses risks, including the dissemination of medical misinformation and privacy concerns. This in turn can influence patients’ health-related decision-making and the patient-physician relationship. There is limited data regarding which SM orthopedic patients use and what benefits and risks of SM they perceive.MethodsAn online survey was conducted from April to December 2023 among orthopedic and trauma patients in five German orthopedic clinics. The questionnaire with 32 variables was designed to assess internet and SM usage patterns, platform preferences, and perceived benefits and risks. Statistical analysis was performed, including subgroup analyses.ResultsA total of 267 patients participated, with 82.0% reporting regular SM use. In total 45.9% of the patients used SM for general health questions and 51.3% for orthopedic-related questions. The most used information platforms were conventional websites, YouTube, Instagram, and messenger apps. A total of 45.9% used SM infrequently for general health questions, and 51.3% for orthopedic-related queries. Only 13.7% of patients agreed that SM helped in medical decision-making, and 31.1% felt confident in assessing the credibility of SM content. Additionally, 58.6% of patients were unsure about allowing physicians to present their cases on SM, and 62.3% were uncertain about posting their medical images.ConclusionAmong German orthopedic patients, the use of SM for health-related and gain of orthopedic information was low in the given study. While SM may offer valuable health information, their role in medical decision-making remains limited due to concerns over content credibility and privacy. Video-based content seems to achieve the best reach. Future research should explore these aspects longitudinally and across diverse populations to better understand and address the challenges and benefits of SM in healthcare.

Osteoarthritis is a common disease worldwide, most commonly affecting the knee. With the rise of obesity, paired with higher life expectancy, prevalence of osteoarthritis of the knee will rise as well. Therefore, Total Knee Arthroplasty (TKA) rates are expected to increase 85 %, estimating 1.26 million procedures worldwide in 2030. Patients will become older with demographic changes and more elderly people will be eligible for procedure, a patient group is often considered vulnerable, with a higher risk of mortality and complications. This systematic review aimed to compare perioperative outcomes after TKA in Octogenarians with those in a younger cohort. After screening 33,336 publications on total joint arthroplasty in the elderly in the PubMed and Web of Science databases, four studies investigating TKA and matching criteria were included. No notable variations in outcomes were detected among elderly compared to younger patients. Eligibility for a procedure should be based on comorbidities and overall health status rather than age alone.

Percutaneous minimally invasive retrograde screw fixation is a widely accepted treatment strategy for patients with superior ramus fractures and has shown good biomechanical stability compared to plating. Recently, elastic stable intramedullary nailing (ESIN) devices have been proposed as an alternative in the treatment of superior ramus fractures. However, biomechanical studies on this new treatment are lacking. Thus, the aim of this study was to compare the biomechanical stability of ESIN in pubic ramus fractures versus retrograde screw fixation. Standardized pubic ramus fractures (Nakatani type II) were created in fresh-frozen paired hemipelves. Fractures were either stabilized with a 6.5 mm cannulated screw (n = 4) or a 3.5 mm Stainless Steel Elastic Nail System (n = 4). In a validated setup, a cyclic loading protocol was applied with increasing axial force (1500 cycles, 250–750 N). Outcome parameters were fracture mobility over time, fracture displacement and construct survival. Descriptive and opto-metric methods were used to describe the mode of failure. Amongst all tested hemipelves (n = 8), no construct failure was observed. There was no significant difference in mean vertical fracture displacement between the groups (ESIN 0.07 mm, SD 0.12 versus screw 0.04 mm, SD 0.05; p = 0.773). After 500 cycles at 250 N, mean vertical fracture displacement was 0.09 mm (SD 0.16) in the ESIN group and 0.03 mm (SD 0.04) in the screw group (p = 0.773). After subsequent 500 cycles at 500 N in the vertical plane, mean fracture displacement increased to 0.35 mm (SD 0.31) in the ESIN group and to 0.14 mm (SD 0.17) in the screw group (p = 0.281). With a maximum load of 750 N, after 500 cycles, mean fracture displacement was 0.58 mm (SD 0.51) in the ESIN group and 0.31 mm (SD 0.26) in the screw group (p = 0.376). There was no difference between the implants regarding the accumulated fracture movement over time (ESIN 494 mm*cycles, SD 385 versus screw 220 mm*cycles, SD 210; p = 0.259). In this in-vitro biomechanical study, fixation of superior ramus fracture using ESIN was not different in construct survival, relative motion to fracture, and fracture displacement when compared to retrograde screw fixation.