Abstract Background Due to the difference in size between the humeral head and the glenoid, the shoulder joint is prone to instability. Therefore, the reconstruction of the physiological joint morphology is of great importance in shoulder joint preservation and replacement surgery. The aim of this study was to describe physiological reference parameters for the morphology of the glenoid for the first time. Material and methods MRI images of the shoulder joints of 418 patients (mean age: 50.6 years [± 16.3]) were retrospectively analysed in a low-grade osteoarthritic population. The glenoid distance in coronal (GDc) and axial view (GDa), glenoid inclination (GI) and version (GV) as well as scapula neck length (SNL) were measured. Parameters were studied in association for age, gender, side and degeneration grade. Results Mean GDc was 33.4 mm (± 3.6), mean GDa 26.8 mm (± 3.2), mean GI 10.5° (± 6.4), mean GV -0.4 mm (± 5.4) and mean SNL was 33.4 mm (± 4.7). GDa was significant higher in right shoulders (p < 0.001). GDc and GDa showed significant higher mean values in older patients (p < 0.001) and in shoulders with more severe degenerative changes (p < 0.05). While GDc, GDa and SNL were significant larger in male patients (p < 0.001), GI had a higher mean value in female shoulders (p = 0.021). Conclusion Age, gender and shoulder joint degeneration influence changes in the morphological parameters of the glenoid. These findings have to be considered in shoulder diagnostics and surgery. Clinical trial number Not applicable.

The aim of the present study was to determine physiological reference values for the morphology of the patella and to analyse these parameters according to patella position in healthy knee joints. Healthy knee joints of 409 patients (mean age, 52.3 years [± 16.8]) were analysed retrospectively on MRI images for Insall-Salvati index (ISI), sagittal patella thickness (PTS) and patella length (PLS) as well as axial patella thickness (PTA) and patella width (PWA). Differences between patellar diameters were analysed depending on ISI, side, age and gender. Mean PTS was 20.1 mm (± 2.4), PLS 44.0 mm (± 4.4), PTA 21.8 mm (± 2.4) and PWA 44.5 mm (± 4.7). Depending on the vertical patellar position (ISI), all patellar parameters (p < 0.01) showed significant differences between patients with a patella alta, norma and baja. In general, a smaller ISI showed higher measured values for the patellar parameters. There were no significant differences for the laterality. Only PTS showed a significant age difference (p = 0.031). All parameters were significantly larger in male compared to female knees (p < 0.001). Reference parameters for the patella morphology are reported. Concluding from the results, a relationship between vertical patellar position and patellar morphology seems to exist. This finding should be taken into account in diagnostics and therapy of patella disorders.

ObjectiveClosed reduction and dynamic hip screw (DHS) osteosynthesis are preferred as joint‐preserving therapy in case of medial femoral neck fractures (MFNFs). A change in the femoral offset (CFO) can cause gait abnormality, impingement, or greater trochanteric pain syndrome. It is unknown whether the femoral offset (FO) can be postoperatively fully restored. The aim of the study was to investigate the extent of a possible CFO in hip joints after DHS osteosynthesis in the case of an MFNF.MethodsIn this retrospective study, 104 patients (mean age: 71.02 years, men: n = 50, women: n = 54) with MFNF who underwent closed reduction and DHS osteosynthesis were analyzed by postoperative x‐rays to assess CFO between the operated (OS) and nonoperated joint side (NOS). The studies covered the time period 2010–2020. A statistical comparison was performed between the mean values of FO between OS and NOS, taking into account patient age, gender, and fracture severity.ResultsAll operated hip joints showed a CFO. In 76.0% (79 of 104), the FO decreased (FOD), and in 24.0% (25 of 104), the FO increased (FOI). A critical CFO (>15% CFO) was detected in 52.9% (55 of 104). In hip joints with postoperative FOD, the mean FO between NOS (49.15 mm [±6.56]) and OS (39.32 mm [±7.87]) and in hip joints with postoperative FOI the mean FO between NOS (41.59 [±8.21]) and OS (47.27 [±6.68]) differed significantly (p < 0.001). Preoperative FO (r S: −0.41; p > 0.001) and caput–collum–diaphyseal angle (CCD; r S: 0.34; p > 0.001) correlated with postoperative CFO. FOD was found in hip joints with a preoperative FO >44 mm and CCD <134° vice versa FOI in hip joints with a preoperative FO <44 mm and CCD >134°.ConclusionClosed reduction and DHS osteosynthesis in patients with MFNF result in a clustered significant CFO. The individual FO should be taken into account pre‐ and intraoperatively to avoid a postoperative extensive CFO.

The data on the use of a one- or two-screw technique (1S, 2S) for ventral osteosynthesis of type II dens fractures are contradictory. The aim was to design an apparatus to mimic the physiological conditions and test stability with 1S, 2S, and a headless compression screw (HCS) for osteosynthesis of artificially created type II odontoid fractures. The apparatus was mounted on a Zwick materials testing machine. A total of 18 C1–2 specimens were stratified into three groups (1S, 2S, HCS). Odontoid fractures were artificially created, and osteosynthesis was performed. Each specimen was tested at loads increasing from 1 to 40 N. Screw loosening was observed visually, by fatigue data, and by a camera tracking system. Analysis of the Zwick data and the camera data revealed a significant higher stability after 2S compared to 1S and HCS treatment (Zwick data: p = 0.021, camera data: p < 0.001), while visible screw loosening showed a superiority of the 2S only over HCS (p = 0.038). The developed apparatus allowed the dynamic study of the atlantoaxial joint with a high approximation to physiological conditions. The results demonstrated superiority of the 2S over the 1S and HCS in biomechanical stability in the treatment of type II odontoid fractures.

BACKGROUND:Free chatbots powered by large language models offer lateral ankle sprains (LAS) treatment recommendations but lack scientific validation. METHODS:The chatbots-Claude, Perplexity, and ChatGPT-were evaluated by comparing their responses to a questionnaire and their treatment algorithms against current clinical guidelines. Responses were graded on accuracy, conclusiveness, supplementary information, and incompleteness, and evaluated individually and collectively, with a 60 % pass threshold. RESULTS:The collective analysis of the questionnaire showed Perplexity scored significantly higher than Claude and ChatGPT (p < 0.001). In the individual analysis, Perplexity provided significantly more supplementary information than the other chatbots (p < 0.001). All chatbots met the pass threshold. In the algorithm evaluation, ChatGPT scored significantly higher than the others (p = 0.023), with Perplexity below the pass threshold. CONCLUSIONS:Chatbots' recommendations generally aligned with current guidelines but sometimes missed crucial details. While they offer useful supplementary information, they cannot yet replace professional medical consultation or established guidelines.

INTRODUCTION:Fragility fractures without significant trauma of the pelvic ring in older patients have an increasing incidence due to demographic change. Influencing factors other than osteoporotic bone quality that lead to an insufficiency fracture are not yet known. However, it is suspected that the pelvic tilt (PT) has an effect on the development of such an insufficiency fracture. This study explores the influence of the PTs in patients with insufficiency fractures of the posterior pelvic ring.MATERIALS AND METHODS:A total of 49 geriatric patients with fragility fractures of the pelvic ring were treated at a university hospital level-1 trauma center during a period between February and December 2023, and their fractures were classified according to the FFP classification of Rommens and Hofmann. Complete sets of computer tomography (CT) and radiological images were available to determine the PT angle of the patients.RESULTS:34 FFP type 2 and 15 FFP type 3 classified patients were included in the study. Significant difference was seen in the pelvic tilt (PT) angle between the patient group with insufficiency fractures (n= 49; mean age: 78.02 ± 11.80) and the control group with lumbago patients (n= 53; mean age: 69.23 ± 11.23). The PT was significantly higher in the patients with insufficiency fractures (25.74° ± 4.76; p⁎⁎⁎⁎ ≤ 0.0001).CONCLUSIONS:The study demonstrates a significant extension of the PT angle of individuals with insufficiency fractures when compared to those with lumbago. The result suggests a potential association between pelvic tilt and fracture susceptibility.TRIAL REGISTRATION:A retrospective study about the influence of sagittal balance of the spine on insufficiency fractures of the posterior pelvic ring measured by the "pelvic tilt angle", DRKS00032120. Registered 20th June 2023 - Prospectively registered. Trial registration number DRKS00032120.

Early diagnosis of surgical site infections (SSIs) could prevent surgical revision. Inflammatory markers (IMs), such as procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α), seem more accurate in diagnosing SSI than C-reactive protein (CRP) and white blood cell (WBC) count. The aim was to compare the predictive values of CRP, WBC count, PCT, IL-6, and TNF-α in SSI detection. A total of 130 patients undergoing dorsal spondylodesis from 2019 to 2024 were enrolled in a prospective diagnostic study at a maximum care spine center. IMs were measured preoperatively and on the postoperative days (PODs) 1, 2, 3, 5, and 7. Patients with high suspicion of SSI underwent revision surgery. SSI was diagnosed when the microbiological evidence was positive. Patients were divided a posteriori into the non-infection and infection groups. IMs of 118 patients (66.9 ± 13.0 years, 61.0

Study design In vitro human cadaveric biomechanical analysis. Objectives Optimization of prostheses for cervical disc arthroplasties (CDA) reduces the risk of complications. The instantaneous helical axis (IHA) is a superior parameter for examining the kinematics of functional spinal units. There is no comprehensive study about the IHA after CDA considering all 3 motion dimensions. Methods Ten human functional spinal units C4-5 (83.2 ± 7.9 yrs.) were examined with an established measuring apparatus in intact conditions (IC), and after CDA, with 2 different types of prostheses during axial rotation, lateral bending, and flexion/extension. Eccentric preloads simulated strains. The IHA orientation and its position at the point of rest (IHA 0 -position) were analyzed. Results The results confirmed the existing data for IHA in IC. Lateral preloads showed structural alterations of kinematics after CDA: During axial rotation and lateral bending, the shift of the IHA 0 -position was corresponding with the lateral preloads’ applied site in IC, while after CDAs, it was vice versa. During lateral bending, the lateral IHA orientation was inclined, corresponding with the lateral preloads’ applied site in the IC and oppositely after the CDAs. During flexion/extension, the lateral IHA orientation was nearly vertical in the IC, while after CDA, it inclined, corresponding with the lateral preloads’ applied site. The axial IHA orientation rotated to the lateral preloads’ corresponding site in the IC; after CDA, it was vice versa. Conclusion Both CDAs failed to maintain physiological IHA characteristics under lateral preloads, revealing a new aspect for improving prostheses’ design and optimizing their kinematics.

Background: Traumatic spinal cord injuries represent a devastating condition in the lives of those affected, with physical, emotional, and economic burdens for the patients themselves, their social environment, and society as a whole. Objective: Surgical approach and techniques in traumatic spinal cord injuries. Results: Traumatic spinal cord injuries should be surgically treated as soon as possible, but at least within 24 h of injury. If accompanying dural injuries occur, suturing or applying a patch is the primary method of choice. Early surgical decompression is essential, particularly in cervical spinal cord injuries. Stabilization in terms of instrumentation or fusion is inevitable and should be carried out over short segments to maintain the functionality of the cervical spine. Long-distance dorsal instrumentation with prior reduction in thoracolumbar spinal cord injuries provides high stability and preserved functionality in patients. Injuries to the thoracolumbar junction often require a two-stage anterior treatment. Conclusion: Early surgical decompression, reduction, and stabilization of traumatic spinal cord injuries within 24 h are recommended. While short-segment stabilization is recommended in the cervical spine in addition to decompression, instrumentation should be over long segments in the thoracolumbar spine to provide the necessary stability while maintaining functionality.

Traumatische Querschnittsverletzungen stellen einen schwerwiegenden Einschnitt in das Leben der Betroffenen mit physischer, emotionaler, aber auch ökonomischer Belastung für die Patient*Innen selbst, das soziale Umfeld sowie die Gesellschaft als Ganzes dar. Chirurgisches Vorgehen und Techniken bei traumatischen Querschnittsverletzungen. Traumatische Querschnittsverletzungen sollten so früh wie möglich, mindestens aber innerhalb von 24 h nach der Verletzung operativ versorgt werden. Treten begleitende Duraverletzungen auf, ist eine Naht oder die Versorgung mit einem Patch die primäre Methode der Wahl. Die frühzeitige chirurgische Dekompression ist v. a. bei Querschnittsverletzungen der Halswirbelsäule (HWS) notwendig. Eine Stabilisierung im Sinne einer Instrumentierung oder Fusion ist unumgänglich. Diese sollte zum Erhalt der Funktionalität der HWS kurzstreckig sein. Langstreckige dorsale Instrumentierungen mit vorheriger Reposition bei thorakolumbalen Querschnittsverletzungen bieten eine hohe Stabilität und erhalten die Funktionalität bei den Patient*Innen. Verletzungen des thorakolumbalen Übergangs benötigen häufig eine zweizeitige anteriore Versorgung. Die frühzeitige chirurgische Dekompression, Reposition und Stabilisierung der traumatischen Querschnittsverletzungen sind innerhalb von 24 h empfohlen. Während an der HWS zu einer kurzstreckigen Versorgung neben der Dekompression geraten wird, sollte die Instrumentierung an der BWS langstreckig sein, um die nötige Stabilität bei erhaltener Funktionalität zu erreichen.

BACKGROUND:In Germany, current revision rates after arthroplasty range between 28-37%. In particular, remaining cement residues are causative for additional revision surgery after periprosthetic joint infection, which is why complete cement removal is of high importance. However, the removal of remaining cement residues often confronts the surgeon with technical challenges. Complication-free and complete cement removal requires extensive preoperative preparation in order to develop the best possible surgical strategy. TREATMENT:Special instrument sets to facilitate cement removal in revision cases are available from various manufacturers. In addition to endoluminal approaches, access enhancements such as extended osteotomies exist to facilitate complete cement removal. Finally, the surgeon should be able to give the indication for an intraoperative procedural change after a defined time interval.

Background: In the age of individualised arthroplasty, the question arises whether currently available standard implants adequately consider femoral condylar morphology (FCM). Therefore, physiological reference values of FCM are needed. The aim was to establish physiological reference values for anterior (ACO) and posterior condylar offset (PCO) as well as for the length of the medial (LMC) and lateral femoral condyles (LLC). Methods: The knee joints of 517 patients (mean age: 52.3 years (±16.8)) were analysed retrospectively using MRI images. Medial (med) and lateral (lat) ACO and PCO, as well as LMC and LLC, were measured. All FCM parameters were examined for association with age, gender, side and osteoarthritis. Results: Mean ACOmed was 2.8 mm (±2.5), mean ACOlat was 6.7 mm (±2.3), mean PCOmed was 25.7 mm (±4.6), mean PCOlat was 23.6 mm (±3.0), mean LMC was 63.7 mm (±5.0) and mean LLC was 64.4 mm (±5.0). Except for PCOmed, the mean values of all other FCM parameters were significantly higher in male knees compared to female knees. ACOmed and PCOmed showed significant side-specific differences. There were no significant differences in relation to age and osteoarthritis. Conclusion: The study showed significant differences in FCM side- and gender-specifically in adult knees. These aspects should be considered in the discussion of individual and gender-specific knee joint replacement.

Zusammenfassung Hintergrund Aktuelle Re-Revisionsraten nach endoprothetischem Gelenkersatz liegen in Deutschland bei 28–37 %. Insbesondere verbliebende Zementreste sind für erneute Revisionseingriffen nach Sanierungsoperationen bei periprothetischen Infektionen ursächlich, weswegen die vollständige Zemententfernung von großer Bedeutung ist. Die Entfernung letzter Zementreste stellt den Operateur jedoch häufig vor technische Herausforderungen. Eine komplikationslose und vollständige Zemententfernung bedarf einer umfangreichen präoperativen Vorbereitung, um die bestmögliche Operationsstrategie zu entwickeln. Therapie Von verschiedenen Herstellern werden Spezialinstrumente angeboten, die die Zemententfernung im Revisionsfall erleichtern. Neben endoluminalen Zugängen existieren Zugangserweiterungen wie zusätzliche Osteotomien, welche die vollständige Zemententfernung erleichtern. Nicht zuletzt sollte der Operateur in der Lage sein, nach einem definierten Zeitintervall die Indikation zum intraoperativen Vorgehenswechsel zu stellen.

BACKGROUND:Osteoporosis causes an increased fracture risk. Clinically, osteoporosis is diagnosed late, usually after the first fracture occurs. This emphasizes the need for an early diagnosis of osteoporosis. However, computed tomography (CT) as routinely used for polytrauma scans cannot be used in the form of quantitative computed tomography (QCT) diagnosis because QCT can only be applied natively, i.e., without any contrast agent application. Here, we tested whether and how contrast agent application could be used for bone densitometry measurements. METHODS:Bone mineral density (BMD) was determined by QCT in the spine region of patients with and without the contrast agent Imeron 350. Corresponding scans were performed in the hip region to evaluate possible location-specific differences. RESULTS:Measurements with and without contrast agent administration between spine and hip bones indicate that the corresponding BMD values were reproducibly different between spine and hips, indicating that Imeron 350 application has a location-specific effect. We determined location-specific conversion factors that allow us then to determine the BMD values relevant for osteoporosis diagnosis. CONCLUSIONS:Results show that contrast administration cannot be used directly for CT diagnostics because the agent significantly alters BMD values. However, location-specific conversion factors can be established, which are likely to depend on additional parameters such as the weight and corresponding BMI of the patient.

Background: Pelvis fractures are commonly stabilized by surgical implants to facilitate their healing. However, such implants immobilize the iliosacral joint for up to a year until removal. We report how iliosacral joint immobilization affects the walking of patients. Methods: The gaits of patients with immobilized sacroiliac joints after unstable pelvic fracture (n = 8; mean age: 45.63 ± 23.19; five females and three males) and sex- and age-matched healthy control individuals (n = 8; mean age: 46.50 ± 22.91; five females and three males) were recorded and analyzed using a motion capture system. The forces between the tread and feet were also recorded. Standard gait parameters as well as dynamic patterns of joint angles and moments of the lower extremities were analyzed using the simulation software OpenSim. Results: With the exception of hip extensor strength, the monitored joint parameters of the patients showed task-dependent deviations during walking, i.e., plantarflexor force was increased when stepping on an elevated surface, as were hip flexion and extensor moments, knee flexion and extensor moments, as well as ankle dorsiflexion and the associated negative plantarflexor force during stance on the elevated surface. Conclusions: Iliosacral joint fixation causes reduced forward and upward propulsion and requires an extended range of hip motion in the sagittal plane. Patients show significant mobility limitation after iliosacral screw fixation.

BACKGROUND CONTEXT:Recent findings revealed a correlation between vertebral bone quality based on T1-weighted (VBQT1) magnetic resonance imaging (MRI) and volumetric bone mass density (vBMD) measured using quantitative computerized tomography. The coherence of VBQ for other MRI sequences, such as T2 or short tau inversion recovery (STIR), has not been examined. The combination of different VBQs has not been studied. PURPOSE:The aims of the study were to confirm the correlation between VBQT1 and vBMD and to examine VBQs from other MRI sequences and their combination with vBMD. STUDY DESIGN/SETTING:This was a retrospective cross-sectional study. PATIENT SAMPLE:The sample consisted of patients older than 18 years, who received treatment at a level-one university spine center of the German Spine Society for degenerative or traumatic reasons in 2017-2021. OUTCOME MEASURES:The outcome measures were the correlation of VBQs from different MRI sequences with vBMD and the association of VBQs with osteopenia/osteoporosis. METHODS:Patients' VBQ was calculated based on the signal intensities of the vertebral bodies L1-4 in T1-, T2-, and STIR-weighted MRI. The VBQ was standardized according to the signal intensity of the cerebrospinal fluid. The vBMD was determined using data from a calibrated scanner (SOMATOM Definition AS+) and processed with CliniQCT (Mindways Software, Inc., USA). Groups were divided according to vBMD into the following groups: (I) osteoporosis/osteopenia (< 120 mg/m3) and (II) healthy (≥120 mg/m3). An analysis of the correlation between various VBQs and vBMD as well as receiver operating characteristic (ROC) and binary regression analyses were performed for the prediction of osteoporosis/osteopenia. RESULTS:We included 136 patients (women: 56.6%) in the study (69.7 ± 15.0 years). According to vBMD, 108 patients (79.4%) had osteoporosis/osteopenia. Women were affected significantly more often than men (p = .045) and had significantly higher VBQT1 and VBQT2 values than men (VBQT1: p = .048; VBQT2: p = .013). VBQT1 and VBQT2 values were significantly higher in patients with osteoporosis/osteopenia than in healthy persons (VBQT1: p<.001; VBQT2: p = .025). VBQT1 and VBQT2 were significantly negatively correlated with vBMD with a moderate effect size (p<.001), while VBQSTIR was not significantly correlated with vBMD, although it showed a positive coherence. The combination of different VBQs in terms of VBQT1 × VBQT2 / VBQSTIR distinctly increased the effect size of the negative correlation with vBMD compared to VBQ alone. A cutoff value for VBQT1 × VBQT2 / VBQSTIR of 2.9179 achieved a sensitivity of 80.0%, a specificity of 75.0%, and an area under the curve (AUC) of 0.775 for the determination of osteoporosis. The mathematical model derived from the binary logistic regression showed an excellent AUC of 0.846. CONCLUSIONS:This study confirms a significant correlation between VBQT1 and vBMD. The combination of VBQs from different MRI sequences enhances the prognostic value of VBQ for the determination of osteoporosis. While safe clinical application of VBQ for the determination of osteoporosis requires further validation, VBQ might offer opportunistic estimation for further diagnostics.

Background: The tibial slope (TS) defines the posterior inclination of the tibial plateau (TP). The “individual physiological” TS plays a crucial role in knee-joint stability and should be taken into account in knee-joint surgery. The aim of this study was to analyse the specific morphology of the TS for the medial (med) and lateral (lat) TP in relation to patient characteristics and the measurement method. Methods: In this retrospective study, MRI images of knee joints from 720 patients (mean age: 49.9 years [±17.14]) were analysed. The TS was assessed using two established methods according to Hudek (TSH) and Karimi (TSK) for the med and lat TP and gender/side specificity was analysed. Results: TSH for the med and lat TP showed significantly (p < 0.001) different values compared to TSK (TSKmed: 2.6° (±3.7), TSHmed: 4.8° (±3.5); TSKlat: 3.0° (±4.0), TSHlat: 5.2° (±3.9)). The angles of the lat TP were significantly higher than those of the med TP (TSK: p < 0.001; TSH: p = 0.002). Females showed a higher med and lat TS compared to males (p < 0.001). Conclusions: The measurement method has an influence on the values of the TS in knee-joint MRIs. The TS is significantly different for the med and lat TP regardless of the measurement method. There are gender-specific differences for the TS.

Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient’s age has to be taken into account in shoulder diagnostics and surgery.

Background: Physiological reference values for morphological parameters of the hip (MPH) are of clinical importance for the treatment of painful, degenerated or fractured hip joints, as well as to detect morphological deformities, which could result in early osteoarthritis of the hip. Currently, sufficient data for MPH are lacking. Therefore, it remains unclear if age-dependent alterations in adult hip morphology are physiological and if there are side- and gender-dependent differences. The aim of the study was to analyze MPH according to gender, side and age in a large-scaled cohort by CT scans. Methods: A total of 1576 hip joints from 788 patients (female: 257, male: 531; mean age: 58.3 years (±18.9; 18–92 years)) were analyzed by CT. For all hips, acetabular anteversion (AcetAV); lateral centrum edge angle (LCE); acetabular index (AI); femoral neck version (FNV); centrum-collum-diaphyseal angle (CCD); and anterior alpha angle (AαA) were measured. Results: The mean values in this cohort were: AcetAV 20.5° (±6.9); LCE 40.8° (±8.8); AI 0.3° (±5.3); FNV 11.0° (±9.8); CCD 129.9° (±7.4); and AαA 41.2° (±7.7). There was a detectable side-specific difference for AcetAV (p = 0.001); LCE (p < 0.001); CCD (p < 0.001); and AαA (p < 0.001). All the analyzed parameters showed a significant gender-specific difference, except for AI (p = 0.37). There was a significant correlation between age and AcetAV (r = 0.17; p < 0.001); LCE (r = 0.39; p < 0.001); AI (r = −0.25; p < 0.001); CCD (r = −0.15; p < 0.001); and AαA (r = 0.09; p < 0.001), except FNV (p = 0.79). Conclusions: There are side-, gender- and age-specific alterations in hip morphology, which have to be considered in treating hip joint pathologies.

Percutaneous screw fixation combined with pelvic reduction is a surgical technique used to stabilize fractures of the posterior pelvic ring. This is the standard surgical treatment of unstable posterior pelvic ring injuries. The primary goal of this treatment is an anatomic reduction and stable fixation. This has been shown to reduce pain and improve the patients' long‐term well‐being. The aim of this analysis was to determine the possible screw lengths and the positioning of the screws in the S1 and S2 sacral segments. A population of 697 pelvises from the Stryker Orthopaedic Modeling and Analytics database were analyzed. The dimensions of the S1 and S2 screw corridors were determined and after assessing for sacral dysmorphism, the correct screw placement was chosen to determine the necessary screw length for surgical treatment. The measurements of the screw lengths show a Gaussian distribution for the analyzed population. The percentage of dysmorphic pelvises for the S1 screw corridor was 31.3% and for the S2 corridor 8%. Average screw length for S1 was 163.8 ± 16.2 mm and for the S2 137.3 ± 9.5 mm. The results show that the S1/S2 axis cannot be used for a trans‐sacral screw placement in every patient. The study shows that intraosseous screw corridors are present in 68.7% of the patients in the S1 position and in 92% at the S2 level where an intended implant can be placed fully intraosseous.