Background:Given the decline in performance in German fencing since 2012, systematic athletic training has become increasingly important in youth development. This study is the first to investigate the effects of structured athletic training on physical performance parameters in German youth fencing. Materials & Methods:In a twelve-month interventional cohort study, 22 youth fencers (aged 13-17 years) from a performance centre were examined. The intervention group (n=12) completed 60 minutes of structured athletic training per week in addition to regular fencing training, while the control group (n=10) performed an exclusively fencing-specific training. Pre- and post-tests included standing long jump, 10 m sprint, T-test, rotational throw, Bourban test, and beep test. The intervention group also underwent Functional Movement Screen (FMS), Y-Balance test, and Skillcourt assessments. Statistical analysis was performed using t-tests and Mann-Whitney U tests, supplemented by effect sizes (Cohen's d). Results:Compared with the control group, the intervention group showed significant improvements in explosive strength (sprint: p=0.023, d=1.31; T-test: p=0.043, d=1.00; rotational throw right: p=0.023, d=1.05; left: p=0.003, d=1.44) and endurance (beep test: p=0.002, d=1.54). Core stability showed a trend towards significance (p=0.065, d=0.84). Within the intervention group, flexibility improved significantly (FMS: p=0.002, d=1.14; Y-Balance lower extremity right: p=0.012; left: p=0.019). Conclusion:Structured athletic training produces large to very large training effects in fencing-relevant physical performance parameters. The results provide evidence-based support for the integration of systematic athletic training into youth development programmes in German fencing.

Background: Injury epidemiology in women's football has primarily focused on elite athletes, whereas the amateur level, representing the vast majority of female players worldwide, remains largely under-explored. We aimed to provide a first prospective one-season characterisation of injuries in German amateur women's football. Methods: In this prospective observational cohort study, 26 clubs comprising 450 female amateur players in Bavaria were monitored over the 2023/24 season using standardised time-loss injury questionnaires as used in current professional registry studies. Injuries were characterised by anatomical location, type, mechanism, and activity context (match vs. training); proportions are reported with 95% binomial exact confidence intervals (CI). Results: A total of 68 injuries were recorded. Regarding injuries with documented information, 66.7% (95% CI 54.0-77.8) were acute traumatic and 78.2% (95% CI 65.0-88.2) occurred during matches. Lower-extremity injuries dominated (80.3%; 95% CI 71.2-90.5), led by the knee as the single most frequent region (28.2%; 95% CI 18.1-40.1). Ligament injuries were the most common injury type (27.9%). Seven ACL ruptures were documented (10.3%; 95% CI 4.2-20.1), all of which occurred during match play. Indirect-contact mechanisms were significantly over-represented among all knee injuries (OR 6.92, 95% CI 1.52-31.6; p = 0.012). Conclusions: Amateur injury profile in this study reproduced the knee-centred, match-dominated pattern of elite female football while carrying a relative ACL burden at the upper end of professional reference data; given the small number of ACL events (n = 7), this signal is hypothesis-generating. These findings support the extension of structured neuromuscular prevention programmes into German amateur women's football.

Anterior cruciate ligament (ACL) ruptures represent one of the most severe injuries in professional football, often resulting in long rehabilitation, impaired performance, and increased risk of re-injury. The aim of this study was to investigate whether performance parameters derived from match statistics can serve as early indicators of ACL rupture in professional male football players. A retrospective case-control design was applied. Forty-two male professional football players from the German Bundesliga and 2. Bundesliga with confirmed ACL ruptures between 2016 and 2024 were included, alongside 42 matched controls from the same teams and positions. Match performance data from ten games preceding the injury were analyzed. Parameters included minutes played, total distance covered, number of sprints, maximal speed, pass accuracy, number of duels, and duel success rate. Independent t-tests compared injured and control players across individual matchdays and aggregated intervals (the average values across the last four, three, and two matches before injury). Additionally, odds ratios (OR) with 95

Angesichts des Leistungsrückgangs im deutschen Fechtsport seit 2012 gewinnt systematisches Athletiktraining im Nachwuchsbereich an Bedeutung. Diese Studie untersucht erstmals die Effekte eines strukturierten Athletiktrainings auf die konditionellen Leistungsparameter im deutschen Jugendfechten. In einer 12-monatigen interventionellen Kohortenstudie wurden 22 Jugendfechter (13–17 Jahre) eines Leistungsstützpunkts untersucht. Die Interventionsgruppe (n=12) absolvierte zusätzlich zum regulären Fechttraining wöchentlich 60 Minuten strukturiertes Athletiktraining, die Kontrollgruppe (n=10) trainierte ausschließlich fechtspezifisch. Prä- und Post-Tests umfassten Standweitsprung, 10m-Sprint, T-Test, Rotationswurf, Bourban-Test und Beep-Test. Zusätzlich wurden in der Interventionsgruppe Functional Movement Screen (FMS), Y-Balance-Test und Skillcourt erfasst. Die statistische Auswertung erfolgte mittels t-Tests und Mann-Whitney-U-Tests, ergänzt um Effektstärken (Cohenʼs d). Die Interventionsgruppe zeigte signifikante Verbesserungen gegenüber der Kontrollgruppe in der Explosivkraft (Sprint: p=0,023, d=1,31; T-Test: p=0,043, d=1,00; Rotationswurf rechts: p=0,023, d=1,05; links: p=0,003, d=1,44) und Ausdauer (Beep-Test: p=0,002, d=1,54). Die Rumpfstabilität zeigte einen Trend zur Signifikanz (p=0,065, d=0,84). Innerhalb der Interventionsgruppe verbesserte sich die Beweglichkeit signifikant (FMS: p=0,002, d=1,14; Y-Balance untere Extremität rechts: p=0,012, links: p=0,019). Strukturiertes Athletiktraining führt zu großen bis sehr großen Trainingseffekten bei fechtsportrelevanten konditionellen Parametern. Die Ergebnisse liefern evidenzbasierte Grundlagen für die Integration systematischen Athletiktrainings in die deutsche Nachwuchsförderung im Fechten.

Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0-10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = -0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL-collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation.

Background: Posterior tibial slope (PTS) is commonly measured on lateral radiographs, but there is an ongoing discussion on which criteria are essential as quality standards. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of malrotation of the tibia on lateral radiographs for PTS measurement. It was hypothesized that malrotation alters the measured PTS. Study Design: Descriptive laboratory study. Methods: An infratuberositary osteotomy was performed on a tibial saw bone model, and 3 conditions—2 with increased PTS—were tested with the same experimental setup (series 1, closed osteotomy; series 2, 5-mm anterior opening; series 3, 10-mm anterior opening). Long lateral radiographs were taken from +12.5° of external tibial rotation (ETR) to −20° of internal tibial rotation (ITR), in steps of 2.5°. PTS was measured with the mechanical axis (MA) and the proximal anatomic axis (PAA). In addition, the distance between the medial and lateral posterior tibial condyles was measured (in mm). Results: In test series 1, between +12.5° to 0° of ETR and 0° to−20° of ITR, a change in PTS of 2.8°± 1.0 (ETR) and 3.7°±1.3 (ITR) for the MA and 3.7°± 1.4 (ETR) and 4.1°±1.5 (ITR) for the PAA was detected. In test series 2, changes of 1.5°± 0.5 (ETR) and 3.7±1.3 (ITR) for the MA and 1.6°± 0.6 (ETR) and 4.3°±1.4 (ITR) for the PAA were observed; likewise, in test series 3, changes of 1.8°± 0.7 (ETR) and 3.7°±1.3 (ITR) for the MA and 2.2°± 0.9 (ETR) and 4.2°±1.3 (ITR) for the PAA were observed. ETR of +12.5° resulted in a distance of 5 mm, and ITR of −20° resulted in a distance of 10 mm between the posterior tibial condyles in all testing conditions. There was no significant difference among the 3 testing conditions ( P > .05). A change of 1 mm in distance was equivalent to 2° (ITR) or 2.5° (ETR) of change in rotational alignment and 0.4° of change in PTS measurement, irrespective of whether MA or PAA was used. Conclusion: Tibial malrotation strongly influences PTS measurement on lateral radiographs. ETR leads to an underestimation, and ITR to an overestimation, of PTS. Every 1° of change in rotational alignment was equivalent to 0.2° of change in PTS measurement. For a reliable PTS measurement on lateral radiographs, the posterior tibial condyles should be superimposed exactly. Clinical Relevance: Dependent on PTS values, surgical correction of the PTS can be indicated. For a correct indication, it is of utmost importance to be able to determine the posterior slope exactly. This investigation demonstrates the effect of tibial rotation on PTS measurement and defines quality criteria, as well as a simple grading system for lateral radiographs for the measurement of the PTS. This helps surgeons to interpret radiographs correctly, allowing a better decision-making process, if and when a corrective osteotomy for PTS correction is indicated.

Mit zunehmendem Alter verändern sich die funktionellen und strukturellen Voraussetzungen des Bewegungsapparates – auch bei ambitionierten Sportlerinnen und Sportlern. Der sogenannte „Masters“-Sport erfreut sich zunehmender Beliebtheit, birgt jedoch altersbedingte Risiken, insbesondere im Bereich des Fußes. Gerade Fußball als Kontaktsportart mit abrupten Bewegungswechseln ist hier prädestiniert für spezifische Überlastungen und Verletzungen. Dieser narrative Review beleuchtet sportartspezifische Herausforderungen, Präventionsansätze und therapeutische Optionen bei Fußverletzungen für Fußballspieler im Alter über 35 Jahren.

The management of anterior cruciate ligament (ACL) ruptures is carried out differently in prevention, treatment and rehabilitation for athletes than for non-athletes. However, different approaches to managing ACL ruptures are also discussed in different sports. This narrative review includes first time the current situation of ACL management in football by experiences from the practical routine as well as from scientific reports. No other sport shows such high number of literature reports and sufficient scientific evidence in the management of ACL ruptures like football and this article provides a football specific overview in prevention, treatment and return to sports strategies. These scientific reports underline the surgical treatment of ACL ruptures in football player and show a high sustainability and return to sports rate. However, reports from football show that despite good knowledge, the implementation of sustainable prevention and rehabilitation is difficult and needs improvement. CLINICAL TRIAL REGISTRATION: Considering that this manuscript is a narrative review, no clinical trial registration is neccesary. LEVEL OF EVIDENCE: Level V.

Background: Distal tibial deformities are not assessed using the proximal anatomical axis (PAA) to determine the posterior tibial slope (PTS). Therefore, it seems advantageous to measure PTS on full-length lateral tibial radiographs using the mechanical axis (MA). Purposes: To (1) compare the PTS measurements using the MA and the PAA and (2) determine whether using the PAA fails to detect a certain number of significantly elevated PTS values compared with using the MA. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Full-length lateral tibial radiographs of 218 consecutive cases were reviewed. Radiographs were checked for malrotation. Therefore, the distance between the posterior tibial condyles was measured in millimeters. Patients with a difference of ≥7 mm between the posterior tibial condyles were excluded, leaving 196 cases for the final statistical analysis. The PTS was measured using the MA and the PAA. Differences between these 2 techniques were analyzed. The sensitivity and specificity of the PAA as a screening method for pathological PTS were calculated, with the MA as the standard for comparison. Four subgroups were formed, all with PAA <12° and different lower limits for the MA: group 1, MA ≥10°; group 2, MA ≥10.5°; group 3, MA ≥11°; and group 4, MA ≥11.5°. Results: Radiographs with ≥7 mm between the posterior tibial condyles showed an increased inconsistency between the PTS measurement with the MA and the PAA. In the group with a distance of <7 mm between the posterior tibial condyles (n = 196), the mean PTS measured with the MA was 9.4°± 3.8° (range, 0.4° to 21.9°), and the mean PTS was 10.5°± 3.5° (range, 1.7° to 20.9°) according to the PAA. The mean difference in PTS between the PAA and the MA was 1.1°± 1.2° (range, –2.4° to 4.1°; P < .001). Group 1 had a sensitivity of 73% and specificity of 98%; group 2, sensitivity of 84% and specificity of 97%; group 3, sensitivity of 87% and specificity of 93%; and group 4, sensitivity of 95% and specificity of 89%. Conclusion: Measuring the PTS using the MA was advantageous, as the measurement with the PAA did not correctly identify all cases with sagittal alignment changes. The proportion of patients with pathologically increased PTS not identified with the proximal anatomical measurement, reflected by the sensitivity, depended on the threshold value defined for the MA. Lateral radiographs, showing an increased distance between the posterior tibial condyles, indicated malrotation of the tibia leading to measurement inaccuracy.

OBJECTIVE:Despite the growing interest in racket sports, injury prevalence, circumstances and severity as a function of gender, performance level and return to play have not been investigated to date. The aim was therefore to evaluate the occurrence of sport-specific injuries from a quantitative and qualitative perspective in the Olympic disciplines Tennis, Badminton and Table Tennis. METHODS:Injury characteristics were recorded using a three-part questionnaire with 139 items, which was distributed through an online link. Racket sport-specific injuries and frequencies were assessed according to gender and performance level in one Olympic cycle (from the Olympic Games in London in 2012 until Rio de Janeiro in 2016). The Injury severity was recorded by time loss and performance reduction. RESULTS:A total of 390 (55%) athletes have suffered a serious injury. There were more injuries during training than competition. 78% of the three most common injuries in the various racket sports involved the lower extremities. The longest injury time loss was seen in Tennis for an unspecified injury of the shoulder (16±12 weeks), in Badminton for the foot-ligament injury (13±14 weeks) and the meniscus injury of the knee in table tennis (13±10 weeks). The injuries to the knee accounted for the highest number of athletes with a reduced level of performance (Badminton: Knee - unspecified injury: reduced level=64%; Table tennis: Knee - meniscus injury: reduced level=54%) CONCLUSION: Although recognized as one entity of racket sports with some similar trends in terms of injuries, there are some relevant differences in injury type, circumstances and consequences, which should be considered in future sport-specific injury prevention strategies.

Background: Osteochondral fractures (OCFs) following acute patellar dislocation significantly influence treatment decisions and long-term prognosis, yet reliable risk stratification remains elusive. This study aimed to identify demographic and trochlear morphology predictors of fracture occurrence in a large patient cohort. Methods: This retrospective analysis included 261 skeletally mature patients with acute patellar dislocation from 2000 to 2024 (mean age 24 ± 10 years, 59% male), excluding those with previous knee surgery, additional injuries, or skeletal immaturity. A comprehensive MRI assessment evaluated trochlear morphology (Dejour classification, sulcus angle, trochlear groove depth, and facet measurements) and patellofemoral alignment parameters (TT-TG distance, Q-angle, and congruence angle). Multivariate logistic regression identified independent risk factors for the development of osteochondral fractures. Results: Osteochondral fractures occurred in 133 patients (51% [of those undergoing MRI evaluation]). Male gender emerged as the strongest predictor (OR 2.38, 95% CI: 1.30–4.42, p = 0.005), followed by right-sided dislocation (OR 2.33, 95% CI: 1.21–4.58, p = 0.013). Notably, higher-grade trochlear dysplasia (Dejour Grades 3–4) was associated with lower fracture rates, being more common in non-fracture patients (27% vs. 10%, p = 0.003). Trochlear condyle asymmetry was also significant (OR 1.14, p = 0.004). Most patellofemoral alignment parameters, including TT-TG distance and Q-angle, showed no significant predictive value. Conclusions: Male gender and right-sided dislocation are associated with higher rates of osteochondral fracture after patellar dislocation. Patients with normal trochlear anatomy have higher fracture rates than those with severe dysplasia. These findings suggest that demographic factors and trochlear morphology should be considered in the diagnostic workup of acute patellar dislocations, though prospective validation is needed before implementing screening protocols.

Background/Objectives: Proximal interphalangeal joint (PIJ) arthrodesis is a common surgical intervention for patients with PIJ osteoarthritis or trauma-related joint destruction. The objective of this study was to evaluate the biomechanical stability of various arthrodesis techniques under forces comparable to activities of daily living (ADL) to assess their suitability for early active movement protocols. Methods: In this in vitro study, composite cylinders simulating PIJ arthrodesis were subjected to standardized fusion angles of 40° using different fixation techniques, including crossed K-wires, compression screws, cerclage wires, tension band wiring, anatomical fixation plates, and locking grid plates. Forces representing ADLs such as typing, holding a pencil, carrying weight, and opening a jar were applied using a universal testing machine in a four-point bending setup. Micromotion and gap clearance were calculated and analyzed. Results: Techniques involving compression, such as compression screws, tension bands, and cerclage wires, exhibited lower micromotion and gap clearance under forces up to 17 N, suggesting potential suitability for early active movement protocols. In contrast, fixation plates demonstrated structural failure or excessive clearance during early active motion ADLs. K-wires showed intermediate results with moderate gap clearance and micromotion. Conclusions: Compression-based fixation techniques for PIJ arthrodesis may permit early active movement without external stabilization, while fixation plates are prone to failure under ADL forces. Further dynamic biomechanical testing and clinical studies are recommended to confirm these findings.

Background The use of painkillers in football is a much-criticized topic, but there is hardly any scientific data at amateur level. The aim of the study is therefore to establish data on the prevalence of painkiller use in German amateur football. In addition, reasons for painkiller use and other influencing factors are investigated. Methods In a cross-sectional analysis, the painkiller use among German amateur footballers was surveyed through an online protocol, involving players from the 4th league to the lowest amateur divisions. Results Of the 604 participants, 489 were male (81.0%) and 115 were female (19.0%). The prevalence of painkiller use over the players’ entire careers in connection with football is approximately 77%. 75% of players report using painkillers only for acute injuries, with over two-thirds rarely or never taking them before a game. At 80%, female players report slightly higher painkiller use for acute injuries than male players (74.4%, p = 0.19). Age-related differences show that older players take painkillers more frequently than younger players ( p < 0.001). Furthermore, league-specific differences show that higher playing levels (4th league) are associated with higher pain prevalence and higher painkiller use compared to the lowest five leagues ( p < 0.001). Conclusions This is the first study to record the use of painkillers in amateur football from the players’ perspective with a large sample size. The lifetime prevalence of painkiller use among amateur football players in this study matches levels found in previous studies of amateur and professional sports. Most players take painkillers for medically justified reasons, with misuse being minimal. However, a minority of players show less responsible usage. Further research into the contextual factors influencing painkiller use is needed, and educational initiatives are important to improve awareness regarding pain management in football.

Background: Despite the high prevalence of anterior cruciate ligament (ACL) surgeries, standardized, evidence-based rehabilitation protocols remain lacking. Digital medical devices (DMDs) like the “Orthelligent” system have gained relevance as adjuncts to traditional physiotherapy, offering continuous, objective monitoring of functional recovery. Methods: A retrospective cohort analysis included 335 patients who underwent ACL reconstruction and used the “Orthelligent home” system between August 2022 and December 2024. In total, 5675 recorded test and exercise events were analyzed. Functional recovery was assessed using the Limb Symmetry Index (LSI) across five defined rehabilitation phases (0–4). All patients followed a structured rehabilitation program aligned with current clinical practice guidelines, supplemented by Orthelligent as a home-based digital tool for daily monitoring. Results: Significant functional improvement was observed during early rehabilitation phases, with the LSI increasing from 0.64 ± 0.02 in phase 0 to 0.81 ± 0.01 in phase 2 (p < 0.001). Time since surgery was a significant positive predictor (p = 0.034), while pain showed a strong negative impact on performance (p < 0.001). Anthropometric factors had no significant effect. Exercises associated with high rates of drop-out, pain, or difficulty were identified and linked to specific rehab phases. Conclusions: This study demonstrates that digital rehabilitation monitoring can reliably reflect patient progress after ACL reconstruction. The early postoperative period (first 3 months) is critical for functional gains, highlighting the need for individualized, pain-sensitive rehabilitation strategies.

Kniegelenksverletzungen stellen im Fußball eine regelmäßig auftretende schwerwiegende Verletzung dar, welche häufig eine lange Ausfallzeit für Spieler und somit einen wichtigen Nachteil für Vereine darstellen. Die unterschiedlichen Strukturen des Kniegelenkes wie Bänder, Meniskus oder Knorpel sind durch verschiedene sportartspezifische Situationen im Fußball einer Verletzungsgefahr ausgesetzt und benötigen für ihre adäquate Heilung unterschiedliche und spezifische Therapieansätze. Sowohl operative als auch konservative Therapiemaßnahmen sind gerade bei Kniegelenksverletzungen im Fußball gut wissenschaftlich untersucht, sodass eine erfolgreiche und nachhaltige Rückkehr aufs Spielfeld in hohem Maße möglich ist. Einzig im Profifußball wird in speziellen Situationen vom üblichen Therapiestandard abgewichen, um den Ansprüchen und den Zielen von Profifußballern gerecht zu werden. Um verschiedenen Subpopulationen im Fußball in den verschiedenen Verletzungstypen sowohl in Therapie als auch der „Return to play“-Entscheidung und somit einer nachhaltigen sekundären Prävention gerecht zu werden, sind neben der Kenntnis von wissenschaftlicher Evidenz über Kniegelenksverletzungen auch eine grundsätzliche Erfahrung in der Sportart sinnvoll, in welcher sich die Patienten mit Kniegelenksverletzungen bewegen.

Knee joint injuries are a regular and serious injury in football, often resulting in a long period of absence for players and are, therefore, a significant disadvantage for clubs. The various structures of the knee joint, such as ligaments, meniscus or cartilage, are exposed to the risk of injury due to different sport-specific situations in football and require different and specific therapeutic approaches for their adequate healing.

Ambulante Eingriffe benötigen besondere strukturelle Voraussetzungen und eine durchdachte Auswahl der Patienten, um Patientensicherheit und Wirtschaftlichkeit zu gewährleisten. Im Rahmen der Erarbeitung des ambulanten Operationskataloges durch die zuständigen Organe wurden diese Faktoren jedoch kaum berücksichtigt. Nahezu alle perioperativen Risiken werden auf den Patienten übertragen. Das betrifft sowohl die Schmerztherapie als auch das Risiko häuslicher Unfälle. Um wirtschaftlich arbeiten zu können, muss das pflegerische und ärztliche Personal auf ein Minimum reduziert werden. Dadurch wird die Ausbildung junger AssistenzärztInnen nahezu unmöglich gemacht. Auch Eingriffe, die die Qualität der Versorgung in den letzten Jahren erheblich gesteigert haben, werden teilweise nicht mehr vergütet. Die Umsetzung und die finanziellen Rahmenbedingungen verlangen daher dringend Änderungen des bisherigen Regelwerkes, um die Patientensicherheit, die personellen Ressourcen der Krankenhäuser und die chirurgische Ausbildung nicht nachhaltig zu gefährden.

Background: Proximal humerus fractures are common fractures of the elderly population which can lead to long-term compromise of a patient’s shoulder function. Closed reduction and internal fixation with intramedullary nailing is a well-established surgical technique yielding good outcomes, as perceived by patients, obtained via Patient-Reported Outcome Measures, and objectified by clinical shoulder testing. Apart from conventional range-of-motion testing and clinical shoulder tests, strength testing of the shoulder is a yet-neglected but meaningful and standardizable outcome parameter. In this study, isometric shoulder strength is evaluated in relation to fracture morphology/postoperative reduction quality as well as with patient-reported outcomes. Methods: 25 patients (mean age 73.2 ± 10.5 years) underwent isometrics strength-testing of the shoulder joint in the scapular plane (abduction) as well as in the sagittal plane (flexion) as well as hand-grip strength-testing at 4.5 ± 1.88 years follow-up. Pre- and postoperative radiographs were analysed. Patients completed ASES and CMS questionnaires. Results: Patients exhibited a decrease in abduction and flexion force (−24.47% and −25.30%, respectively, p < 0.001) using the contralateral, uninjured arm as reference. Abduction force tended to be decreased in three- and four-part fractures. Patient satisfaction correlated negatively with the relatively reduced force of the affected arm. Varus-angulated humeral heads produced significantly lower abduction force output than valgus- or physiologic angulation (p = 0.014), whereas flexion force was unaffected (p = 0.468). The anatomical reduction had no influence on shoulder strength. Conclusions: Proximal humerus fractures may cause a significant reduction in shoulder function, both reported by patients and objectified by shoulder strength testing. Varus head angulation demonstrated the greatest loss of shoulder strength and should be avoided to ensure proper functioning. Further, strength testing seems a valuable outcome parameter for a thorough shoulder examination with easy obtainability.