Die posteriore Schulterinstabilität vom Typ C1 stellt eine präarthrotische Pathologie dar, die durch eine chronische, statische posteriore Subluxation des Humeruskopfes gekennzeichnet ist. Die multifaktorielle Ätiologie umfasst unter anderem eine vermehrte Glenoidretroversion, eine veränderte posteriore Akromionmorphologie, eine verminderte Humerusretrotorsion, eine abnorme skapulothorakale Ausrichtung sowie muskuläre Dysbalancen. Klinisch manifestiert sich die Pathologie überwiegend durch atraumatische Schulterschmerzen, meist ohne Instabilitätssymptomatik. Die Diagnosestellung basiert auf einer umfassenden Anamnese, einer gezielten körperlichen Untersuchung sowie dem Einsatz moderner bildgebender Verfahren, mit denen eine posteriore Dezentration des Humeruskopfes, Defizite des Glenoidrandes, eine reduzierte posteriore Akromionüberdachung sowie eine posteriore Labrumhypertrophie zuverlässig nachgewiesen werden können. Therapeutisch bestehen bislang heterogene Behandlungsansätze mit sehr limitierter Evidenz, ohne dass ein kuratives Standardverfahren etabliert ist. Konservative Therapieprotokolle fokussieren sich primär auf die neuromuskuläre Kontrolle und die Kräftigung der Rotatorenmanschette. Operativ stehen arthroskopische Weichteilstabilisierung, knorpelrekonstruktive Verfahren sowie knöcherne Eingriffe wie Osteotomien und knöcherne Augmentationen des insuffizienten posterioren Glenoidrands. Aktuelle Daten belegen jedoch überwiegend eine vorübergehende Symptomreduktion, ohne eindeutigen Nachweis einer dauerhaften Rezentrierung des Humeruskopfes.

Waste management plays an important role in the healthcare system, as up to 6 million tons of waste are generated annually by the German healthcare sector, contributing to a global environmental burden. Surgical departments in particular produce approximately up to 70% of hospital waste, mostly arising in operating rooms. The waste produced during operations regularly requires disposal at high temperatures and is associated with significant greenhouse gas emissions, underlining the urgent need for action on the path towards a more sustainable healthcare system. Restructuring waste management in the operating room is of central importance in this context. Efficient waste separation and the implementation of recycling processes to reintegrate recyclable materials into the raw material cycle can effectively reduce waste volumes and associated greenhouse gas emissions. In addition, the use of reusable materials represents a promising approach to waste reduction and prevention.

CASE:A 30-year-old woman sustained a complex open pelvic ring injury with urogenital and rectal injuries and a severe Morel-Lavallée lesion after getting stuck between a train platform and an arriving train. Orthopaedic trauma management included extensive debridements, temporary internal and external fixation, staged plate osteosynthesis, and negative-pressure wound therapy. Progressive soft-tissue necrosis due to mucormycosis necessitated a hemipelvectomy. At the 1-year follow-up, the patient had returned to independent living. CONCLUSION:Complex open peripelvic injuries, complicated by mucormycosis infection and subsequent hemipelvectomy, have a high risk of mortality. We outline multidisciplinary surgical and antimicrobial strategies potentially effective in similar scenarios.

BACKGROUND:Waste management in hospitals is an important factor with respect to environmental sustainability. Surgical waste disposal causes substantial CO2 emissions. In addition to recycling, waste reduction is an essential strategy for reducing emissions. Reusable textiles offer a promising approach to decrease waste in operating rooms. OBJECTIVE:Assessment of reusable textiles in terms of waste generation, operational processes and staff acceptance. MATERIAL AND METHODS:This prospective observational study compared waste generation when using disposable or reusable drapes in 272 orthopedic and trauma operations over periods of 2 weeks each. Waste volume and weight as well as preparation, clean-up and surgery times were recorded and statistically analyzed. Surgical staff were then asked about their experiences with reusable textiles. RESULTS AND DISCUSSION:The use of disposable drapes resulted in 93.59l (± 75.16l) and 5.32kg (± 2.04kg) of hospital-specific waste per operation. The introduction of reusable drapes reduced waste volume by 40% and weight by 34% (p < 0.001) without affecting preparation, clean-up or surgical time. Of the staff 96% considered the use of reusable textiles to be unproblematic. The use of reusable textiles significantly reduces waste in operating rooms without affecting workflows and is supported by operating room staff. The implementation represents a practical and effective measure towards greater sustainability in operating rooms.

Background:Waste management is an essential component of ecological sustainability. The healthcare sector generates approximately 5 million tons of waste annually, contributing about 5% of national CO2 emissions. A major proportion originates from hospitals, up to 30% from operating theatres. The disposal of this waste produces high emissions. However, a significant part of this waste consists of valuable materials that could be recycled. Methods:In this prospective study, volume and weight of waste generated in operating theatres for trauma surgery were measured and analysed statistically. After analysis of standard disposal practice, the surgical staff received training, followed by waste segregation into potentially recyclable material and hospital-specific waste. Results:Prior to waste segregation, the mean volume and weight of waste per operation were 219.6 l (± 88.4 l) and 6.65 kg (± 2.92 kg), respectively. The implementation of waste separation resulted in a reduction by 39.48% in volume (z=-4.11; p < 0.01) and 15.44% in weight (z=-2.59; p = 0.01). Conclusion:Effective waste segregation in the operating theatre enables the reintegration of recyclable materials into circular economies, leads to significant reduction of waste and decreases the carbon footprint. Comprehensive staff education and structured implementation of waste separation in operating theatres are therefore essential.

BACKGROUND:Type C1 posterior shoulder instability represents a pre-arthritic condition characterized by chronic, static posterior subluxation of the humeral head. Its multifactorial etiology includes increased glenoid retroversion, altered posterior acromial morphology, reduced humeral retrotorsion, abnormal scapulothoracic alignment, and muscular imbalances. DIAGNOSTICS:Clinically, the condition predominantly manifests as atraumatic shoulder pain, typically without overt instability symptoms. Diagnosis is based on a comprehensive clinical history, targeted physical examination, and the use of advanced imaging modalities, which allow reliable detection of posterior humeral head decentering, posterior glenoid rim deficiencies, reduced posterior acromial coverage, and labral hypertrophy. THERAPY:Therapeutically, heterogeneous treatment approaches with very limited evidence exist, and no curative standard has been established. Conservative management focuses on neuromuscular control and strengthening of the rotator cuff. Surgical options include arthroscopic soft-tissue stabilization, cartilage repair procedures, and bony interventions such as osteotomies and bony augmentations of the insufficient posterior glenoid rim. However, current evidence predominantly demonstrates temporary symptom relief, without clear proof of sustained humeral head recentering.

PURPOSE:To evaluate the long-term outcomes of medial open-wedge high tibial osteotomy (MOWHTO), focusing on conversion to knee arthroplasty and to summarize prognostic factors for conversion reported in the literature. METHODS:A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched up to March 2025. Eligible studies reporting ≥10-year survival rates of MOWHTO-defined as the avoidance of conversion to knee arthroplasty-were included. Data were synthesized using a random-effects model. Subgroup analyses were performed based on region. RESULTS:A total of 16 studies encompassing 1906 knees were included in the final analysis. The pooled long-term non-conversion proportions following MOWHTO, defined as avoidance of knee arthroplasty, was 86% (95% confidence interval [CI]: 80%-90%). Numerically higher long-term non-conversion proportions were observed in Asian studies (92%) compared with European studies (84%). Narrative synthesis indicated durable long-term functional outcomes, with most patients avoiding arthroplasty for at least a decade. CONCLUSIONS:MOWHTO provides durable long-term outcomes, with an overall long-term non-conversion proportion of 86%. These findings could facilitate more personalized treatment strategies for different populations worldwide and ultimately reduce the socioeconomic burden associated with knee arthroplasty. LEVEL OF EVIDENCE:Level IV, systematic review and meta-analysis of Levels III-IV studies.

die Zeitschrift für Orthopädie und Unfallchirurgie veröffentlicht als offizielles Organ der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie vornehmlich wissenschaftliche Originalarbeiten und sieht sich auch als Plattform für die Ergebnisse aus den Arbeitsgemeinschaften und Sektionen unserer Fachgesellschaft. Als Beispiel hierfür ist in der aktuellen Ausgabe eine Auswertung aus dem Knorpelregister der DGOU enthalten mit dem Fokus auf Schmerz bei osteochondralen Läsionen des Sprunggelenkes. Hier wird anhand der Registerdaten die klinische Relevanz der Klassifikationen unterstrichen. Auch die Arbeit „Statuserhebung der studentischen Lehre in Orthopädie und Unfallchirurgie“ stammt vornehmlich von Mitgliedern der AG Lehre unserer Fachgesellschaft und greift das hochaktuelle Thema zur qualifizierten Nachwuchsgewinnung auf mit der Schlussfolgerung, die Zusammenarbeit der Lehrenden in Orthopädie und Unfallchirurgie weiter zu verbessern.

Abstract Background Clinically, fracture healing is typically monitored though serial radiographs. Specifically, callus development (growth and mineralization) is an indicator of healing and associated with local mechanical strain. However, a sustainable relationship between mechanical conditions and the respective healing progress has not been shown so far. Material and methods One hundred sixty-six patients with extra-articular lower-limb fractures treated by osteosynthesis plates or intramedullary nails were included. Callus formation (visible area in X-ray relative to bone shaft) and quality (image intensity relative to the cortex) were measured by consecutive X-ray analyses as well as the modified Radiographic Union-Score for Tibia (mRUST) during follow-up. Corresponding load- and fixation-matched finite element analysis (FEA) modelling was developed for tibia or femur loading as well as plate or intramedullary nail fixation. Mechanical strains (medially, laterally, dorsally, anteriorly) were evaluated from FEA and compared to the progress in X-ray callus formation and quality to perform a correlation analysis between observed callus formation and simulated local mechanical strains. Results For femoral fractures, callus size was largest dorso-medially (1.41 ± 1.57 cm 2 /cm and 1.18 ± 1.11 cm 2 /cm at 180 ± 45 days post-surgery) while largest callus formations were found laterally in tibial fractures (0.75 ± 0.49 cm 2 /cm at 365 ± 45 days post-surgery). These locations of maximal callus size in femur and tibia matched the locations of extreme principal strains from FEA. In femur, callus density increased steadily and exceeded cortex density at 365 ± 45 days post-surgery. For tibia, no such clear trend was observable. While initially showing a similar increase in callus bridging score mRUST, increase over 2 years was 48% higher for the tibial fractures compared to femoral fractures. While principal strains correspond to increases in early callus formation in both femur and tibia (Kendall-Tau-b: p = 0.021 for volumetric strain at 90 ± 45 days post-surgery), shear strains are consistently associated with less callus formation (Kendall-Tau-b: p = 0.048 for volumetric/shear strain associated with callus size*density at 365 ± 45 days post-surgery). Conclusions Callus formation during bone healing may be associated with local mechanical strain in lower limb fractures within a clinically relevant cohort including different fracture locations and fixation types. Shear strain at the fracture site appeared to be associated with reduced quality callus formation, whereas principal strain was observed to correlate with increased early callus formation. The presented methodology may have potential as a predictor of healing processes and could help identify mechanically challenging fracture fixation settings. Level of evidence II. Trial registration Ethical approval was obtained from the local ethics board to this retrospective study design (EA4/099/24).

Waste management in hospitals is important for environmental sustainability, as disposal of operations waste causes substantial greenhouse gas emissions. This study aimed to identify factors influencing waste generation in orthopaedics and traumatology. In this prospective study, the weight of waste and drapes from 272 orthopaedic and trauma operations was measured. Waste production was analyzed regarding to anatomical region, operation type, and duration. Analysing all operations, the amount of waste differed significantly between anatomical regions (p < 0.001). When separating drapes, no significant differences between anatomical regions were found in waste, but in drapes (p < 0.001). The amount of waste differed significantly between operation types and correlated significantly with the operation duration (p < 0.001). Operating room waste is influenced by anatomical regions and the drapes required for it. Operation duration significantly increases the amount of waste. These findings can support the development of targeted strategies to reduce waste in operating rooms.

Das Abfallmanagement im Krankenhaus stellt einen wesentlichen Faktor in Bezug auf ökologische Nachhaltigkeit dar. Abfälle aus Operationen müssen häufig unter hoher CO2-Emission vernichtet werden. Neben Recycling ist Abfallvermeidung eine wichtige Maßnahme zur Reduktion der CO2-Emissionen. Mehrwegtextilien stellen eine vielversprechende Möglichkeit zur Abfallreduktion in Operationssälen dar. Evaluation von Mehrwegabdeckungen in Bezug auf anfallende Abfälle sowie auf Abläufe und Akzeptanz des Personals. In dieser prospektiven Beobachtungsstudie wurde der anfallende Abfall 272 orthopädisch-unfallchirurgischer Operationen gemessen. Je zwei Wochen erfolgte die Nutzung von Einwegabdeckungen sowie nachfolgend von Mehrwegabdeckungen. Es wurden Volumen sowie Gewicht des Abfalls sowie Vor‑, Nachbereitungs- und Operationszeit erfasst und statistisch ausgewertet. Im Anschluss erfolgte die Befragung des Personals zur Nutzung von Mehrwegtextilien. Während unter Nutzung von Einwegabdeckungen 93,59 (± 75,16) l bzw. 5,32 (± 2,04) kg krankenhausspezifischer Abfall pro Operation anfiel, konnte diese unter Nutzung von Mehrwegabdeckungen signifikant um 40

Chronic osteomyelitis continues to present major challenges in orthopedic and trauma surgery. Surgical excision of infected bone creates a defect that must be managed effectively to prevent reinfection. Due to limited penetration of systemic antibiotics into devascularized bone, local antibiotic delivery has gained importance as a therapeutic adjunct. This prospective study evaluates the efficacy of a single-stage surgical protocol using a bioabsorbable calcium sulfate/hydroxyapatite composite loaded with gentamicin. Results are also compared to a previous cohort from the same institution (Niemann et al.). Thirty-six patients with chronic osteomyelitis (Cierny-Mader types III and IV) were treated in a single-stage procedure involving radical debridement, deep tissue sampling, local and systemic antibiotic administration, and immediate soft tissue closure. The diagnosis was confirmed through strict clinical and microbiological criteria. The average follow-up period was 3.05 years (range: 2.2–6.4 years). Three patients experienced recurrence, corresponding to a 94.2% infection-free rate. All recurrences occurred within the first postoperative year. No significant associations were found between recurrence and physiological classification, infection etiology, pathogen type, or preoperative pseudarthrosis. Gentamicin-resistant pathogens were significantly more common in polymicrobial infections, but resistance did not correlate with increased recurrence. Compared to the prior cohort studied by Niemann et al., the need for revision surgery decreased significantly—from 10 out of 22 patients to 4 out of 36 in the current group—representing a 75% reduction. The use of an absorbable, antibiotic-loaded calcium sulfate/hydroxyapatite composite appears to be a safe and effective option for treating chronic osteomyelitis. Complete resorption of the material reduces the risk of foreign body retention after antibiotic delivery. The single-stage surgical approach, in conjunction with local high-dose antibiotic therapy, has shown durable outcomes over midterm follow-up. The improvement in revision rates compared to earlier results may be attributed to enhanced soft tissue management and growing experience with the bio-composite material. Continued research is necessary to evaluate long-term outcomes and to better understand patient-specific prognostic factors.

Traumatic anterior hip dislocation is a severe but poorly studied injury. This study aimed to analyze characteristics, risk factors and prognostic factors regarding long-term morbidity and outcomes in patients who had sustained traumatic anterior hip dislocation. Demographics, injury mechanism, and treatment-related characteristics of patients with anterior hip dislocations at three level-one trauma centers from 2009–2023 were analyzed. Acetabular and femoral morphology were assessed using CT scans to identify anatomical risk factors. Incidence of avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), further complications, return to work and sports, and patient-reported outcomes (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS) were recorded at the follow-up. Out of 196 patients with traumatic hip dislocations, 19 anterior dislocations (12 iliac anterosuperior and 7 obturator) were identified. Ipsilateral knee injuries occurred in 36.8

Despite the utility of three-dimensional (3D) printing in teaching complex anatomy, its application in pelvic ring injury education remains limited. This study aimed to determine whether 3D printed models improve the accuracy of pelvic fracture AO/OTA classification over conventional imaging, and to assess how this effect differs between junior and senior orthopedic residents. Imaging data of 10 pelvic ring injury cases were collected to produce corresponding 3D models. Four rounds of classification tests were conducted among orthopedic residents in our department using different imaging modalities: two-dimensional (2D) images alone, 2D images + 3D computed tomography (CT) reconstructions, 2D images + 3D reconstructions + 3D printed models, and 3D printed models alone. The classification accuracy reaching subgroup level and time consumption were analyzed to assess the utility of 3D models. Additionally, a subjective questionnaire was used to gather participants’ perceptions of 3D models as educational and diagnostic tools. Among 45 enrolled participants, 18 who completed all rounds were included and grouped by experience: junior (≤ 5 years, n = 10) and senior (> 5 years, n = 8). Compared to using conventional digital imaging, both adjunctive and independent use of 3D models improved classification accuracy in junior group (adjunctive: median difference = 25.00