Ulrich Stöckle

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.

Purpose: 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. Methods: 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. Results: 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). Conclusion: 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.

Liebe Leserinnen und Leser, aktuell bewegen uns im Gesundheitswesen und speziell in Orthopädie und Unfallchirurgie zahlreiche Themen. Article published online: 23 September 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: Traumatic hip dislocations are rare but serious injuries, potentially affecting patients’ quality of life and mobility. Given the limited understanding of prognostic factors, this study aimed to identify predictors of long-term clinical outcomes. Materials and methods: Injury characteristics and computed tomography (CT) of patients following traumatic hip dislocation from two level I trauma centers from 2009 to 2015 were analyzed. At follow-up, patients were evaluated for avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), secondary surgery, complications, and return to sports. Patient-reported outcome measures (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS), were evaluated. Results: 38 patients with traumatic hip dislocation were finally included. Concomitant posterior acetabular wall fractures and femoral head fractures (Pipkin type I to IV) were observed in 34 cases (87%). 18 patients (mean age 38.3 ± 17.2 years) completed the follow-up (mean follow-up 12.25 ± 1.03 years). 6 patients (33%) developed PTOA, 2 patients (11%) AVN, and 3 patients (17%) required total hip arthroplasty. Decreased TAS was associated with concomitant fractures ( p = 0.02). 10 patients (56%) did not return to their pre-injury sports level and 7 patients (39%) reported sexual dysfunction. PROMs and return to sports were significantly worse in patients with PTOA or residual sciatic nerve injury ( p < 0.05). Conclusions: Patients after traumatic hip dislocation are at high risk for PTOA or AVN, especially with concomitant acetabular or femoral head fractures, resulting in significant long-term limitations in daily activities, sports, and sexual function. Recognition of concomitant fractures is a critical prognostic factor in assessing long-term outcomes.

Aims: Periprosthetic joint infection (PJI) and periprosthetic fracture (PPF) belong to the most devastating and complex complications following total hip arthroplasty, especially when both occur simultaneously. The aims of this study were (1) to evaluate the clinical outcome of PJI treatment in the setting of concomitant PPF and (2) to determine risk factors for reinfection. Methods: This study retrospectively analysed PPF occurring during the treatment of PJI in total hip arthroplasty (THA). In total 46 THA were included with concomitant PJI and PPF, of which 28 fractures occurred during the explantation and 13 fractures occurred during the interval between explantation and reimplantation. The median follow-up period was 66 months (range: 24–90) and minimum follow up of at least two years. Patients without infection recurrence after their surgical management were considered to have a successful clinical outcome. Reinfections rates were estimated through Kaplan-Meier curve and potential risk factors for reinfection were analysed with univariate non-parametric tests. Multivariate Cox hazard regression was used in order to account for confounders. Results: Overall, the success rate in our cohort was 71%. The overall mortality rate at follow-up was 22%. The estimated cumulative reinfection-free survival was 68% (95% CI = 80.9–50.5%) with a reinfection risk of 20% (95% CI = 10.3%-35.3%) in the first 12 months. Two patients (4.8%) had a re-fracture and another two (4.8%) had a recurrent hip dislocation that needed surgical intervention. High virulence pathogens ( p = 0.038), difficult-to-treat pathogens ( p = 0.016) and number of debridement during the interval ( p = 0.043) were significant risk factors for reinfections. Difficult-to-treat pathogens were shown to be independent risk factors ( p = 0.040). Conclusion: The reinfection rate of concomitant PJI and PPF is high and target treatment should be achieved. Significant risk factors for reinfection were presence of difficult-to-treat or highly virulent pathogens and increased number of debridement between explantation and reimplantation.

Liebe Leserinnen, liebe Leser, wir haben eine neue Regierung. Nach dem Aus der Ampelkoalition am Tag des Wahlsieges von Donald Trump hat sich nach der Bundestagswahl am 23.02.2025 recht schnell die neue Regierungskoalition aus CDU/CSU und SPD gebildet. Nach der schließlich erfolgreichen Wahl von Friedrich Merz zum Bundeskanzler haben wir damit auch eine neue Gesundheitsministerin sowie eine neue Wissenschaftsministerin. Article published online: 04 June 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Purpose: 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. Methods: 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. Results: 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%, and 73.7% had concomitant femoral head or acetabular rim fractures. Obturator dislocations were commonly simple dislocations, while iliac dislocations involved more complex associated fractures often requiring surgery. Acetabular anteversion and cam-type femoroacetabular impingement (FAI) were identified as risk factors. Twelve patients (63%) were available for follow-up (mean 8.33 ± 5.05 years). The majority demonstrated good to excellent mHHS (mean 86.9), and minimal TAS decrease (5.33 to 4.67). AVN was not observed, and only one patient required hip arthroplasty following PTOA. Conclusion: Anterior hip dislocations commonly result from high-energy “dashboard" injuries, with acetabular anteversion and cam-type FAI morphology being contributing risk factors. Long-term functional outcomes were favorable, with low rates of avascular necrosis or osteoarthritis, independent of type and complexity of the dislocation.

Liebe Leserinnen und Leser, Deutschland leistet sich bisher im internationalen Vergleich viele Krankenhäuser mit bevorzugt stationärer Behandlung. Die Politik fordert daher ein Mehr an „ambulant vor stationär“ mit gleichzeitig verbesserter Verzahnung der ambulanten und stationären Strukturen. Dies ist sicherlich ein richtiger Ansatz, um künftig die medizinische Versorgung finanzieren (Stichwort: steigende Ausgaben) und personell (Stichwort: Pflegemangel) gestalten zu können. Article published online: 25 March 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Liebe Leserinnen, liebe Leser, mit der ersten Ausgabe des Jahres wünschen wir Ihnen noch alles Gute für ein gesundes, frohes und erfolgreiches 2025! Wir stehen wieder am Beginn eines interessanten und spannenden Jahres. Article published online: 04 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany