Background: Hip fractures in the elderly population are common and the number of patients is rising. For young and geriatric patients with undisplaced fractures osteosynthesis is the primary type of treatment. The dynamic hip screw (DHS) is around for many years and proved its value especially in displaced fractures. Since 2018 the femoral neck system (FNS) is available as an alternative showing promising biomechanical results. The aim of this study is to evaluate clinical results of the FNS and compare it to the DHS. Materials and methods: Patients older than 18 years with Garden I–IV fractures that were treated with osteosynthesis in a level 1 trauma center were included in the study. Between January 2015 and March 2021, all patients treated with FNS (1-hole plate, DePuy-Synthes, Zuchwil, Switzerland) or DHS (2-hole plate, DePuy-Synthes, Zuchwil, Switzerland) for proximal femur fractures were included in the study. Closed reduction was achieved using a traction table. All operations were carried out by experienced orthopedic trauma surgeons. Primary outcome measures were rate of implant failure (cut out) and surgical complications (hematoma, infection). Secondary outcome measures were Hb-difference, length of hospital stay and mortality. Results: Overall, 221 patients were included in the study. 113 were treated with FNS, 108 with DHS. Mean age was 69 ± 14 years. There were 17.2% Garden I, 47.5% Garden II, 26.7% Garden III and 8.6% Garden IV fractures. No difference between the groups for age, body mass index (BMI), Charlson comorbidity index (CCI), time to surgery, Pauwels and Garden classification, rate of optimal blade position or tip apex distance was found. FNS showed lower pre- to postoperative Hb-difference (1.4 ± 1.1 g/l vs. 2.1 ± 1.4 g/l; p < 0.05), shorter operating time (36.3 ± 11.6 min vs. 54.7 ± 17.4 min; p < 0.05) and hospital stay (8.8 ± 4.3 d vs. 11.2 ± 6.8 d; p < 0.05). Surgical complications (FNS 13.3% vs. DHS 18.4%, p > 0.05), rate of cut out (FNS 12.4% vs. DHS 10.2%, p > 0.05) and mortality (FNS 3.5%; DHS 0.9%; p > 0.05) showed no difference between the groups. Logistic regression showed that poor blade position was the only significant predictor for cut out and increased the risk by factor 7. Implant related infection (n = 3) and hematoma/seroma (n = 6) that needed revision was only seen in DHS group. Conclusion: FNS proved to be as reliable as DHS in all patients with hip fractures. Not the type of implant but blade positioning is still key to prevent implant failure. Still due to minimal invasive approach implant related infections and postoperative hematomas might have been prevented using the FNS.

Background: Proximal humerus fractures are common injuries in the elderly. Locked plating showed high complication and reoperation rates at first. However, with second-generation implants and augmentation, minimally invasive locked plating might be a viable alternative to arthroplasty or conservative treatment. Material and Methods: A retrospective chart review was performed for all patients with proximal humerus fractures treated between 2014 and 2020 with locked plating. All patients over 60 years of age who underwent surgery for a proximal humerus fracture with plate osteosynthesis (NCB, Philos, or Philos with cement) during the specified period were included. Pathological fractures, intramedullary nailing, or arthroplasty were excluded. Primary outcome measurements included secondary displacement and surgical complications. Secondary outcomes comprised function and mortality within one year. Results: A total of 249 patients (mean age 75.6 +/− 8.9 years; 194 women and 55 men) were included in the study. No significant difference in the AO fracture classification could be found. Ninety-two patients were surgically treated with first-generation locked plating (NCB, Zimmer Biomet, Wayne Township, IN, USA), 113 patients with second-generation locked plating (Philos, Depuy Synthes, Wayne Township, IN, USA), and 44 patients with cement-augmented second-generation locked plating (Philos, Traumacem V+, Depuy Synthes). A 6-week radiological follow-up was completed for 189 patients. In all groups, X-rays were performed one day after surgery, and these showed no differences concerning the head shaft angle between the groups. The mean secondary varus dislocation (decrease of the head shaft angle) after six weeks for first-generation locked plating was 6.6 ± 12° (n = 72), for second-generation locked plating 4.4 ± 6.5 (n = 83), and for second-generation with augmentation 1.9 ± 3.7 (n = 35) with a significant difference between the groups (p = 0.012). Logistic regression showed a significant dependency for secondary dislocation for the type of treatment (p = 0.038), age (p = 0.01), and preoperative varus fracture displacement (p = 0.033). Significantly fewer surgical complications have been observed in the augmented second-generation locked plating group (NCB: 26.3%; Philos 21.5%; Philos-augmented 8.6%; p = 0.015). Range of motion was documented in 122 out of 209 patients after 3 months. In the Philos-augmented group, 50% of the patients achieved at least 90° anteversion and abduction, which was only about a third of the patients in the other 2 groups (NCB 34.8%, n = 46; Philos 35.8%, n = 56; augmented-Philos 50.0%, n = 20; p = 0.429). Conclusion: Minimally invasive locked plating is still a valuable treatment option for geriatric patients. With augmentation and modern implants, the complication rate is low and comparable to those of reverse shoulder arthroplasty reported in the literature, even in the challenging group of elderly patients.

Background: Fragility fractures in older adults are associated with high morbidity and mortality, yet evidence beyond hip fractures remains limited. This study analysed one‑year mortality and functional outcomes across multiple fracture types managed under structured orthogeriatric co‑management in a certified Geriatric Trauma Centre. Methods: We retrospectively reviewed 486 patients aged ≥ 70 years (mean 83.8 ± 6.6; 70.2% female) with fragility fractures (proximal and periprosthetic femur, cervical and thoracolumbar spine, pelvic ring, proximal humerus) treated between 2019 and 2021. All patients were screened using the Identification of Seniors at Risk (ISAR) and received interdisciplinary orthogeriatric care. Mortality and residential status at one year were ascertained via the national citizen registry, ensuring complete follow-up. Primary endpoints were one‑year mortality and residential status. Logistic regression identified predictors of survival. Results: Overall, one‑year mortality was 32.3%, highest for periprosthetic femoral (42.3%) and lowest for pelvic ring fractures (18.4%). Pelvic ring fractures independently predicted improved survival (OR 3.46; p = 0.006), while Charlson Comorbidity Index > 6 predicted higher mortality (OR 0.44; p = 0.001). Only 52.3% of previously independent patients maintained independent living after one year. Discharge home strongly correlated with survival (mortality 12.9% vs. 39.6% after nursing home discharge; p = 0.003). Conclusions: Fragility fractures of all types carry high one‑year mortality and substantial functional decline. Discharge destination is a powerful prognostic marker and should inform early rehabilitation planning. Orthogeriatric strategies must extend beyond hip fractures and integrate frailty assessment to identify orthogeriatric responders likely to regain independence.

Background: Proximal femoral fractures occur with increasing incidence, especially in the elderly. Commonly used implants for surgical treatment are cephalomedullary nails. To increase stability, a perforated femoral neck blade can be augmented with cement. The study investigated whether this results in a relevant clinical advantage and justifies the higher cost. Materials and methods: This is a single-center retrospective study of 620 patients with proximal femur fractures treated with cephalomedullary nailing. Between January 2016 and December 2020, 207 male and 413 female patients were surgically treated with a proximal femur nail (DePuy Synthes) using a perforated blade and cement augmentation in cases with severe osteoporosis. Primary outcome measures were the rate of cut-out, tip apex distance and the positioning of the blade in the femoral head. Secondary outcome measures were the implant costs and operating times. Results: Of the 620 femoral neck blades, 299 were augmented with cement. A total of six cut-outs were seen in the first 3 months after the operation. There were three in the cement-augmented group (CAB = cement-augmented blade) and three in the conventional group (NCAB = non-cement-augmented blade). There was a significant positive correlation between age and augmentation, with a mean difference of 11 years between the two groups (CAB 85.7 ± 7.9 vs. NCAB 75.3 ± 15.1; p < 0.05). There was no difference in the tip-apex distance (CAB 15.97 vs. 15.69; p = 0.64) or rate of optimal blade positions between the groups (CAB 81.6% vs. NCAB 83.2%; p = 0.341). Operation times were significantly longer in the cemented group (CAB 62.6 21.2 min vs. NCAB 54.1 7.7 min; p < 0.05), and the implant cost nearly doubled due to augmentation. Conclusion: When the principles of anatomic fracture reduction, optimal tip-apex distance and optimal blade position are combined with cement augmentation in cases of severe osteoporosis, a cut-out rate of less than 1% can be achieved. Nevertheless, it should be noted that augmentation remains expensive and prolongs surgery time without definite proof of mechanical superiority.

Background: Fragility fractures of the posterior pelvic ring are associated with osteoporosis and are becoming more common with demographic change. Known limitations of conservative therapy include a significant loss of autonomy and high mortality. Surgical stabilisation using percutaneous sacroiliac (SI) or trans-iliac trans-sacral (TITS) screws, has been established to increase mobility, but long-term results have not yet been studied. Materials and Methods: 138 patients with percutaneous SI and TITS screw fixation of the posterior pelvic ring in osteoporotic fragility fractures were followed up for more than a year postoperatively in this retrospective study. Thereby, all patients were operated in the conventional supine position in a hybrid operating room consisting of a fixed, robot-assisted 3D flat-panel detector and a navigation system. Results: 34 patients were male and 104 female. The mean age was 77.6 ± 9 years. 26 patients were ASA 1 + 2, 93 patients ASA 3 and 19 patients ASA 4. 80 fractures were classified as FFP 2, 23 FFP 3 and 35 FFP 4. Time to surgery was 127.5 ± 113.2 hours. Hospitalisation lasted an average of 15.7 ± 8.5 days. At the time of discharge, 68.8% of the patients had regained their original mobility, while 31.2% remained limited. The home situation remained unchanged in 73.9% of the patients, worsened in 26.1% and improved in 2.8%. 90.6% of the screw fixations showed no signs of loosening. In 9.4%, loosening could not be ruled out radiologically, but a surgical revision was not necessary. The 1-year mortality rate was 10.1%. Conclusion: Percutaneous navigated screw fixation of the posterior pelvic ring in fragility fractures is a simple, safe, minimally invasive and precise method with good clinical results in terms of rapid recovery with early mobilization of patients to maintain autonomy and reduce mortality. Further clinical studies with controlled cohorts and a large number of patients with long follow-up periods should be carried out to compare the procedure with other methods. In particular, the question of an additional standardized treatment of the anterior pelvic ring in unstable dislocated fragility fractures should be investigated.

Introduction: Proximal humerus fractures are common and often associated with osteoporosis in the elderly. Unfortunately, the complication and revision rate for joint-preserving surgical treatment using locking plate osteosynthesis is still high. Problems include insufficient fracture reduction and implant misplacement. Using conventional intraoperative two dimensional (2D) X-ray imaging control in only two planes, a completely error-free assessment is not possible. Materials and methods: The feasibility of intraoperative three-dimensional (3D) imaging control for locking plate osteosynthesis with screw tip cement augmentation of proximal humerus fractures was retrospectively studied in 14 cases with an isocentric mobile C-arm image intensifier set up parasagittal to the patients. Results: The intraoperative digital volume tomography (DVT) scans were feasible in all cases and showed excellent image quality. One patient showed inadequate fracture reduction in the imaging control, which then could be corrected. In another patient, a protruding head screw was detected, which could be replaced before augmentation. Cement distribution in the humeral head was consistent around the screw tips with no leakage into the joint. Conclusion: This study shows that insufficient fracture reduction and implant misplacement can be easily and reliably detected by intraoperative DVT scan with an isocentric mobile C-arm set up in the usual parasagittal position to the patient.