Introduction: After surgical treatment of fractures of the distal radius, radiographs in 2 planes are routinely performed postoperatively as a standard procedure to verify anatomic reduction and implant positioning. However, the postoperative radiological examinations rarely has a consequence. Therefore, the purpose of this study was to evaluate the frequency of treatment plan changes based on standardized postoperative radiographs. Secondarily, abnormalities, already being present in the intraoperative radiographs, were examined. Methods: Between 2015 and 2019 a total of 664 consecutive patients who underwent open reduction and internal fixation of a distal radius were evaluated in a retrospective study. Results: The median age was 60 (range 92 − 16 years). Overall, a treatment plan change was detected in 20 patients. After standardized postoperative radiographs a CT scan was performed in 16 patients and 14 patients underwent early operative revision; in only four of these cases, the revision could be attributed to the postoperative radiograph. Conclusion: Considering the low incidence of treatment plan changes, routinely performed radiographs after surgical treatment of distal radius fractures must be critically questioned.

Background: Orthogeriatric treatment, which involves a collaborative approach between orthopedic surgeons and geriatricians, is generally considered to be superior to standard care following hip fractures. The aim of this study was to investigate additional effects of a geriatrician-led multidisciplinary rehabilitation program. Methods: In this matched paired observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery were included. Between 1 January 2016 and 31 December 2022 data were recorded from hospital admission to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a registry of older adults with hip fractures. Out of 60,254 patients, 9580 patients met the inclusion criteria, 4669 patients received early multiprofessional rehabilitation (EMR) and 4911 patients were treated by standard orthogeriatric co-management (OGC). Results: Compared to standard orthogeriatric treatment, multiprofessional therapy significantly lowered the 7-day mortality rate (2.89% vs. 5.11%) and had a significant impact on walking ability seven days after surgery (86.44% vs. 77.78%). Conclusions: In summary, a geriatrician-led multiprofessional rehabilitation program resulted in lower mortality and improved walking ability than standard orthogeriatric care.

Einleitung: AltersTraumaZentren (ATZ) in Deutschland bieten eine interdisziplinäre Versorgung für ältere Traumapatienten mit dem Ziel, die Behandlungsergebnisse nach proximalen Femurfrakturen zu verbessern. Delir, eine häufige und schwerwiegende Komplikation bei dieser Patientengruppe, wird mit einer erhöhten Mortalität und funktionellen Einschränkungen in Verbindung gebracht. Das Ziel dieser Studie war es, die Prävalenz und die Folgen von Delir bei proximalen Femurfrakturen unter Verwendung des Deutschen Traumaregisters DGU zu untersuchen. Methode: Die Studie umfasste 32.934 Patienten im Alter von≥70 Jahren, die im Zeitraum 2022–2023 proximale Femurfrakturen erlitten hatten. Die demografischen und klinischen Parameter, die Art der Fraktur, der Zeitpunkt der Operation, die Mobilität, Komplikationen und die Mortalität wurden sorgfältig dokumentiert. Der primäre Endpunkt der Studie war das Auftreten von Delir und dessen Einfluss auf den Ausgang bei Patienten mit Hüftfrakturen. Zusätzlich wurde eine Subanalyse durchgeführt, um periimplantäre/periprothetische Frakturen zu berücksichtigen. Ergebnisse: Von den 21.540 Patienten, die sich einer Untersuchung unterzogen, waren 23,6% bereits bei der Aufnahme mit einem Delir diagnostiziert worden. Die Delir-Rate unterschied sich nicht zwischen klassischen und periimplantären/periprothetischen Frakturen. Patienten im Delir waren älter, gebrechlicher und pflegebedürftiger. Sie wiesen eine höhere Sterblichkeitsrate (8,6% gegenüber 4,6%), eine schlechtere Mobilität und häufigere Verlegungen in Pflegeheime auf. Im Zusammenhang mit periimplantären/periprothetischen Frakturen wurde nachgewiesen, dass Delir mit erhöhten Revisionsraten (9,6% gegenüber 5,7%) und Mortalitätsraten (9,6% gegenüber 4,1%) assoziiert ist. Die Entwicklung eines Delirs während des Krankenhausaufenthalts des Patienten war mit einem erhöhten Risiko für Mortalität und funktionelle Beeinträchtigungen verbunden. Diskussion: Delir ist daher eine häufige und klinisch bedeutsame Komplikation. Die frühzeitige Erkennung und Prävention sind für Patienten mit proximalen Femurfrakturen in der orthogeriatrischen Versorgung von entscheidender Bedeutung. Keywords: Geriatrisch, Delir, Proximale Femurfrakturen Korrespondenzadresse: Vanessa Ketter, Helios Kliniken Kassel, Unfallchirurgie und Orthopädie, Hansteinstr. 29, 34121 Kassel, Deutschland, E-Mail: vanessa.ketter@helios-gesundheit.de Article published online: 23 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Background: Geriatric trauma centers (ATZ) in Germany provide interdisciplinary care for elderly trauma patients with the objective of enhancing treatment outcomes following proximal femur fractures. Delirium, a prevalent and grave complication in this patient population, has been associated with elevated mortality and functional limitations. The objective of this study was to examine the prevalence and consequences of delirium in proximal femur fractures by utilizing the Registry for Geriatric Trauma (ATR-DGU). Methods: The study encompassed 32,934 patients aged ≥70 years who sustained proximal femoral fractures during the period 2022–2023. The demographic and clinical parameters, fracture type, time of surgery, mobility, complications, and mortality were meticulously documented. The primary endpoint of the study was the occurrence of delirium and its influence of the outcome of hip fracture patients. Additionally an analysis was conducted to account for peri-implant/periprosthetic fractures. Results: Of the 21,127 patients who underwent screening, 23.6% had already been diagnosed with delirium upon admission. The delirium rate did not differ between hip-/pertrochanteric and peri-implant/periprosthetic fractures. Patients in a delirious state were found to be older, frailer, and more dependent on care. They exhibited more non-surgical complications, poorer mobility, and more frequent transfers to nursing homes. In the context of peri-implant/periprosthetic fractures, delirium showed no significant difference regarding surgical revision (p = 0.192) and mortality rates (p = 0.229). Conclusions: Delirium is therefore a prevalent and clinically significant complication. Its early detection and prevention are essential for proximal femur fracture patients in orthogeriatric care.

Background: The decision of the Joint Federal Committee on the treatment of hip fractures stipulates that proximal femur fractures must be treated within the first 24 h. This leads to organizational and personnel difficulties in day-to-day care. Therefore, we investigated the question at what times of day we operate to maintain this timeline and whether there is a difference in the outcome for the patients according to treatment hours. Methods: Data from the DGU’s “AltersTraumaRegister” from 2016 to 2020 were analyzed. For the analysis, the patients were divided into seven cohorts depending on the time of surgery. Pre-operative, operative, and follow-up data were analyzed. Results: A total of 29,470 patients were included in our study. The results showed that 74% of patients were treated within 24 h. 72% of patients operated on between 0–7 h had pertrochanteric fractures, while 56% of all arthroplasties were performed during normal working hours. In supra-regional trauma centers, significantly fewer operations were performed during normal working hours, while significantly more surgeries were carried out in the late evening and at night (p < 0.001). There were no significant differences in mortality and morbidity between the individual groups. Conclusions: Although we manage to treat most patients within 24 h, only 46% of patients are operated on within normal working hours. In terms of the outcome parameters, this does not appear to be a disadvantage for the patients. Nevertheless, night work and fatigue affect concentration and post-operative results in many areas, as we know. Consequently, patient care during normal working hours within 24 h creates the best possible initial situation for the patient, as significantly more personnel resources are available during normal working hours. The aim should be to create the logistical and personnel requirements for this.