Patients with epilepsy often sustain uncommon shoulder injuries, including bilateral lesions and posterior dislocations. Increased glenoid retroversion is associated with posterior instability, although it remains unclear whether this is a cause or an adaptation. During tonic-clonic seizures, the humeral head is driven cranially and posteriorly against the glenoid by muscle contractions, potentially leading to acute dislocation or plastic deformation, which can be particularly relevant during skeletal development, even without instability episodes. This cross-sectional study aimed to evaluate whether the cumulative frequency of tonic-clonic seizures affects glenoid anatomy in patients with epilepsy who have not experienced shoulder instability. Patients with epilepsy referred to a tertiary epilepsy center were enrolled sequentially. The duration of epilepsy and the frequency of tonic-clonic seizures were recorded and the glenoid version, the glenoid vault angle and the scapulohumeral subluxation index were measured on axial magnetic resonance imaging scans. The cumulative Burden of Recurrent Seizures over Time (BuRST) was calculated multiplying the duration of epilepsy by the number of yearly tonic-clonic seizures to compare patients with no BuRST, with those with a low BuRST (<40) and with a high BuRST (≥40). Statistical tests, including one-way analysis of variance with post hoc Tukey's test for multiple comparisons, were used to assess variable differences, correlations, and measurement reliability. Data were collected for 91 epileptic patients, 34 of which with a low and 28 with a high BuRST. A significant difference between the 3 BuRST groups emerged for all investigated parameters, with higher BuRST correlated with more pronounced changes (glenoid version angle: -1.93 ± 4.02°; -3.80 ± 4.34°; -6.67 ± 4.73°; glenoid vault angle: -12.78 ± 3.81°; -16.58 ± 4.02°; -20.66 ± 4.35°; subluxation index: 51.2% ± 4.7%; 54.6% ± 5.2%; 55.9% ± 5.1%). Intra- and interrater reliability was good to excellent for angular measurements and moderate to good for subluxation measurements. Patients with epilepsy who experience frequent tonic-clonic seizures, but have not yet had a shoulder instability episode, show increased glenoid retroversion, a more retroverted vault, and a higher scapulohumeral subluxation index compared to those with none or rare tonic-clonic seizures. These findings may suggest a possible link between recurrent tonic-clonic seizures and plastic deformation of the glenoid during growth, potentially influenced by repeated, powerful posteriorly directed muscular contractions. Although causality cannot be established, these results may pave the way for prospective studies aimed at better understanding the increased incidence of posterior shoulder instability observed in patients with epilepsy and recurrent tonic-clonic seizures.

Background: Acetabular fractures continue to pose a major challenge in clinical practice, not least because of the growing geriatric population. While the influence of the force vectors on fracture formation is well established, the impact of anatomical factors on fracture morphology remains poorly understood. The aim of this study was to investigate patient-specific hip joint geometry, identify structural risk factors and correlate these with the resulting fracture patterns. Methods: This retrospective cohort analysis included 226 patients (Mdn age = 58 yrs.) with acetabular fracture categorized by Judet/Letournel and the AO/OTA classification. Computed tomography (CT) datasets of the injured and contralateral sides were analyzed using multiplanar reconstruction. Parameters included modified center-edge (CE) angle (Wiberg), rotation angles (Ullmann and Anda), acetabular sector angle (Anda), true caput-collum-diaphyseal (CCD) angle, femoral head diameter and volume, as well as femoral neck length, circumference, and diameter. In addition, intrarater reliability within a subcohort was assessed for the metric measurements and inter-rater analysis for the classification of the entire sample. Results: The primary analysis showed direct effects of femoral head diameter, femoral neck length and femoral head size on the fracture type according to AO/OTA (type A/B/C), whereby this effect was particularly seen between type A and type C fractures (p = 0.001). Ordinal regression identified femoral head diameter as the only significant predictor (p = 0.02), with a 25% increased likelihood of complex fractures per unit of change. Low-energy trauma doubled the risk of severe fractures. Specific findings include a higher acetabular anteversion in anterior column fractures. Age correlated positively with the cause of injury and fracture type. The inter-rater reliability for fracture classification was excellent, as was the intrarater reliability of the measurements. Conclusions: This study suggests that anatomical factors, particularly proximal femoral geometry, have an impact on acetabular fracture morphology—in addition to factors such as trauma type and patient demographics.

Background: Germany’s high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU^®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. Material and Methods: A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants’ clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. Results: The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. Conclusions: This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

Purpose: Periprosthetic loosening is a major complication after total hip and knee arthroplasty. Early and accurate diagnosis is essential to choose the right therapeutic path and to avoid further complications. The aim of the study was to evaluate the diagnostic performance of ⁶⁸Gallium-Zoledronate ([⁶⁸Ga]Ga-DOTA^Zol) PET/CT in detecting periprosthetic loosening in total hip (THA) and total knee arthroplasty (TKA). Methods: This retrospective study included 26 patients with painful prosthesis (THA n = 17; TKA n = 16) and clinical suspicion of periprosthetic loosening, but without a confirmed diagnosis. Patients underwent [⁶⁸Ga]Ga-DOTA^Zol PET/CT at least one year post-implantation. Diagnosis was confirmed through revision surgery or long-term clinical follow-up, with an observation period of at least 6 months. The analysis included both an assessment of the prosthesis as a unit and a separate evaluation of the individual components. Statistical analysis involved calculating sensitivity, specificity and accuracy using SPSS. Results: Overall, a sensitivity of 77.8%, a specificity of 95.8% and an accuracy of 90.9% were found for detecting periprosthetic loosening, when considering the prosthesis as a unit. Individual component analyses showed a sensitivity of 71.4% and specificity of 96.2%. Conclusion: The use of [⁶⁸Ga]Ga-DOTA^Zol PET/CT in periprosthetic loosening is a remarkable diagnostic tool and a promising approach. In comparison to established radionuclide tracers, ⁶⁸Gallium-Zoledronate offers notable advantages due to its availability via ⁶⁸Ge/⁶⁸Ga-generators, improving its potential for clinical application.

The management of shoulder injuries resulting from epileptic seizures presents a particular challenge. These injuries often present complex patterns, ranging from dislocations and fractures to damage to the rotator cuff. Recurrent seizures can significantly impact the outcome and must be considered a central risk factor when choosing the therapeutic approach. Accordingly, these injuries require close multidisciplinary cooperation between orthopaedics/trauma surgery, neurology/epileptology and physiotherapy, both in diagnosis and treatment. Despite their clinical relevance, standardised treatment algorithms are currently lacking, and the available scientific evidence remains limited. This review article addresses the specific characteristics of seizure-related shoulder injuries within a multidisciplinary approach. Epidemiological aspects, including pathomechanical principles, diagnostic challenges, and current conservative and surgical treatment options, are discussed.