The use of wearable technology is steadily increasing. In orthopedic trauma surgery, where the musculoskeletal system is directly affected, focus has been directed towards assessing aspects of physical functioning, activity behavior, and mobility/disability. This includes sensors and algorithms to monitor real-world walking speed, daily step counts, ground reaction forces, or range of motion. Several specific reviews have focused on this domain. In other medical fields, wearable sensors and algorithms to monitor digital biometrics have been used with a focus on domain-specific health aspects such as heart rate, sleep, blood oxygen saturation, or fall risk. This review explores the most common clinical and research use cases of wearable sensors in other medical domains and, from it, derives suggestions for the meaningful transfer and application in an orthopedic trauma context.

Background/Objectives: Using a patient’s own wearable sensor to obtain objective outcome data is a growing field in trauma allowing for the assessment of the recovery trajectory back toward the pre-injury performance. The aim of this study was to analyze recruitment characteristics and reasons for declined study participation in an orthopedic trauma study that measures postoperative recovery using wearables. Methods: Data from 225 patients screened for participation in a wearable-sensor-based outcome study were assessed. The influence of age, sex and injury location on study participation was analyzed. Reasons for patients declining to participate were investigated from the screening log. Availability and type of sensor system in patients agreeing to participate were analyzed. Results: Overall, 48% of patients agreed to participate. Age was the only significantly different factor between agreeing and declining patients (p < 0.05). The main reasons to decline study participation were technical difficulties with or inability to use the wearable device, lack of availability of a wearable, and general disinterest to participate in a study. Notably, 7% declined due to data safety concerns. Conclusions: The results show that age, availability of the wearable, and technical ability to use a wearable are the main obstacles impacting objective outcome measurement using a personal wearable device. In studies including geriatric patients, a dedicated device requiring no patient handling can be a valid option to improve enrollment. Understanding the reasons for declining to participate will facilitate the development of future sensor-based studies to address concerns of technical handling through alternative means of data harvesting and increase the inclusion rate. These outcomes will guide future study designs to optimize patient inclusion.

Zusammenfassung: Hintergrund: Die digitale Transformation der Medizin stellt ein zentrales politisches Thema dar, welches auch die chirurgische Weiterbildung betrifft. Die bisherigen Bemühungen zur Umsetzung der Digitalisierung wurden von Ärztinnen und Ärzten als unzureichend wahrgenommen. Es besteht noch erhebliches Potenzial, die Chancen der Digitalisierung gezielt zur Verbesserung der chirurgischen Weiterbildung einzusetzen. Fragestellung: Wie bewerten Ärztinnen und Ärzte in (spezieller) chirurgischer Weiterbildung die Verfügbarkeit, Umsetzung sowie Chancen und Hindernisse der Digitalisierung in der chirurgischen Weiterbildung in Deutschland? Material und Methoden: Ärztinnen und Ärzte in (spezieller) chirurgischer Weiterbildung wurden über einen webbasierten Fragebogen zum Stand der Digitalisierung in der chirurgischen Weiterbildung befragt. Insgesamt wurden 313 Fragebögen ausgewertet. Ergebnisse: Die Mehrheit der Ärztinnen und Ärzte sieht großes Potenzial in der Digitalisierung zur Verbesserung der Weiterbildung. Digitale Weiterbildungen, Apps und Onlinedatenbanken werden regelmäßig genutzt. Demgegenüber verwendet lediglich ein Viertel der Befragten ein digitales Logbuch. Die Mehrheit der Befragten sieht in der Umsetzung der Digitalisierung zudem Verbesserungschancen bei der Vereinbarkeit von Familie und Beruf. Diskussion: Digitale Tools sowie die Nutzung von Augmented Reality (AR) und Virtual Reality (VR) werden als potenziell wertvoll zur Verbesserung der Weiterbildung angesehen. Bislang werden diese Möglichkeiten jedoch kaum genutzt. Die bislang unzureichende Implementierung digitaler Logbücher verdeutlicht die Notwendigkeit einer optimierten Integration dieser digitalen Lösungen. Eine umfassende digitale Transformation in der Chirurgie ist erforderlich, um die Effizienz im klinischen Alltag und die Qualität der Weiterbildung nachhaltig zu optimieren. Daher besteht sowohl hinsichtlich des Ausbaus der digitalen Infrastruktur in den Kliniken als auch bei der Integration theoretischer und praktischer digitaler Tools in die Weiterbildung dringender Handlungsbedarf. Graphic

Background: Fractures of the lower extremity are commonly associated with impaired mobility, whereas injuries of the upper extremity primarily affect limb-specific function. Wearable devices allow the objective and continuous monitoring of physical activity and may therefore provide additional insight into postoperative recovery processes under real-world conditions. This exploratory study aimed to compare postoperative trajectories of daily step count following surgical treatment of upper versus lower extremity fractures and to explore possible associations with general health status and return to work. Methods: In this prospective observational study, 38 patients with upper extremity fractures and 55 patients with lower extremity fractures were included. Daily step counts were recorded postoperatively. Patient-reported general health (PROMIS Global Health) and work status at three months were assessed. Results: During the early postoperative period, patients with lower extremity injuries recorded lower daily step counts than patients with upper extremity injuries. Within three months, 89% of patients with upper extremity injuries and 49% of patients with lower extremity injuries had returned to work. Conclusions: In this exploratory cohort, postoperative step count trajectories differed between surgically treated upper and lower extremity fractures during the early postoperative period. Return-to-work rates at three months also differed between groups. Interpretation of these findings is limited by the real-world use of heterogeneous consumer wearable devices and the exploratory study design. These findings should be considered preliminary and hypothesis-generating.

Background: Demographic change and evolving expectations regarding work–life balance are increasingly challenging the medical workforce in Germany. Work-time arrangements play a key role in physician job satisfaction, well-being, and career development. However, part-time and alternative working models remain unevenly implemented and are frequently perceived as limiting career opportunities. This study characterized current work-time arrangements among physicians in Germany and examined satisfaction, employer support, colleague acceptance, perceived career opportunities, barriers to reducing working hours, and work–family balance. Methods: This cross-sectional study is based on an anonymous digital survey conducted by the German Medical Women’s Association between September 2022 and July 2023. Physicians across medical specialties and career stages were invited to participate. The questionnaire assessed sociodemographic and professional characteristics, work-time arrangements (full-time, part-time, and alternative models), satisfaction with current arrangements, employer support, and perceived career opportunities. Results: Of the 898 respondents, 90.9% were women and 46.2% were resident physicians. Full-time employment was the most common arrangement (56.8%). Physicians working in non-full-time arrangements were more frequently satisfied with their work-time arrangement than those working full-time (52.8% vs. 45.3%; p = 0.020). Hospital-based physicians were less likely to be satisfied with their work-time arrangement (aOR 0.33) or to receive support from their employer in implementing alternative work-time arrangements (aOR 0.24). They were also less likely to report acceptance of alternative work-time arrangements among colleagues (aOR 0.21) and equal career opportunities under such arrangements (aOR 0.31), while being more likely to report difficulties balancing work and family responsibilities (aOR 2.44; all p < 0.001). Compared with physicians in leadership positions, resident physicians and board-certified physicians without leadership responsibility reported lower satisfaction and lower perceived equal career opportunities, while reporting greater difficulty balancing work and family responsibilities (all p < 0.001). Fear of negative career consequences was the most frequently reported reason for not reducing working hours (58.2%), and approximately two thirds of respondents perceived unequal career opportunities for colleagues using alternative work-time arrangements. Conclusions: Although full-time employment remained the most common arrangement, respondents not working full-time reported greater satisfaction. Part-time and alternative work-time-arrangements are widely perceived as career-limiting. Addressing structural barriers and ensuring equal career opportunities for physicians who require or prefer family-friendly working conditions are essential for physician well-being, workforce retention, and the long-term resilience of healthcare systems.

Background: Malnutrition is highly prevalent in geriatric trauma patients and is associated with impaired recovery, complications, and reduced likelihood of returning home. Nonetheless, the impact of a targeted protein-enriched diet during the acute hospital stay on patient outcome and rehabilitation remains to be investigated. Materials and methods: This single-center randomized controlled study enrolled patients ≥ 70 years with fragility fractures admitted to a Level I trauma center. Nutritional status was assessed using the Nutritional Risk Screening 2002 and Mini Nutritional Assessment. Patients screened positive in ≥ 1 tool were classified as being at nutritional risk and randomized to a protein-enriched diet (Group A) or standard diet (Group B); patients with negative screening served as observational reference group without nutritional risk (Group C). The intervention targeted 1.5–2.0 g/kg/day protein. Primary outcomes were in-hospital medical complications, surgical site infections and functional mobility at discharge. Secondary outcomes included length of stay, discharge destination, and in-hospital mortality. Multinomial logistic regression assessed independent associations with discharge destination. Results: Of the 218 patients (mean age 81.8 ± 6.9 years; 72.0% female), 100 (45.9%) screened positive for being at nutritional risk and were randomized to intervention (A, n = 46) or control (B, n = 54), while 118 (54.1%) patients without nutritional risk served as reference group (C). Patients at nutritional risk showed higher comorbidity burdens, higher ASA classes, and greater frailty than group C. Medical complications occurred in 45.0% of patients, with no significant differences between groups. Serum albumin decreased and CRP increased during hospitalization, without differences among the groups. Patients in reference group C were more often independently mobile and discharged home, whereas all patients at nutritional risk more frequently required institutional care. In multivariable analysis, a higher age-adjusted CCI was independently associated with discharge destination, whereas no independent effect of the nutritional intervention was observed. Conclusion: In this geriatric trauma cohort, being at nutritional risk was closely linked to frailty and multimorbidity. A protein-enriched diet during the acute hospital stay did not translate into measurable short-term benefits regarding complications, functional mobility, length of stay or discharge destination. Nutritional risk should therefore be considered within the broader context of overall vulnerability, and nutritional care may need to be embedded in comprehensive longitudinal rehabilitation strategies extending beyond the acute in-hospital phase. Trial registration: The study was retrospectively registered at ClinicalTrials.gov on 12 May 2026 (NCT07582575).